HTN Flashcards
primary htn
Family history
African American
Hyperlipidemia
Smoking
Age > 60 or post-
menopausal
Excessive sodium or
caffeine intake
Obesity
Sedentary lifestyle
Excessive alcohol
Low potassium,
calcium or
magnesium intake
Excessive stress
secondary htn
Kidney disease
Adrenal-mediated
causes:
Primary aldosteronism
Pheochromocytoma
Cushing’s disease
Coarctation of the aorta
Brain tumors
Encephalitis
Pregnancy
Drugs –
Estrogen
Glucocorticoids/
mineralocorticoids
Sympathomimetics
what is bp
co X pvr
what is pvr depending on
Autonomic Nervous System
Circulating Hormones
Norepinephrine & Epinephrine
pathophysiologic processes
Can result from
increases in cardiac
output, peripheral
resistance, or both
Must also be a
problem with the
body’s control
system
Dysfunction of the
autonomic nervous
system
Increased renin–
angiotensin–
aldosterone system
Resistance to
insulin action
Activation of the
immune system
heart damage from htn(3)
CAD
Left Ventricular Hypertrophy
Heart Failure
kidney damage from htn
nephrosclerosis
brain damage htn
cerebrovascular disease
eye damage htn
retinal damage
peripheral vessel damage htn
Peripheral Vascular Disease - (more
specifically, Peripheral ARTERIAL
Disease)
hypertensive emergency
BP greater than 180/120 with new or
worsening target organ damage.
Requires critical care monitoring and
intervention:
Continuous IV infusion of anti-hypertensive
medication
Frequent, or possibly continuous, BP
monitoring
Watch for neurological or cardiac
complications:
Seizures
Numbness, weakness, tingling of
extremities
Stroke
Chest pain, dysrhythmias, LV heart failure
hypertensive urgency
BP greater than 180/120 in stable patients
without target organ damage as evidenced
based on clinical examination and results of
laboratory studies.
Investigate cause of hypertension (ex.
Nonadherence to medications).
Requires close monitoring of blood pressure
and cardiovascular status.
how much sodium for dash diet
no more than 2g per day
what is the goal of dash diet
,aintain bp <130/80
thiazide diruetics
name(1)
moa
se
Hydrochlorothiazide
* Inhibit sodium, chloride, and water
reabsorption
* Monitor for orthostatic hypotension and
hypokalemia
ccbs
names(3)
moa
se
Amlodipine, Diltiazem, Verapamil
* Lower blood pressure by interfering with
the transmembrane flux of calcium ions
resulting in vasodilation
* Side effects of flushing, peripheral
edema, HA
* Block SA and AV node conduction –
decreases HR
* Most effective in older adults and African
Americans
ace inhibitors
names(3)
moa
se
Captopril, Lisinopril, Enalapril
Block ACE from converting angiotensin I to angiotensin II –
inhibiting vasoconstriction
Decreases sodium and water retention at kidneys – lowering
PVR
Most common side effect is a nagging dry cough
Monitor for hyperkalemia and orthostatic hypotension
Caution in clients with renal impairment
Neutropenia, angioedema (rare but serious)
arbs
name(3)
moa
se
Losartan, Valsartan, Candesartan
Block angiotensin II from binding with receptor sites
Inhibits vasoconstriction
Decrease sodium and water retention
Monitor for hyperkalemia and orthostatic hypotension
Caution in clients with renal impairment
ace inhibitors end in….
pril
arbs end in….
sartan
loop diruetics
name(1)
moa
se
Furosemide
Inhibit sodium, chloride and water
reabsorption and promote potassium
excretion
Monitor for orthostatic hypotension and
hypokalemia
Ototoxicity risk
Fall Risk in older adults
aldosterone antagonist
name1
moa
se
Spironolactone
Competitive inhibitors of aldosterone binding
(doesn’t allow aldosterone to become
functional)
Side effects: drowsiness, lethargy headache
Monitor for hyperkalemia (especially if also on
an ACE inhibitor or ARB
potassium sparing diuretics
name(1)
moa
se
Amiloride
Blocks sodium reabsorption
Side effects: drowsiness, lethargy headache
Monitor for hyperkalemia
beta blockers
Metoprolol, Atenolol,
Bisoprolol
Cardio-selective – Beta-1
are used in the
management of
hypertension
*Block beta-1 receptors in the
heart and peripheral vessels
Decreases heart rate and
contractility
Monitor for bradycardia,
hypotension, fatigue,
weakness, depression, and
sexual dysfunction
Clients with diabetes need
to be monitored closely for
hypoglycemia (“masked
symptoms”)
Drug of choice for clients
with history of MI or stable
heart failure
alpha-adrenergic antagonists
name(3)
moa
se
Doxazosin, Prazosin, Terazosin
Block alpha1-adrenergic effects
* Produces peripheral vasodilation
Monitor for orthostatic hypotension
Primarily used for treatment of BPH
hydralazine
Reduces peripheral vascular resistance
and blood pressure by direct arterial
vasodilation
Can be given PO or IV (for
hypertensive crisis)
