Chapter 32 Hypertension Flashcards
Which race has the highest prevalence of hypertension in the world?
African Americans
have a higher incidence of hypertension among women than among men
Have more nocturnal non-dipping BP
results in more severe end-organ damage
Which race is least likely to receive hypertension treatment?
Mexican-Americans
Low rate of controlled BP
Low levels of awareness
Which sex is more likely to develop hypertension?
Men
BUT
Women on an oral contraceptive are 3x more likely to develop hypertension
How do you calculate Blood Pressure?
Cardiac Output x Systemic Vascular resistance = BP
What two body systems affect cardiac output?
Cardiac (Heart rate, contractility, conductivity)
Renal Fluid Volume Control (RAA system, natriuretic peptides)
What 3 body systems affect vascular resistance
Sympathetic Nervous System (Alpha 1 and 2 that causes vasodilation and Beta 2 that causes vasodilation) Neurohormonal (vasoconstrictors like angiotensin and norepinephrine) Local regulation (Vaso- Dilators/constrictors
What type of specialized cells in the carotid arteries and arch of aorta sense changes in BP and transmit this info to the brain
Barocreceptors (pressure receptors)
What effect does Alpha 1 have on the body?
Vasoconstriction increased contractility (positive ionotropic)
What effect does Alpha 2 have on the body
Inhibits norepinephrine release
vasoconstriction
What effect does Beta 1 have on the body
Causes a positive
Inotropic effect (contractility)
Chronotropic (heart rate)
dromotropic effect (conduction)
What is a positive and negative
1) inotropic effect
2) chronotropic effect
Dromotropic effect
1) increase or decrease in heart contractility
2) increase or decrease in heart rate
3) increase or decrease in heart conduction
What effect does Beta 2 have on the body
Vasodilation
What effect does dopamine receptors have on the body
Vasodilation
How does the renal system contribute to hypertension?
The kidneys regulate sodium and ECF volume, which dictates total fluid volume of the body
It also regulates the renin-angiotensin-aldosterone system.
Overall the kidneys regulate the amount of sodium and fluid in the body
What is are the different stages of hypertension
Normal BP: 100-120 /60-80
Pre-hypertensive: 120-139/ 80-90
Hypertensive Stage 1: 140-159/90-100
Hypertensive Stage 2: >160/>100
What is Isolated Systolic Hypertension (ISH)
An average systolic BP of 140 or greater with an average diastolic BP under 90
What is Primary Hypertension and what is the patients treatment goal?
Hypertension without an identified cause (it is idiopathic)
There are contributing factors though, such as:
SNS activity, hypernatremic, greater than ideal body weight, tobacco use, too much alcohol
Usually treated by trying to lower the BP by weight loss, lower sodium intake, or antihypertensive meds
What is Secondary Hypertension and what is the patients treatment goal?
Elevated BP with a specific cause such as cirrhosis, endocrine disorders, renal disease, NSAIDS, Oral contraceptives, corticosteroids
Treatment at removing the underlying cause
What role does the SNS have on BP
Increases HR and hear contractility
controls vasoconstriction and renin release
What are some severe symptoms of hypertension?
Fatigue, dizziness, palpitations, angina, dyspnea
What is the most common complication of hypertension?
Target organ disease
These include: CAD, Left ventricular hypertrophy, Heart failure, atherosclerosis, nephrosclerosis
How does hypertension affect the kidneys?
It causes Ischemia that leads to the narrowing of the renal blood vessels. This causes atrophy of the tubules and the eventual death of the nephrons
What labs are analyzed to see if renal disease is occurring?
Albuminuria, proteinuria, elevated serum creatinine and BUN
Is the retina important with hypertension?
Yes, it can provide important information about the severity and duration of hypertension
The damage can provide information that can help see if damage is occurring in the heart, brain, and kidneys.
What is the overall goal of treatment for a patient who has hypertension
Lower their BP, reduce their cardiovascular risk factors and their risk of target organ disease
What is the purpose of an electrocardiogram?
It provides baseline information about heart status
It can identify LVH (if suspected though an echocardiography is performed), Cardiac ischemia, previous MI
What is White Coate Hypertension
Elevated BP that occurs in a clinical setting but not in a normal setting
When is blood pressure the highest and lowest for a day-active person?
Blood pressure is highest in the morning and decreases during the day to eventually be the lowest at night.
Pt with hypertension sometimes do not experience this nocturnal dip (nondippers)
What is a reverse dipper?
This is a patient who has their highest systolic BP at night, they have the highest risk of CVD
What are the 7 lifestyle modifications that can be used to help treat hypertension and overall decrease a patients cardiovascular risk
1) Weight reduction
2) Dietary Approaches to Stop Hypertension eating plan(DASH)
3) Reducing dietary sodium
4) Moderating alcohol intake
5) getting regular exercise for at least 30 min most days of the week (about 5)
6) avoiding tobacco
7) managing psychosocial risk factors
How many mmHgcan a person reduce their systolic blood pressure by losing 22lb?
a patient who loses 22lb (10kg) will often see a decrease anywhere from 5-20 mmHg
What is the DASH Eating Plan and what does it consist of?
Dietary Approaches to Stop Hypertension
It emphasizes eating fruits, veggies, fat-free or low fat milk and milk products in general, whole grains, fish poultry, beans, seeds, and nuts.
Overall the patient will eat less red meat, salt, sweets, added sugars, and soda
How much sodium a day should a healthy adult intake?
Less than or equal to 2300mg/ Day
How much sodium a day should someone with hypertension, chronic renal disease, or a middle-aged or older African American consume
Less than or Equal to 1500mg/ Day
What common foods are high in sodium?
Canned soups and frozen dinners
By restricting Sodium intake, what other electrolyte deficiency is being prevented
Hypokalemia
Too much salt will result in too little potassium because of diuretic therapy
How often should moderate intensity aerobic exercise be performed?
30 minutes most days of the week
How often should vigorous-intensity aerobic activity be performed?
20 minutes 3 days a week
How often should muscle- strengthening and flexibility and balance activities be performed
at least 2 times a week for both
How many drinks a day should men and women limit themselves to a day?
Men should consume no more than 2 drinks per day (if their lighter weight than no more than one)
Women should consume no more than one drink per day
What is one drink defined as?
12oz of regular beer, 5oz of wine, and 1.5oz of 80-proof distilled spirits
Why is nicotine avoided with hypertension and if stopped when are benefits usually seen?
Nicotine has a vasoconstrictive affect and can cause an elevated BP (narrow pathways), benefits are seen usually within one year
What is included as a psychosocial risk factor?
low socioeconomic status, social isolation, lack of support, stress, and negative emotions (depression is higher in those with job stress)
These risk factors activate the SNS and stress hormones increasing ones risk of CVD
What are the recommendations for antihypertensive drug therapy based on age?
Patients over 60 years old should receive treatment if they are in stage 2 hypertension and patients under 60 should begin treatment with stage 1 hypertension
What are the 2 main actions of current anti-hypertensive drugs?
1) reduce the volume of circulating blood
2) reduce systemic vascular resistance
How do Diuretics affect hypertension and what are the common drugs?
Promotes sodium and water excretion
Thiazide, loop, potassium-sparing, aldosterone receptor blockers
How do Adrenergic-inhibiting agents affect hypertension and what are the common drugs?
It reduces SNS effects on BP
Clonidine
How do Calcium Channel Blockers affect hypertension and what are the common drugs?
It increases sodium excretion and causes arteriolar vasodilation
Dilitiazem and verapamil
What is the biggest issue with a patients adherence to anti-hypertensive therapy
Side-effects
educate the patient and care-giver of these side effects and that they will lessen over time
What is the most common side effect of an antihypertensive drug?
Orthostatic hypotension
What are some other side effects of antihypertensive drugs?
Sexual dysfunction, dry mouth, frequent urination, orthostatic hypotension
What is resistance hypertension?
the failure to reach the goal BP despite the patient taking an appropriate three- drug therapy regimen that includes a diuretic.
What are the 4 overall goals for a patient with hypertension
1) achieve and maintain the goal BP
2) follow the therapeutic plan and attend appointments with the HCP
3) experience minimal side effects of therapy
4) manage and cope with the condition
How should a blood pressure be taken (according to the book)
Take it in both arms and note a difference (artherosclerosis on one side can cause a false low reading).
Use the arm with the highest BP and take 2 readings one minute apart.
ALWAYS TRY TO KEEP ARM RELAXED AND AT HEART LEVEL
Are forearm and brachial BP interchangeable?
No, a forearm reading is the last resort and should be documented appropriately (BP 120/80 Left forearm)
How does a nurse test for orthostatic hypotension?
1) Have the patient lay down and after 2-3 minutes take their pulse and their BP
2) Have the patient sit up, wait 1-2 minutes and then record the BP and pulse
3) Have the patient stand, wait 1-2 minutes, and then record the BP and pulse
How does a nurse assess that a patient has orthostatic hypotension after performing a test for it?
The patient from supine to standing will have a decrease in systolic pressure greater than 20 OR a decrease in diastolic pressure greater than 10 OR an increase in pulse of 20 or more beats per minute
What time should a patient monitor their BP at home?
In the morning
What is a hypertensive crisis?
Occurs when a systolic BP is greater than 180 and a diastolic pressure is greater than 110
What is the difference between a hypertensive urgency and emergency?
the difference is the absence or presence of target organ damage
Does hypertensive urgency or emergency have the presence of target organ disease?
Hypertensive urgency does not have target organ disease while a hypertensive emergency requires hospitalization and has target organ disease
What manifestation often emerges from a hypertensive emergency and what are the side effects?
Hypertension encephalopathy
S/S severe headache, nausea, vomiting, seizures, confusion, and coma
What other clinical manifestations can occur from a hypertensive Crisis
hypertensive encephalopathy, Renal insufficiency, cardiac decompensation (MI, HF, pulmonary edema), aortic dissection
How do you calculate the Mean Arterial Pressure (MAP)
MAP= (SBP + 2x DBP) /3
What early manifestations is the patient with primary hypertension likely to report? A) no symptoms B) cardiac palpitations C) dyspnea on exertion D) Dizziness and vertigo
A) hypertension is asymptomatic and often referred to as the silent killer. This absence of symptoms often leads to non-compliance. Severe hypertension has symptoms such as, fatigue, palpitations, angina, dyspnea, and dizziness
The patient who is being admitted has had a history of uncontrolled hypertension. High SVR is most likely to cause damage to which organ? A) Brain B) Heart C) Retina D) Kidney
B) Heart
an increased SVR directly increases the workload of the heart. The hear tcan be indirectly damaged by atherosclerotic changes in blood vessels, as are the brain, retina, and kidney
