Hypertension Flashcards
Define essential hypertension
Is the term applied to 95% of hypertensive patients when no single cause can be identified
Structures involved with HTN
Arterioles
Arteries
Heart
Blood pressure is regulated by?
Relaxing or contracting of the smooth muscle around the arterioles
How does the blood flow?
From area of high pressure to lower pressure
As you get further away from the heart the blood pressure increase or decreases due to branching of the arterial tree
Decreases
What’s the importance of the Maintenance of arterial blood pressure
It’s essential for organ perfusion and nutrients
When inflating the cuff it should be [number range] mm Hg above the level where auscultatory sound disappears
20-30
When deflating the cuff what is the mm Hg per second and listen for the korotkoff sounds
2 mm Hg
What genetic factors can elevate BP
Sympathetic hyperactivity
Abnormal cardiovascular development
Renin-angiotensin system
Defects in natriuresis
Define secondary hypertension
High BP has an identifiable cause and should be suspected in patients with HTN at early age
Found in PE
Essential hypertension is usually asymptomatic
BP will be elevated on 3 or more separate occasions
Can have PMI ( long term uncontrolled HTN)
Mitral valve murmurs
S4 sounds
Differential Diagnosis
- Essential HTN
- Secondary HTN
- Hyperthyroidism
- stimulant use
- adrenal steroids
- OTC supplements
- anorexic medications
- NSAIDs
- oral contraceptives
- ETOH withdrawal
- obesity
When evaluate new Dx of HTN ( specifically looking for evidence of?)
End organ damage or comorbidities
LABs drawn
Fasting glucose UA CBC Chemistry TSH Lipid panel
Studies taken/ordered?
EKG
10 year atherosclerotic cardiovascular disease risk ( if over 40)
What is the assessment?
- Must have elevated BP recordings on 3-5 separate visits
2. R/o causes of secondary HTN if suspected due to secondary causes
First line of treatment if Patient is stage I and below
Lifestyle modifications Diet Weight reduction ( 10 kg can lower SBP 5-20 mm Hg) Reduced ETOH consumption Increase in physical activity
First line pharmacological medication
Diuretics
ACEI
Diuretics
HCTZ
ACEI
End in -pril
Lisinopril
ARBs ( angiotensin receptors blockers)
-sartan
Losartan
Calcium channel blockers
“Peripheral vasodilation”
Diltiazem
Amlodipine
Alpha blockers
Terazosin
“ peripheral vasodilation”
When managing HTN with medication, you need to?
Re-evaluate them one month after any medication change, usually give it 3 months before adjusting doses of medication
