Heart 5 Hypertension

Question 1

Hypertension

Answer 1

Elevated blood pressure

Cut off values for categories vary amongst different societies

Question 2

Primary hypertension

Answer 2

90-95 cases
Elevated bp without identifiable cause
Contributing factors
Increased sodium intake 
Diabetes mellitus 
Tobacco use
Excessive alcohol consumption 
Increased sympathetic nervous system activity 
Excessive alcohol consumption

Question 3

Secondary hypertension

Answer 3

Elevated bp with a cause
5-10 percent
Secondary htn should be suspected

Question 4

Main factors contributing the development of high blood pressure

Answer 4

Social determinants of health ( ageing, income, education)
Behavioural risk ( unhealthy diet, tobacco use, harmful use of alcohol)
Metabolic risk factors (high blood pressure, obesity, diabetes, raised blood lipids)
Cardiovascular disease (heart attacks, strokes, heart failure)

Question 5

Factors affects affects population blood pressure

Answer 5

Age
Ethnic group
Gender
Underlying disease
Environmental and lifestyle causes of hypertension 
( salt, smoking, stress, exercise)

Question 6

Pathophysiology of hypertension

Answer 6

Blood increase with increase of co and svr
Most patients with htn have elevated svr
Co may be increased in initial stages ( increasing svr to maintian normal tissue perfusion)
Autonomic nervous system - sns and plasma catecholamines. Stimulation if sns canccause arteriolar constrictionthe and dilation

Question 7

The raas system

Answer 7

The renin-angiotensinc-aldosterone systemcis kne kf the major hormonal systems that influence blood pressure

Inappropriate activation of this system or mutation of the angiotensin gene are suggested theories of htn

Question 8

Complications of hypertension

Answer 8

Hypertensive heart disease
Carebrovascular disease
Peripheral vascular disease 
Nephrosclerosis
Retinal damage

Question 9

Hypertensive heart disease

Answer 9

Coronary artery disease
Left ventricular hypertrophy
Heart failure

Question 10

Cerebrovascular disease

Answer 10

Major risk factors for cerebral atherosclerosis and stroke

Question 11

Peripheral vascular disease

Answer 11

Speeds up the process of atherosclerosis leading tic

Aortic dissection and aneurysm

Question 12

Nephrosclerosis

Answer 12

Htn is a leading cause of chronic kidney disease

ischaemia caused by the narrowing

Question 13

Retinal damage

Answer 13

Direct visualizatiin of retinal vessels can provide an indication of vessel damage in the heart, beain and kidneys

Question 14

Diagnosis of hypertension

Answer 14

Bp measurements
Medical history 
Physical examination
Assessment of absolute cad 
Laboratory investigation 
Further diagnostic tests recquired

Question 15

Accurate measurement of bp

Answer 15

Prepare the patient
Correct techniques
Take correct measurements 
Correctly document reading
Average reading communicate results

Question 16

Prepare the patient

Answer 16

Pt to relax in chair with feet on the groud
Avoid caffeine ensure emptied bladder
Remove clothing from the arm
Not talking during rest period

Question 17

Corrct technique

Answer 17

Use device that has been calibrated
Support pr arm
Position cuff and use corrct cuff (80% of arm)

Question 18

Take correct measurements

Answer 18

Palpate radial pulse when inflating the cuff art 30 and inflate further
Deflate cuff at 2-3 mmhg
Fully deflate wait 30 seconds
Inflate cuff while auscultating over the brachial artery
At 30 mmhg above palpated pulse

Question 19

Correct document reading

Answer 19

Record sbp and dvp to the nearesr 2 mmhg
Record the sbp level at which two consecutive beats are heard
Use higher arm with hugher reading

Question 20

Average reading and communication skills to

Answer 20

Use an average of 2 reading estaimate bp

Provide result verbally and writen to pt

Question 21

Lifestly advice for confirmed hypertension

Answer 21

Lowering bp reduces cardiovascular events and reduces premature mortality
Lifestly advice js recommended for all pts with or without htn regardless drug therapy
Use 5as and motivational interviewing to encourage behaviour change
Physical activity
Weight control
Diet
Smoking cessation

Question 22

Drugs for hypertension

Answer 22

Angiotensin converting enzyme
Angiotensin 11 receptor blockers
calcium channel blockers
Dihydropyridines
B adrenergic blocker
Non-cardio selective

Question 23

Angiotensin convertinf enzyme inhibitors
Types
Actions
Nursing considerations

Answer 23

Captopril
Ramipril
Peridopril
Inhibit ace
Reduce conversion of angiotensin 1 to angiotensin 11. Inhibits angiotensin — mediated vasoconstriction 

Aspirin and nsaid may reduxe drug’s effectiveness. Diuretics enhance effect and should not be used with potessium sparing diuretic
Inhibits breakdown if bradykinin which may bcause a dry cough

Question 24

Angiotensin 11 receptor blocker

Answer 24

Losartan
Prevents actioncof angiotensin 11 and produces vasodilation and increased na + and water excretion

May take 3-6 weeks for full effect to be seen does not affect bradykinin so cancbe used for those pts who develop cough on ace inhibitors

Question 25

Calcium channel blockers

Answer 25

Diltuazem er
Verapamil
Inhibits movement of ca+ across cell membrane = vasodilation. Cardioselective, resulting in decreased hr and slowing av conduction
Use with caution in patients with hf. Aboud grapefruit juice avoid in ots eith 2nd and 3 rd degree av block or lv systolic dysfunction

Question 26

Dihydropyridine

Answer 26

Amlodipone
Vascular smooth muscle relaxation, decreased svr and arterial bl

More potent peripheral vasodilation

Question 27

B adrenergic blocker cardioselective

Answer 27

Metropolol
Blocks b adrenergic effects. Decrease co and reduce vasoconstriction. Decrease renin secretion by kidney

Monitor bp and hr regularly use in caution in diabetic patient

Question 28

Non-cardioselective

Answer 28

Propanalol
Non-selective b adrenergic blocking. Decrease hr, peripheral vasodilation, reduce co, svr, and bp

May cause bronchospasm, esp.in pts with a history of asthma

Question 29

Hypertension in children and adolescents

Answer 29

Childhood htn first recognized in mid 1960s
Increasingly clear that adult htn have origins in chuldhood
Impact of childhood ovesity on prevalence of htn in you g is seen in several studies (obese mostly)

Question 30

Target organ damage in youngsters

Answer 30

Left ventricular hypertrophy
Increased carotid intima media thickness
Impaired cognitive function
Increased risk of developing metabolic syndrome

Question 31

Factors related to bo levels in children and adolescent

Answer 31

Genetic
Environmental
Mixed genetic and environmental

Question 32

Genetic

Answer 32

Autonomic abnormalities 
Deletion of ace gene
Increased salt sensitivity in african americans
Obesity 
Parental and siblings bp levels

Question 33

Environmental

Answer 33

Bir Th weight
Breast feeding
Early childhood growth
Neonatal weight gain
Socioeconomic status
Exercise/ physical activity

Question 34

Mixed genetic and environmental

Answer 34

Height
Weight 
Body mass
Pulse rate
Somatic growth and sexual maturation
Sodium and other nutrient intakes
Sympathetic nervous system reactivity
Stress
Uric acid

Question 35

Management od hypertension in children and adolescents

Answer 35

Nonpharmacological

Pharmacological

Question 36

Nonpharmacological

Answer 36

Dietary modifications
Aerobic exercise
Weight loss

Question 37

Pharmacological management

Answer 37

Lack of data on ling term effects of antihypertensive medication on growth and development

Define indication for initiating pharmacological therapy should be prescribed
Diabetes
Hypertension
Stage 2 htn
Persistent hrtn despite nonpharmacological measures
Hypertensive target organ damage