HTN and CAD Flashcards
HTN stage 1
2+ BP readings with
SBP 140-159
or
DBP 90-99
or
current use of antihypertensives
HTN Stage 2
2+ BP readings with
SBP over 160
or
DBP over 100
Prehypertension range
SBP 120-139
DBP 80-89
primary HTN
90-95% of all cases
No identified cause
Factors: Alcohol/tobacco Age Inc. lipids Younger men Older women DM Obesity Genetics Stress
Secondary HTN
Elevated BP w/specific cause
5-10% of cases in adults
80% of cases in kids
If under 20 or over 50 and BP spikes suspect secondary
Treatment: fix the cause- can be congenital narrowing of aorta, renal disease, sleep apnea, cirrhosis
BP equation
BP=CO x Vascular Resistance
renin-angiotensin function
Constricts vesels
Stimulate ADH release
Stimulate thirst
Stimulate aldosterone
Aldosterone function
Cause kidneys to retain sodium and water
Increases blood volume and CO
Atrial naturetic factor
Produced by Renin-Angiotensin, excretes sodium and water
Humoral BP influencers
Vasoconstrictors
Angiotensin
Catecholamines
HTN diagnosis
BP measured in both arms
Use arm with higher reading
BP highest early morning, lowest night
Urinalysis labs
clear or cloudy
pH 4.5-8
Specific gravity 1.001-1.025
Bilirubin: may indicate liver damage
Protein: Should be trace to zero
Cholesterol ranges
0-200: desirable
201-239: elevated
240+: high
Drug choice without compelling indications for stage 1 HTN
SBP 140-159 or DBP 90-99
Thiazides
May consider ACE inhibitor, ARB, Beta blocker, calcium channel blockers
Drug choice without compelling indications for stage 2 HTN
SBP 160+ or DBP 100+
Two drug combination for most
Drug choice for HTN with compelling indications
More than two drugs as needed
Lifestyle modifications to reduce bp
22lb weight loss can reduce bp by 5-10 systolic
Decrease Na <2.4g/day
Priority problems for HTN
Tissues perfusion
Ineffective health maintenance
Compliance
Preload
Pressure from volume of blood in ventricles
End diastolic pressure
Increased in
- Hypervolemia
- Valve regurgitation
- Heart failure
Afterload
Resistance L ventricle must overcome to circulate blood
Inc. in HTN and vasoconstriction
Review drug therapy on table 32-7
Diuretics Adrenergic inhibitors Direct vasodilators Angiotensin inhibitors Ca channel blockers
Diuretics
Reduce preload
inhibit sodium reabsorption
inc. excretion of sodium and water
HCTZ- Hydrochlorothiazide
Diuretic
Can result in low electrolyte values, hyperglycemia, dehydration, renal calcium
watch electrolytes
Adrenergic inhibitors
Reduce afterload
Alpha and beta blockers
Lower sympathetic (fight or flight) activity lowers vasoconstriction
Monitor pulse- Needs to be ABOVE 60 BPM
May cause severe orthostatic hypotension,
Alpha blockers
vertigo, tachycardia, sexual dysfunction
ex. doxasozin (Cardura), prazosin (Minipress)
Prazosin (Minipress)
Give initial dose at bedtime to avoid first dose effect (fainting after taking first dose)
Side effects: Orthostatic Hypotension
Reflex tachycardia
Inhibition of ejaculation
Nasal congestion
Beta blockers
Examples:
Propranolol
Atenolol
Metoprolol
Blocks beta receptors in heart: lowers HR, force of contraction, and rate of AV conduction
Can cause
Hypotension
Bradycardia
HF symptoms (coughing, SOB, edema, fatigue)
Drowsiness, depression
Vasodilators
Decrease SVR (systemic vascular resistance)
Reduce afterload
reserved for hospitalized patients, need IV access
Nitroglycerin
Vasodilator
Used to treat angina
Rapid onset: 2-5 min
Sublingual tabs, IV, translingual spray
Slow onset: 20-60 min
Transdermal patch
Nitro ointments
XR capsules
SE:
- Hypotension
- Tachycardia
- Dizziness
- HA
- Syncope
Angiotensin inhibitors
ACE inhibitors or ARB
ACE inhibitors: prevent angiotensin vasoconstriction–>reduces afterload
ARB: Vasodilation and inc. sodium/water excretion–> reduces preload
ARBs
Blocks action of Angiotensin 2
ex.
Valsartan
Losartan
Olmesartan
Can cause
- Angioedema
- Fetal harm
- Renal damage
doesn’t cause hyperkalemia or cough
Which ARB is the only sartan approved for MI, stroke, CVD in patients not able to take ACE inhibitors?
Telmisartan
Which ARB is the only sartans approved for HF?
Valsartan, Cadesartan
Inc. L ventricular ejection fraction
Which ARB is the only sartan approved for nephropathy in hypertensive patients with DM2?
Losartan
Irbesartan
Ace inhibitors (PRILS)
Captopril
Lisinopril
Enalapril
Quinapril
Lower peripheral vasc. resistance WITHOUT increasing: CO, HR, contractility
Indicated for HTN, HF, post MI
can cause: Postural hypotension Angioedema nonproductive cough Hyperkalemia
Fosinopril (Monopril)
Decrease peripheral and arterial resistance and pulmonary capillary pressure.
Increases exercise tolerance and CO
May cause First dose effect
Watch for Hyperkalemia, Hypotension, N/V, cough
Calcium channel blockers (Very Nice Drugs)
Blocks movement of calcium into cells
ex.
Verapamil
Nifedipine
Diltiazem
Reduces afterload by inc. vasodilation-> which lowers SVR and BP.
Lowers HR and contractility
Side effects: Hypotension Bradycardia AV block HA GI distress peripheral edema
Hypertensive crisis
Severe abrupt increase in DBP (over 140)
Rate more important than actual value
Often occurs in pt w/ hx of HTN that failed to comply w/ meds or have been underdosed
Hypertensive emergency: -evidence of acute target organ damage \: Hypertensive encephalopathy, cerebral hemorrhage -Acute renal failure -MI HF w/ pulmonary edema
Hospitalization for hypertensive crisis
Critical care unit
IV drug therapy titrated to MAP—slowly decrease
MAP=(SBP + 2(DBP))/3
Monitor cardiac and renal function
neuro checks
determine cause
education to avoid future crises
