HTN Flashcards
high-normal BP?
130-139 or 85-89
Stage 1 HTN:
> 140-159 or >90-99
Stage 2 HTN:
> 160-170 or 100-109
Stage 3 HTN:
> = 180 or >=110
How is HTN diagnosed in non-urgent situations?
- If BP is >140/90 - 2 more readings during that visit, first reading is eliminated and next 2 are averaged
- No caffeinated drinks
- No smoking
- No alcohol
- Use same blood pressure cuff every time you take a reading
- Ideally use a manual cuff and use proper size cuff – do not take BP over clothing
Why are we concerned about hypertension?
- Target organ damage
- Increase stress on heart -> L ventricular hypertrophy
- Increased stress on blood vessels -> atherosclerosis, CVA
- Renal disease (hypertensive neuropathy)
Modifiable risk factors of hypertension:
- Stress
- Abdominal obesity
- Substance abuse
- Oral contraceptives
- Dyslipidemia (hyperlipidemia)
- Personality traits
- Non-adherence
- Poor dietary habits (Increased Na+ and trans & Saturdated fats)
- Sedentary lifestyle
non-modifiable risk factors:
- Age >= 55
- Male gender
- Family history and premature CV disease (age <55 in men and <65 in women)
- African American population is at greater risk for developing hypertension
Why is HTN called a silent killer?
because ppl are usually asymptomatic
Symptoms that can occur:
o Breathlessness o Headache o Bleeding from nose o Blurred vision o Fatigue and sleepiness o Tinnitus o Profuse sweating
What do the kidneys secrete renin in response to?
1) decreased arterial pressure in the kidneys
2) decreased sodium in the blood
3) increased sympathetic tone
What are the different actions of Angiotensin 2?
- stimulates aldosterone secretion in adrenal glands promoting sodium and fluid retention
- stimulates muscle hypertrophy and fibrosis in the heart
- sympathetic outflow in the brain
- vasoconstriction
BP considerations for children?
o Normally lower and gradually to adult BP in
adolescence
o Obesity in children today -> HTN, hyperlipidemia
o Type 2 diabetes
Orthostatic HTN, the causes and how it is measured:
o Change in BP from lying to standing
o Wait for 2-3 full minutes between taking BPs
- SBP >/= 20 mmHg
- DBP >/= 10 mmHg
• Causative factors:
o Prolonged bed rest (fluid volume, venous tone)
o Aging
o Tall, thin people; adolescents; those with low BPs
o Some medications (diuretics)
o Hypovolemia
Teaching/learning for orthostatic HTN:
- Instructing pt to sit, then stand slowly, then start walking slowly if she/he has orthostatic HTN
- Use a walker as necessary for balance
- Teach expected symptoms, dizzy, light headed, possible syncope
Diagnostics for HTN:
- Urinalysis
- Electrolytes and fasting blood glucose
- BUN and creatinine
- Lipid profile (Total Chol, HDL, LDL, Triglyceride)
- CRP
- 12-lead ECG
- Echocardiogram
3 step approach to treating HTN:
- Lifestyle changes
- Pharmacology
- Combination pharmacology
lifestyle modifications:
- Smoking cessation
- Decrease ETOH use – 1-2 standard drinks/day
- Diet/weight loss – DASH
- Exercise: Leight weights/ aerobic
- Blood glucose control for people diabetes
- Patient education
pharmacological approach to HTN:
• Start with one drug at a low dose and increase if necessary: o Thiazide/loop diuretics o Calcium channel blockers o ACE inhibitors, ARBs o Beta blockers o Vasodilators
target organ damage for HTN:
o Heart o Brain o Kidney o PVD o Retinopathy
How do diuretics lower BP? side effects? common diuretics used?
o They work on your kidneys by increasing the amount of salt and water that comes out through your urine. Too much salt can cause extra fluid to build up in your blood vessels, raising your blood pressure. Diuretics lower your blood pressure by flushing salt out of your body, taking this unwanted extra fluid with it.
- Hypotension, electrolyte imbalances, dehydration
- Furosemide, HCTZ, spironalactone (K+)
Common side effects of ACE inhibitors:
Pre/post assessment:
common drugs (-pril):
Pre/post assessments: BP, potassium (excess), hematocrit
Common side effects: Hypotension, increased potassium, cough
*same side effects and assessments for Angiotensin 2 receptor blockers
Enalapril (Vasotec), Captopril
-pril = usually an ACE inhibitor
Pre/post Ax for calcium channel blocker, common side effects and common drugs:
- How do CCBs work: Decrease force of contraction of the heart –relaxes arteries so they don’t constrict as much.
- Pre/post assessments: NP, HR
- Common side effects: Hypotension, worsen heart failure
- What juice do you not give: Grapefruit juice
- Norvasc, Renidil, Diltiazem, Verapamil
pre/post Ax for beta blockers, common side effects, common drug:
- Pre/post assessments: BP, HR – hold if BP 90 sys and/or HR <50 bpm
- Common side effects: Hypotension, dizziness, bradycardia
- Atenolol, Metroprolol, Propranolol
- Doxazosin, Terazosin
pre/post Ax for direct vasodilators, common side effects, common drugs:
o Typically used in hypertensive crisis (ER/ICU)
o Pre/post assessments: BP q5 min if given IV, watch for reflex tachycardia
o Common side effects: Rapid hypotension, reflex tachycardia, headache, dizziness
o Hydralazine, Nipride
