HTN 33 Flashcards
Ethnic group with highest prevalence of hypertension
African American
Healthy people: prevention and control of hypertension
Maintain a healthy weight, reduce salt and sodium intake, increase level of physical exercise, limit consumption of alcohol to moderate levels, monitor blood pressure and know if blood pressure is high, low, normal, or borderline, if ordered, take bp meds
What are men more likely to suffer from hypertension?
MI over stroke
Arterial BP is a function of
CO and systemic vascular resistance
What is a principal factor for determining vascular resistance?
Radius of the small arteries and arterioles. A small change in the radius, can create a major change in SVR
Mechanisms that regulate BP are
CO and SVR
A decrease in BP is addressed in the body by (what system)
SNS
Increase in SNS activity results in
Increase in HR, and ❤️ contractibility, widespread vasoconstriction in the peripheral arterioles, and promote the release of rennin from the kidneys
NE receptors can be found
SA node, myocardium, and vascular smooth muscle
Significant cardiovascular SNS change due to aging
Diminished responsiveness of cardiovascular cells to SNS stimulation
Where is the sympathetic vasomotor center?
Brainstem
A fall in BP results in ( describe the events)
The baroreceptors sense the change, which leads to the activation of the SNS. Peripheral arterioles constrict, HR increases, heart contractility increases
What is the baroreceptors response to long term elevated BP
Come to recognize the elevated BP as normal
Substances produced by vascular endothelium
Vasoactive substances and growth factor
Nitric oxide, and endothelium- derived relaxing factor which inhibit platelet aggregation
Prostacyclin and endothelium- derived hyperpolarizing factor
Endothelin
What does endothelin do?
Vasoconstrictor (very potent)
Which endothelin is the most potent if the three subclasses?
ET-1
What does ET-1 do?
Vasoconstrictor, causes adhesion, and aggregation of neutrophils and stimulates smooth muscle growth
Define hypertension
SBP greater than or equal to 140, couples with average DBP of greater than or equal to 90 or current use of antihypertensive medication
Prehypertension is
SBP from 120 to 139 or DBP 80 to 89
Isolated systolic hypertension
Average systolic bp greater than or equal to 140 coupled with an average diastolic bp less than 90. Common in older adults
Why do older adults commonly have isolated systolic hypertension?
Loss of elasticity in larger arteries from atherosclerosis
Psuedohypertension
Occurs with advanced atherosclerosis. Sclerotic arteries do not collapse when cuff is fully inflated. Needs to be measured with intraarterial catheter
Primary hypertension
Elevated bp without an identified cause
Occurrence of primary hypertension
90% to 95% of all cases
Secondary HTN
Elevated do to a cause that can be identified and corrected
People over 50 who suddenly develop high BP should be considered for (especially when severe)
Secondary HTN
Tx of secondary HTN
Treat underlying cause
classic symptom of peripheral vascular dz involving the arteries in the leg
intermittent claudication
ischemia caused by narrowed lumen of the intrarenal blood vessels
renal dysfunction
manifestations of severe retinal damage
blurring of vision, retinal hemorrhage and loss of vision
gradual narrowing of the arteries and arterioles leads to (in the kidney)
atrophy of the tubules, destruction of the glomeruli, destruction of the glomeruli and eventual death of the nephrons
white coat HTN
patients have elevated BP readings in a clinical setting and normal readings when BP is measured elsewhere
BP is usually highest (part of the day)
in the early morning
BP is usually lowest (part of the day)
at night
% that BP drops by from day to night
usually 10% or more
lifestyle modifications
wt reduction, Dietary approaches to stop hypertension (DASH), dietary sodium reduction, moderation of alcohol consumption, regular physical activity, avoidance of tobacco, manage psych r/f
DASH diet
emphasize fruits, vegetables, fat free or low fat milk and milk products, whole grains, fish, poultry, beans, seeds and nuts
overweight persons have increased risk for
HTN and CVD
alcohol should be limited to
no more than 2 drinks per day for men, and no more than 1 drink per day for women or lighter men
restrict sodium to
less than or equal to 2300mg per day, those with HTN, DM, CKD should have less than or equal to 1500mg/day
physical activty recommended by the American Heart Association and American college of Sports Medicine
moderate-intensity aerobic physical activity for at least 30 minutes most days (5 or more) per week or vigorous intensity aerobic activty for at least 20 minutes 3 days per week
effects of Nicotine in HTN patients
cause vasoconstriction and increases BP
psychosocial risk factors
low SE status, social isolation, lack of support, stress at work and in family life, negative emotions
drug therapy for prehypertension
drug therapy is not recommended for prehypertension unless it is required by another condition, such as diabetes mellitus or chronic kidney dz
drug therapy actions (2)
decrease the volume of circulating blood and reduce SVR
action of diuretics
promote sodium and water excretion, reduce plasma volume and reduce vascular response to catecholamines
actions of adrenergic inhibiting agents
diminish the SNS effect that increase BP. Work on vasomotor center and peripherally to inhibit NE release or to block the adrenegic receptors on blood vessels
action of direct vasodilators
decrease BP by relaxing vascular smooth muscle and reducing SVR