Heart 5 Hypertension Flashcards
Hypertension
Elevated blood pressure
Cut off values for categories vary amongst different societies
Primary hypertension
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
Secondary hypertension
Elevated bp with a cause
5-10 percent
Secondary htn should be suspected
Main factors contributing the development of high blood pressure
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)
Factors affects affects population blood pressure
Age Ethnic group Gender Underlying disease Environmental and lifestyle causes of hypertension ( salt, smoking, stress, exercise)
Pathophysiology of hypertension
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
The raas system
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
Complications of hypertension
Hypertensive heart disease Carebrovascular disease Peripheral vascular disease Nephrosclerosis Retinal damage
Hypertensive heart disease
Coronary artery disease
Left ventricular hypertrophy
Heart failure
Cerebrovascular disease
Major risk factors for cerebral atherosclerosis and stroke
Peripheral vascular disease
Speeds up the process of atherosclerosis leading tic
Aortic dissection and aneurysm
Nephrosclerosis
Htn is a leading cause of chronic kidney disease
ischaemia caused by the narrowing
Retinal damage
Direct visualizatiin of retinal vessels can provide an indication of vessel damage in the heart, beain and kidneys
Diagnosis of hypertension
Bp measurements Medical history Physical examination Assessment of absolute cad Laboratory investigation Further diagnostic tests recquired
Accurate measurement of bp
Prepare the patient Correct techniques Take correct measurements Correctly document reading Average reading communicate results
Prepare the patient
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
Corrct technique
Use device that has been calibrated
Support pr arm
Position cuff and use corrct cuff (80% of arm)
Take correct measurements
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
Correct document reading
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
Average reading and communication skills to
Use an average of 2 reading estaimate bp
Provide result verbally and writen to pt
Lifestly advice for confirmed hypertension
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
Drugs for hypertension
Angiotensin converting enzyme Angiotensin 11 receptor blockers calcium channel blockers Dihydropyridines B adrenergic blocker Non-cardio selective
Angiotensin convertinf enzyme inhibitors
Types
Actions
Nursing considerations
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
Angiotensin 11 receptor blocker
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
Calcium channel blockers
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
Dihydropyridine
Amlodipone
Vascular smooth muscle relaxation, decreased svr and arterial bl
More potent peripheral vasodilation
B adrenergic blocker cardioselective
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
Non-cardioselective
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
Hypertension in children and adolescents
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)
Target organ damage in youngsters
Left ventricular hypertrophy
Increased carotid intima media thickness
Impaired cognitive function
Increased risk of developing metabolic syndrome
Factors related to bo levels in children and adolescent
Genetic
Environmental
Mixed genetic and environmental
Genetic
Autonomic abnormalities Deletion of ace gene Increased salt sensitivity in african americans Obesity Parental and siblings bp levels
Environmental
Bir Th weight Breast feeding Early childhood growth Neonatal weight gain Socioeconomic status Exercise/ physical activity
Mixed genetic and environmental
Height Weight Body mass Pulse rate Somatic growth and sexual maturation Sodium and other nutrient intakes Sympathetic nervous system reactivity Stress Uric acid
Management od hypertension in children and adolescents
Nonpharmacological
Pharmacological
Nonpharmacological
Dietary modifications
Aerobic exercise
Weight loss
Pharmacological management
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
