HTN Flashcards
What happens to vessels over time and how does the body compensate?
Lose elasticity and become narrow
Body creates collateral vessels
What is affected by atherosclerosis of the aorta?
LV afterload
Which vessels and what parts of the vessels does atherosclerosis affect?
Intima of large and medium arteries
Which vessels does arteriosclerosis affect?
Small arteries
What are the results of atherosclerosis?
Narrowing of lumen Obstruction Aneurysm Ulceration Rupture
What can obstruction of the vessel lead to?
Ischemia (lack of blood flow) -> hypoxic tissue -> infarction (death)
What is the biggest cause of an aneurysm (weakening of the vessel wall)?
Turbulent blood flow
How does an ulceration form in an artery?
Ulceration gets scarred over (granulation tissue) - tough material
What is the reaction to injury theory?
Injury increases aggregation of platelets & monocytes
Smooth muscle forms a matrix of collagen & elastic fibers - causes tightening of vessels
What is an arteriogram/angiogram?
Sending a camera through femoral or radial artery to view the vessels
What circumstances will you see because of diseased and sclerosed arteries?
Will find low blood flow in the legs, decreased hair growth, discolored extremities, intermittent claudication, ulcers, weak pedal pulses
What are the two atherosclerotic lesions?
Fatty streaks
Fibrous plaques
What are characteristics of fatty streaks?
Yellow and smooth
Protrude into lumen
Composed of lipids & elongated smooth muscle cells
How can fatty streaks be decreased?
Diet, exercise, medication
What are characteristics of fibrous plaques?
White to whitish-yellow in color
Protrude into lumen
Composed of smooth muscle cells, collagen fibers, plasma components, and lipids
Found mostly in abdominal aorta, coronary, popliteal, and internal carotid arteries
IRREVERSIBLE
How can fibrous plaques be decreased?
Stent
Carotid endarterectomy
Why is age a risk factor for vascular disease?
Vessels lose elasticity
Why is sex a risk factor for vascular disease?
Estrogen is cardioprotective
Men are at a higher risk until women hit menopause
Why is a diet high in fat a risk factor for vascular disease?
Fat solidifies and causes fibrous plaques within the body
Why is HTN a risk factor for vascular disease?
Due to turbulent blood flow damaging the vessels
Why is diabetes a risk factor for vascular disease?
Sugar sticking to the walls in the blood vessels
Problem with the microcirculation in the eyes, distal peripheries, and kidneys
Why is smoking a risk factor for vascular disease?
Directly affects intima of vessels and changes it
Nicotinic acid changes vasculature
Why is obesity a risk factor for vascular disease?
Tend to have worse lifestyle (eating/exercising) practices
Why is stress a risk factor for vascular disease?
Increases turbulent blood flow
What are the BP guidelines for anyone <60?
SBP <140
DBP <90
What are the BP guidelines for anyone >60
SBP <150
DBP <90
What are the BP guidelines for anyone with diabetes/no CKD?
SBP <140
DBP <90
What are the BP guidelines for anyone with CKD?
SBP <140
DBP <90
What is essential or primary HTN?
No identifiable medical cause
Possibly due to norepinephrine (vasoconstriction), epinephrine (vasoconstriction), response of kidneys in the body
What are clinical manifestations of HTN?
May only be change in B/P Change in retina Coronary artery disease (CAD) or Angina Left Ventricular hypertrophy Change in kidneys CVA or TIA
How does HTN affect the kidneys?
Glomerulus (filtration system) becomes less effective
*Need to do a UA
What is secondary HTN?
HTN secondary to something else
What can cause secondary HTN?
Diabetes High salt Stress Smoking Cancer Adrenal disease Corticosteroids CKD
What are the 4 first-line treatments of HTN?
Thiazide diuretics
CCBs
ACE inhibitors
ARB
What are second- and third-line alternative treatments for HTN?
Higher doses or combinations of ACEIs, ARBs, thiazide-type diuretics, and CCBs
What are later-line alternatives for treating HTN?
Beta-blockers (-olol)
Alpha-blockers (ex. doxazosin)
Alpha1/beta-blockers (-ilol - Coreg)
Vasodilating beta-blockers (ex. nebivolol)
Central alpha2-adrenergic agonists (ex. clonidine)
Direct vasodilators (ex. hydralazine)
Loop diuretics (ex. furosemide - Lasix)
Aldosterone antagonists (ex. spironolactone)
Peripherally acting adrenergic antagonists (ex. reserpine)
What is a concern for Lasix?
Hypokalemia and excessive urination
Which two classes of HTN meds should not be used simultaneously?
ACE inhibitors and ARBs
Which class of HTN meds should black people use?
CCBs and thiazides instead of ACE inhibitors
Which 2 classes of meds are recommended for patients with CKD regardless of ethnic background?
ACE inhibitors or ARBs
Which 2 HTN meds are renal protective?
ACE inhibitors and ARBs
