Hypertension Flashcards
what is hypertension describe as?
one of the MOST IMPORTANT modifiable risk factors for cardiovascular disease
what is blood pressure and the equation?
BP is the force exerted by the blood against the walls of blood vessels
BP = cardiac output (CO) x systemic vascular resistance (SVR)
CO = volume of blood ejected from the heart per minute
SVR = force opposing the movement of blood within the blood
what are short time and long term regulations?
1) short term:
- seconds
- sympathetic nervous system and endothelium
2) long term:
- seconds to hours
- renal and hormonal processes regulating arteriolar resistance and blood volume
discuss the sympathetic nervous system with its relation to BP
baroreceptors (which are specialized nerve cells) sense change in BP and transmitted to vasomotor centres in brainstem
so when BP drops, the baroreceptors are like oh no lets signal so
it activates the sympathetic nervous system -> increase HR, CO, SVR
what are the 5 adrenergic receptors? know all briefly except #4
1) alpha 1 : response when activates is vasoconstriction and increased contractility
2) alpha 2: inhibition of norepinephrine release and vasoconstriction
3) beta 1 : increase HR, conductions etc…
4) beta 2 : vasodilation, relaxation, gluconeogenesis
5) dopamingeric receptors : vasodilation
what does vascular endothelium do and what does it release?
produces vasoactive substances and growth factors
1) when blood flow increases the endothelium releases nitric oxide to help decide when to dilate
Nitric oxide:
- maintains low material tone at rest
-inhibits growth of the smooth muscle layer
-inhibits platelet aggregation
2) endothelia - strong vasoconstrictor
discuss endothelial dysfunction
contributes to atherosclerosis and primary hypertension
weakening of endothelium with age and other factors
no blockage in heart arteries but the large vessels constrict instead of opening up
how does the renal system intertwine with BP?
the kidneys contribute by controlling sodium excretion and ECF volume
sodium retention results in water retention which equates to increase ECF volume
Renal system also uses the RAAS system (renin-angiotensin-aldosterone system?
how does the endocrine system control bP?
stimulation of SNS results in release of:
1) epinephrine
- activates beta 2 adrenergic receptors which causes vasodilation
2) norepinephrine
3) aldosterone
4) ADH
so what happens when hypertension develops in the body? and name the 4 systems
it means that either one of the BP regulating mechanisms are defective
so either
1) sympathetic nervous system
2) vascular endothelium
3) endocrine system
4) renal system
what is hypertension (HT) and range?
sustained elevation of systematic arterial BP.
range >= 140/90
what is the range for stage 1 HT and stage 2 HT?
STAGE 1: sys= 140-159, dia= 90-99
STAGE 2: sys>160, dia>100
what is the value for HT AND DM?
sys <= 130, dia <=80
what is hypertension known as
silent killer
what does pre-hypertension include?
high-normal BP
needs annual BP assessment
what are the 3 types of hypertension?
1) isolated systolic hypertension
2) primary (essential) hypertension
3) secondary hypertension
discuss isolated systolic hypertension
sustained elevation in sys >=140 with a diastolic value < 90
- results because arteries have lost elasticity due to widened pulse pressure
- it is also considered independent risk factor for CVD and organ damage
- mostly in old ppl too lol
if you have one reading that shows sys is higher than 140 and dia is <90 does that mean you have isolated systolic hypertension?
nah bro you good
*discuss primary (essential) hypertension
this is elevated BP WITHOUT a specific cause. this is what majority of people have.
although cause isn’t known there are some contributing factors:
1) increased SNS activity
2) increase sodium
3) DM
4) if you bigggg
5) if you a little alcoholic shorty
what is the path behind primary HT?
Primary HT occurs because there is an increase in either cardiac output or systemic vascular resistance
what are clinical manifestations of primary HT?
symptoms are ASYMPTOMATIC until they become severe
sever HT occurs because of heavy workload on the heart
basically tired, dizzy, angina etc..
discuss secondary hypertension
basically compared to the primary HT, this one actually has an underlying cause and can be corrected low % in adults but high % in children
possible causes:
- narrowing of aorta
- renal disease
- endocrine or neuro disorders
basically the treatment is to eliminate the underlying cause
what are clinical manifestations of primary HT?
symptoms are ASYMPTOMATIC until they become severe
sever HT occurs because of heavy workload on the heart
basically tired, dizzy, angina etc..
what Is the diagnostic test for HT?
doesnt rely on only one reading but MULTIPLE over several weeks
what are interprofessional care for HT?
risk stratification - periodic, home and ambulatory monitoring then when BP stabilizes once every 3-6 months
nutrition - DASH diet; low fat dairy products
what is the primary intervention for HT?
lifestyle modifications as majority of hypertension is diagnosed on routine screening
how do they measure BP for diagnosing it?
1) Take BP 2-3 times, at least 2 minutes apart
2) Record average pressure
3) Ensure proper size BP cuff used for accurate measurement
4) Measure both arms to detect any differences
5) Arm uncovered and placed at level of the heart
?what are some age related considerations when taking BP for the old peeps?
1) wide auscultatory gap
2) older ppl have impaired baroreceptors
3) orthostatic occurs often
discuss hypertensive crisis
severe and abrupt elevation in BP. occurs often because of pt non-compliance with meds or undermedicated by doctor. can also occur from drugs
- dia > 120-130
the MOST important thing is the rate in which its rising rather than the absolute value
what to do if someone has hypertensive crisis
MEDICAL EMERGENCY aka organ damage lol
what is hypertensive crisis clinical manifestation?
hypertensive encephalopathy
what is hypertensive urgency?
elevation of BP but no evidence of target organ damage
