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Health Assessment Spring 2024 > Exam 4 Hypertension > Flashcards

Exam 4 Hypertension Flashcards

1
Q

How many people have HTN in the US?

A
  • 100 million people

African Americans are more affected.

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2
Q

Women over the age of _____ will have a greater prevalence of hypertension than men.

A
  • 60 years
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3
Q

Worldwide, hypertension is the leading risk factor for _________ and __________.

A
  • Morbidity
  • Mortality
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4
Q

The clinical consequences of chronic ___________have been well characterized and underscore a high age-related association with ischemic heart disease, CVA, renal failure, retinopathy, peripheral vascular disease, and overall mortality.

A
  • Hypertension
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5
Q

In anesthesia, hypertension increases pulse pressure which will lead to ________ and ___________.

A
  • Intraoperative hemodynamic instability
  • Adverse post-op outcomes
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6
Q

Definition of Hypertension

A
  • Sustained systolic BP > 130 mm Hg
  • Sustained diastolic BP > 80 mm Hg
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7
Q

Definition of Isolated systolic hypertension

A
  • Systolic > 130 mm Hg
  • Diastolic < 80 mm Hg
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8
Q

Definition of Isolated diastolic hypertension

A
  • Systolic < 130 mm Hg
  • Diastolic > 80 mm Hg
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9
Q

Definition of Combined systolic and
diastolic hypertension

A
  • Systolic > 130 mm Hg
  • Diastolic > 80 mm Hg
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10
Q

Normal BP
SBP
DBP

A

Normal
SBP: <120 mmHg
DBP < 80 mmHg

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11
Q

Elevated BP
SBP
DBP

A

Elevated BP
SBP: 120-129 mmHg
DBP: < 80 mmHg

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12
Q

Stage 1 Hypertension
SBP
DBP

A

Stage 1 Hypertension
SBP: 130-139 mmHg
DBP: 80-89 mmHg

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13
Q

Stage 2 Hypertension
SBP
DBP

A

Stage 2 Hypertension
SBP: >140 mmHg
DBP: > 90 mmHg

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14
Q

Contributing Factors to Primary HTN

A
  • Dysregulation of SNS activity
  • Dysregulation of RAAS
  • Deficient production of endogenous vasodilators
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15
Q

What receptors regulate our BP and give us acute control of CO, vascular resistance, and blood volume?

A
  • Cardiac Stretch Receptor
  • Vascular Baroreceptor
  • Peripheral Chemoreceptor
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16
Q

Chronic inflammation will disrupt the _________ and cause autonomic dysfunction leading to hypertension.

A
  • Blood Brain Barrier
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17
Q

Oxidative stress and inflammation within the brain will
* _______SNS output
* increase_________ release
* _________ baroreflex regulation

A
  • ↑ SNS output
  • Increase Vasopressin release
  • Inhibits baroreflex regulation
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18
Q

RAAS has acute and sustained control over what factors?

A
  • ECF volume
  • Peripheral Vascular Resistance
  • BP
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19
Q

What is the result of dysregulated renin release?

A
  • Elevated renin levels → ANG II overproduction → Increase aldosterone → HTN
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20
Q

The vascular endothelium produces what vasoactive substances that are major regulators of vascular tone?

A
  • Nitric oxide
  • Endothelin
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21
Q

What other vasoactive substances does the vascular endothelium produce that will cause vasodilation and blunt RAAS?

A
  • ANP
  • BNP
  • CNP
  • Urodilatin
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22
Q

What are the results of oxidative stress on the endothelium?

A
  • Impaired endothelial function
  • Disruption of natriuretic peptide release or receptor response → HTN
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23
Q

Secondary hypertension has a correctable cause that may be __________ or ____________.

______% of the population has secondary hypertension.

A
  • Age-dependent
  • Drug-induced
  • 5%
24
Q

What herbal drugs will cause elevated BP?

A
  • Ephedra
  • Ginseng
  • Ma Huang
25
Q

What illicit substance can elevate BP?

A
  • Cocaine
  • Meth

Cancel the case if the patient used meth/coke that morning.

26
Q

70% to 85% of children who develop secondary hypertension is result from what two conditions?

A
  • Renal parenchymal disease
  • Coarctation of the aorta
27
Q

Pathophysiology of chronic hypertension.

A
  • Remodeling of small and large arteries
  • Endothelial dysfunction
  • Irreversible end-organ damage
28
Q

HTN will lead to vasculopathy (inflamed/damaged blood vessels). What could result from vasculopathy? (Long List/ Common Sense)

A
  • IHD
  • LV hypertrophy
  • CHF
  • CVA
  • PVD
  • Aortic aneurysm
  • Nephropathy
29
Q

Resistant hypertension, defined as uncontrolled blood pressure despite ______ or more antihypertensive drugs of different classes,

A
  • 3
30
Q

__________ Hypertension is defined as 4 or more drugs to achieve BP control.

A
  • Control-resistant
31
Q

________ Hypertension, defined as uncontrolled blood pressure on 5 or more drugs. This affects 0.5% of the population.

A
  • Refractory

At this point, there may be some drug intolerance or pseudo-resistant HTN

32
Q

Lifestyle modification for HTN.

A
  • Weight reduction
  • Moderation of alcohol intake
  • Increased aerobic exercise
  • Smoking cessation
  • ↑ Dietary intake of K+ and Ca2+
  • Salt restriction
33
Q

ACC/AHA Guidelines:
Pt with what conditions should be placed on BP meds when SBP >130 mmHg and DBP > 80 mmHg.

A
  • IHD
  • Cerebrovascular Disease
  • CKD
  • ↑ Risk of Atherosclerotic CV disease
34
Q

ACC/AHA Guidelines:
Non-black hypertensive population (w/ or w/o DM) should be placed on what type of BP meds?

A
  • ACE inhibitors
  • ARBs
  • CCBs
  • thiazide-type diuretics
35
Q

ACC/AHA Guidelines:
Black hypertensive population w/o HF nor CKD (w/ or w/o DM) should initiate treatment w/ what type of BP meds?

A
  • CCB
  • thiazide-type diuretics
36
Q

ACC/AHA Guidelines:
CKD hypertensive patients should be placed on what BP meds?

A
  • ACE inhibitors
  • ARBs
37
Q

First-line antihypertensive therapy

A
  • Diuretics
  • CCBs
  • ACE inhibitors
  • ARBs
38
Q

When will β-blockers be added to antihypertensive therapy?

A
  • CAD or tachydysrhythmia patients
  • Multi-drug therapy in resistant HTN
39
Q

What are some procedures/surgeries done to treat secondary hypertension?

A
  • Correction of renal artery stenosis
  • Direct arterial repair
  • Adrenalectomy
40
Q

Medications for secondary hypertension.

A
  • ACE-inhibitors or in combination with diuretics
41
Q

Patient with chronic hypertension (180/100) w/ no symptoms: urgent or emergent hypertensive crisis?

A
  • Urgent

Emergent Hypertensive Crisis is usually acute and involves progressive end-organ damage.

42
Q

Hypertensive Emergencies that may present in the perioperative setting include manifestations of _______ injury, _________ injury, and _________ insult.

A
  • Central nervous system injury
  • Kidney injury
  • Cardiovascular insult

These need immediate attention and treatment.

43
Q

Women w/ Pregnancy- Induced HTN (PIH) may show evidence of end-organ dysfunction by showing signs of ____________.

What BP in pregnant patients will require immediate attention and treatment?

A
  • Encephalopathy
  • SBP > 160 mmHg and/or DBP >110 mmHG
44
Q

First-line drug for peripartum hypertension

A
  • Labetalol
45
Q

Medication to give for Aortic dissection

A
  • β-blocker (esmolol, labetalol) plus arteriolar dilator
46
Q

What medication will cause rapid arterial dilation and BP reduction?

A
  • Sodium nitroprusside infusion
47
Q

What is a CCB that is a selective arteriolar vasodilator?

A
  • Clevidipine

This drug has a short half-life, making it very easy to titrate.

48
Q

_________, is a second-gen dihydropyridine CCB that has a longer half-life and is less titratable than clevidipine.

A
  • Nicardipine
49
Q

Pre-op evaluation with hypertensive patients.

A
  • Consider the white coat effect
  • Evaluate vasculopathy and end-organ functions
  • Consider whether to cancel or delay surgery

Surgery is usually canceled if the SBP > 180 mmHg

50
Q

Antihypertensive meds are continued on the day of the surgery, except what meds?

A
  • High-dose ARBs
  • ACE-inhibitors

These drugs will lead to profound hypotension with anesthesia.

51
Q

Induction consideration with hypertensive patients.

A
  • Consider the drop in BP w/ the induction agent and gas
  • Consider the increase in BP during intubation
  • Consider A-line placement
  • Consider transient β-blockade w/ esmolol
  • Check for volume depletion
52
Q

Peri-operative considerations

What does hypertension increase?

A
  • Increase Blood loss
  • Increase in Incidence of MI
  • Increase cerebrovascular events
53
Q

Hypertensive Patient Peri-operative Considerations

Volume depletion, loss of vascular elasticity, and baroreceptor desensitization combined w/ antihypertensive treatment will result in intraoperative _____________.

A
  • hemodynamic volatility

You will be chasing your tail.

54
Q

Too much of a drop in BP in chronic hypertensive patients will result in what injuries?

A
  • Renal and myocardial injury
55
Q

What is the most common cause of secondary HTN for middle age adults (40-64 years old)?

A
  • Hyperaldosteronism
  • Thyroid dysfunction
  • OSA
  • Cushing syndrome
  • Phenochrmocytoma

Health Assessment Spring 2024 (24 decks)

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