Hypertension

Question 1

3 classifications of HTN?

Answer 1

1. )Essential Hypertension
2. )Secondary Hypertension
3. )Malignant Hypertension

Question 2

most common type of HTN

Answer 2

Essential/Primary

Question 3

WHY DOES HYPERTENSION CAUSE PERFUSION PROBLEMS?

Answer 3

High pressure leads to microvascular vessel remodeling

• ->Less capillaries and arterioles in vascular bed
• ->Decreased tissue perfusion
• ->TISSUE GETS DAMAGED FROM LACK OF O2

Question 4

Modifiable and non modifiable risk factors increasing risk of essential HTN

Answer 4

Modifiable Risk Factors

• Weight
• Diet
• Alcohol intake
• Stress level
• Smoking
• Exercise level

Non-modifiable

• Family History
• Ethnicity
• Age

Question 5

this kind o HTN has an underlying cause

Answer 5

secondary

Question 6

common causes of secondary HTN

Answer 6

• Disease
• Drugs
• Kidney disease is the most common cause of 2º Hypertension
• Pregnancy
• Obstructive sleep apnea

Question 7

Drugs that cause secondary HTN

Answer 7

• Estrogen replacement
• Glucocorticoids
• Sympathomimetics
• Erythropoietin
• Cyclosporine
• NSAIDS and COX-2 inhibitors

Question 8

JNC8 guidlines for adults >/= 60

Answer 8

<150/90

Question 9

JNC8 guidelines adults 30-59

Answer 9

bp <140/90

Question 10

JNC8 guidelines for 18-29

Answer 10

recommendation is on the basis of expert opinion

Question 11

JNC8 guidelines 18 and older with CKD or diabetes

Answer 11

<140/90

Question 12

AHA guidelines for adults

Answer 12

<120/80

Question 13

AHA says treat anyone whose BP is > ____

Answer 13

130/80

Question 14

Assessment findings for HTN

Answer 14

• Usually, patient has no symptoms
• May experience
  
  • Headache
  • Facial flushing
  • Dizziness
  • Syncope
• History is important in assessing! increases risk of having HTN w/ family hxs
• the higher the BP = more likely to have sxs

Question 15

Labs for HTN

Answer 15

• No lab tests for essential hypertension
• Presence of protein and RBC’s in urine
• Elevated BUN
• Elevated creatinine
• Catecholamines in urine - looks at endocrine issue
• Elevated serum corticoids (and ketosteroids in urine) - Cushing’s syndrome

Question 16

Interventions for HTN

Answer 16

• Health Promotion
• Lifestyle changes
  
  • Weight loss
  • Low sodium diet (DASH)
  • Exercise
  • Smoking cessation
  • Alcohol restriction
  • Relaxation techniques
• Plan-of-care adherence
  
  • Drug therapy
  • Lifestyle changes

Question 17

complications from HTN

Answer 17

• Stroke
• Heart disease
• Kidney Disease
• Retinopathy

Question 18

Who is at risk of Malignant Hypertension?

Answer 18

someone w/ uncontrolled HTN

Question 19

Malignant HTN is characterized by

Answer 19

• Rapidly progressing, severely elevated blood pressure
• Patients are often in their 30’s, 40’s or 50’s
• Blood pressures greater than 200/130-150
• Usually symptomatic
  • Headaches
  • Blurred vision
  • Uremia
  • Dyspnea
  • Nose bleed

*Should be treated as emergency or complications will occur

Question 20

Hypertensive emergency interventions

Answer 20

• Check BP in another Arm
• IV access
• Cardiac monitor
• Foley catheter to monitor renal fxn
• Give IV antihypertensive
• Oxygen
• neuro assessment

Question 21

How do we want to reduce BP

Answer 21

-Slowly reduce blood pressure

~25% reduction in BP within 2-6 hours

Question 22

Big problem w/ managing HTN?

Answer 22

adherence to drugs due to side effects