HTN 1 Flashcards
High blood pressure (or hypertension) is
when your blood pressure or the force of blood flowing through your blood vessels is consistently too high
As human get older there blood vessels get
Stiffer
VENTRICULAR contraction and blood ejection
= Systole
Ventricular relaxation and blood filling
Diastole
If blood pressure is elevated constantly,
it damages arteries and blood vessels
prevalence of hypertension in the US
Half the US have HTN
24% are well controlled.
45% adults in US have HTN > 130/80 or are taking medication
A greater percent of men (47%) have high blood pressure than women (43%)
Mid Eastern and southern states have high blood pressure
It is not well controlled in many cases.
Black adults have a higher rate of hypertension or prevelance.
40-49 or over 60 the HTN is more prevalent
Compliance with medication is problematic.
Very high % of people stop taking meds in their first years
HTN therapy has poor adherence because high blood pressure is
asympotmatic.
Etiology of primary HTN:
90% of the cases we do not know what causes. May be genetic. Environmental reasons. There is no actual reason.
Etiology of Secondary HTN:
Secondary causes: • Renal artery stenosis • Sleep apnea • Endocrine disorder • Cerebral damage • Drug induced
Drug-induced hypertension:
Oral Contraceptives Decongestants Systemic NSAIDs Systemic Corticosteroids Cyclosporine Herbals (Ma Huang, St. John’s wort) Amphetamines MAOIs, SNRIs, TCAs Recreational drugs (“bath salts”, cocaine) High Na+ agents or solutions
Uncontrollable risk factors:
Genetics •
Race: African Americans develop HTN more often than Caucasians, occurs earlier, and is more severe
Family history predisposes the patient to develop HTN
Age: BP increases with age > 35 years old
• Men > 45 yo • Women > 55 yo
Controllable risk factors
Obesity: BMI of 30.0+ more likely to develop HTN
Poor diet: high Na intake, salt sensitivity, low K intake •
ETOH: Heavy and regular consumption can BP
Sedentary lifestyle: Increased likelihood of becoming overweight and developing HTN
Stress: Possible risk factor, difficult to measure, responses to stress (varies from person to person)
Smoking
Consequences of consistently elevated blood pressure
Damage from sustained high blood pressure happens over time
Arteries are damaged from consistent blood flow at high pressure
Cholesterol can form plaques where arteries are damaged
With aging: less flexible, stiffer, and plaque-filled arteries increase the workload of organs and lead to declining function.
declining function OF BODY PART Such as
• Heart • Kidney • Vision • Erectile dysfunction in men • Lower libido in women.
acute events DUE TO HTN are
TIA or Stroke • Heart attack • Angina • PAD: (peripheral arterial disease)claudication
Things caused by high blood pressure in the body are
Protein in urine tells us kidney is not working properly
Left ventricular hypertrophy
Retinopathy
difference between JNC8 and 2017acc/aha
JNC8 utilizes blood pressure numbers and studies of those. They want gold standard data.
2017ACC/AHA use Data and analyzed from - RCT - Meta-analysis - Observational data
what ASCVD risk calculator will tell us
ASCVD risk calculator will tell us the % of cardiovascular events that will happen in the next 10 years. It is used with statins, aspirin, or someone should be on an antihypertensive.
ASVD can be used only for
This is used for the primary invention. It cannot be used with a pt who already has a heart attack or stroke.
Diagnosis should only be made with at least 2 elevated readings made on at
At least 2 different days
If there is a disparity in the category between the systolic and diastolic pressures, the determines the stage
higher value
Initial first-line therapies (4 classes):
ACE inhibitors or Angiotensin receptor blockers (ARB)
Thiazide diuretics
Calcium channel blockers
what type of drugs are recommended for stage 2 hypertension and an average BP of 20/10 mm Hg above the BP target.
Two first-line drugs of different classes are recommended
Improved adherence can be achieved:
With once-daily dosing, rather than multiple dosing
With combination therapy rather than administration of the free individual components,
Using a weekly med box properly, med delivery, blister packing meds, 90-day supplies
No clinical CVD and 10-year ASCVD risk <10% ≥140/90 means What will be the recommendation?
so we recommend starting non-pharmacological therapy.
pt already has a stroke and Secondary stroke prevention is≥140/90. what should be our goal BP for this patient.
PT has a stroke already (secondary stroke prevention) but our goal should still be <130/80.
Less aggressive BP goals are appropriate when there is a high burden of
co-morbidity, older adults with postural hypotension, severe frailty, dementia, limited life expectancy, or residing in an SNF.
Initiating a new or adjusted drug regimen for hypertension should have a follow-up evaluation of adherence and response to treatment at _______ until control is achieved.
monthly intervals
Systematic strategies to help improve BP are
Home BP M,
Team-based care,
telehealth
for titration of BP-lowering medication what is recommended
Out-of-office BP measurements are recommended
Estimated that ___% of patients with elevated BP measured in the office have normal BP measured outside of the office (white coat HTN) . SMBP helps to ensure proper diagnosis
35%
Limitations to using wrist cuffs:
BP can be measured only if the sensor is directly over the radial artery.
An accurate reading is obtained only if the wrist is at heart level.
Readings will be too high or too low if the wrist is below or above heart level, respectively.
Lowering SBP/DBP by 10/5 mmHg will
translate into significant relative risk
reduction of cardiovascular events
(~20%) this can be achieved by
This can be achieved with 1 medication or Targeted lifestyle changes (now referred to as non-pharmacologic treatment)
Statin intensity are
Low risk (<5%): no statin – lifestyle treatment Borderline risk (5-7.5%): shared decision making intermediate risk (7.5-19.9%): moderate-intensity statin High risk (> 20%): high-intensity statin
Non-pharmacologic interventions for treatment of HTN per ACC/AHA
Weight loss Dash diet Dietary sodium Dietary potassium Aerobic physical activity Alcohol consumption
Two first-line drugs of different classes
are recommended with _____
hypertension and average BP of 20/10
mm Hg above the BP targe
stage 2
