HTN Flashcards
HTN drug types
Diuretics, beta blockers, ace inhibitors, ARBs, CCBs
Five related factors in HTN
Cardiac Output, blood volume, peripheral resistance, artery elasticity, blood viscosity
Framingham Heart Study
1948: it was started in Massachusetts in 1948. pt between 30 and 62 yr. they try id. Factors, they tracked their htn through life. In 1972, the 2nd generation, that group was much more diverse. The latest group is way more diverse. The latest group are the grandchildren from the first group. They study the heart’s left ventricle
Pulse pressure
Systolic minus diastolic. It represents the force that the heart generates each time it contracts.
Blood pressure (definition)
Blood pressure is the force exerted on the walls of an artery by the pulsing blood under pressure from the heart.
Systolic pressure
The contraction of the heart forces the blood under high pressure into the aorta. The peak of maximum pressure when ejection occurs is the systolic pressure.
Diastolic pressure
When the ventricles relax, the blood remaining in the arteries exerts a minimum or diastolic pressure.
Factors Influencing Blood Pressure.
Age, stress, ethnicity, gender, daily variation, medications, activity and weight.
Diuretics drug names
Furosemide (Lasix), spironolactone (Aldactone), metolazone, polythiazide, benzthiazide.
Diuretics action
Lowers blood pressure by reducing resorption of sodium and water by the kidneys, thus lowering circulating fluid volume.
Beta-adrenergic blockers drug names
(if it finishes in “lol” is beta-adrenergic blocker) Atenolol (Tenormin), nadolol (Corgard), timolol maleate (Blocadren), propranolol (Inderal).
Beta-adrenergic blockers action
Combines with beta-adrenergic receptors in the heart, arteries, and arterioles to block response to sympathetic nerve impulses; reduces heart rate and thus cardiac output.tbu
Vasodilators drug names
Hydralazine hydrochloride (Apresoline), minoxidil (Loniten).
Vasodilators action
Acts on arteriolar smooth muscle to cause relaxation and reduce peripheral vascular resistance.
Calcium channel blocker names
(ends in pine) Diltiazem (Cardizem, Dilacor XR), verapamil hydrochloride (Calan SR), nifedipine (Procardia), nicardipine (Cardene).
Calcium channel blocker action
Reduces peripheral vascular resistance by systemic vasodilation.
Angiotensin-converting enzyme (ACE) inhibitors names
(ends in pirl) Captopril (Capoten), enalapril (Vasotec), lisinopril (Prinivil, Zestril), benazepril (Lotensin).
Angiotensin-converting enzyme (ACE) inhibitors action
Lowers blood pressure by blocking the conversion of angiotensin I to angiotensin II, preventing vasoconstriction; reduces aldosterone production and fluid retention, lowering circulating fluid volume.
Angiotensin-II receptor blockers names
(ends in tan) Losartan (Cozaar), olmesartan (Benicar).
Angiotensin-II receptor blockers action
Lowers blood pressure by blocking the binding of angiotensin II, which prevents vasoconstriction.
Normal BP values
Systolic:
Pre HTN values
Systolic: 120-139. Diastolic: 80-89
Stage 1 HTN values
Systolic: 140-159. Diastolic: 90-99
Stage 2 HTNvalues
Systolic: ≥160. Diastolic: ≥100
BP definition equation
Cardiac output x peripheral recistance
Classifying Hypertension
Persistent SBP ≥ 140, ≥ DBP 90 or current use of anti-HTN meds in the adult patient. One high reading does not mean the pt is hypertensive
Measuring BP. (7 tips)
- Abstain from smoking, caffeine, exercise 30 minutes prior to BP.
- Rest quietly for 5 minutes
- Patient: seated, feet on floor, arm at heart level. Place arm on a hard surface. Palm up. Pt can’t talk.
- Appropriate sized cuff
- At least 2 measurements,1 minute apart, averaged together & recorded
- Evaluation of “white coat” hypertension
- Pt with hx of disease (breat cancer, lymph cancer or other) it is not recommended to take BP in that side
Isolated Systolic Hypertension
SBP ≥140 coupled with an average DBP ≤ 90
Primary Hypertension (etiology)
Formerly: Essential or Idiopathic Hypertension (same as primary HTN)
No identified cause
90-95% of cases
Risk factors: Age, African-American, obesity, smokers, excessive ETOH, stress, DM, high lipid levels, sedentary lifestyle.
Secondary Hypertension (Etiology)
Results from specific cause or condition. Typically renal related.
RAAS mechanism
Renin + angiotensinogen = angiotensin 1 + ACE = Angiotensin 2 = vaso constriction + aldosterone secretion (sodium retention) =
Vascular endothelium dysfunction
decrease vasodilator response to nitric oxide
increase endothelin levels result in “prolonged & pronounced” vasoconstriction
Nitric Oxide (definition for vascular system)
Is a powerful vasodilator
Gerontological Considerations
- Loss of tissue elasticity
- Increase stiffness of myocardium & PVR
- Blunting of baroreceptor reflex, decrease renal function, renin response to sodium & water depletion
- Increase likelihood of auscultatory gap, increase sensitivity to BP changes
TOD
Target Organ Damage
Dash Diet (food amounts)
Grains: 6 - 12 Fruits: 4-6 Veggies: 4-6 Dairy: 2-4 Meats: 2 Nuts: 3-6 a week Fats and sweets: 2-4
Diagnostic Studies
Accurate BP monitoring Physical exam Target organ focus UA, BUN/creatinine, creatinine clearance Electrolytes (especially potassium) Fasting blood glucose Lipid profile, EKG
Diuretics overall goal
Decreasing circulating volume by increasing urine output
Diuretics major uses
Treat hypertension
Remove edema fluids
Prevent renal failure
Diuretics side effects
Fluid volume deficit, A/B imbalance & electrolyte imbalance
Which diuretics inhibit reabsorption of Na, Cl, K, resulting in osmotic water loss
hydrochlorothiazide (HCTZ) and furosemide (Lasix)
Which diuretic spares potassium
Aldactone
Caution with K+ sparing diuretics:
not given with K supplements or with another K sparing diuretic if patients also taking ACEI’s
