Hypertension

Question 1

what is hypertension describe as?

Answer 1

one of the MOST IMPORTANT modifiable risk factors for cardiovascular disease

Question 2

what is blood pressure and the equation?

Answer 2

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

Question 3

what are short time and long term regulations?

Answer 3

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

Question 4

discuss the sympathetic nervous system with its relation to BP

Answer 4

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

Question 5

what are the 5 adrenergic receptors? know all briefly except #4

Answer 5

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

Question 6

what does vascular endothelium do and what does it release?

Answer 6

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

Question 7

discuss endothelial dysfunction

Answer 7

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

Question 8

how does the renal system intertwine with BP?

Answer 8

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?

Question 9

how does the endocrine system control bP?

Answer 9

stimulation of SNS results in release of:
1) epinephrine
- activates beta 2 adrenergic receptors which causes vasodilation
2) norepinephrine
3) aldosterone
4) ADH

Question 10

so what happens when hypertension develops in the body? and name the 4 systems

Answer 10

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

Question 11

what is hypertension (HT) and range?

Answer 11

sustained elevation of systematic arterial BP.

range >= 140/90

Question 12

what is the range for stage 1 HT and stage 2 HT?

Answer 12

STAGE 1: sys= 140-159, dia= 90-99

STAGE 2: sys>160, dia>100

Question 13

what is the value for HT AND DM?

Answer 13

sys <= 130, dia <=80

Question 14

what is hypertension known as

Answer 14

silent killer

Question 15

what does pre-hypertension include?

Answer 15

high-normal BP

needs annual BP assessment

Question 16

what are the 3 types of hypertension?

Answer 16

1) isolated systolic hypertension

2) primary (essential) hypertension

3) secondary hypertension

Question 17

discuss isolated systolic hypertension

Answer 17

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

Question 18

if you have one reading that shows sys is higher than 140 and dia is <90 does that mean you have isolated systolic hypertension?

Answer 18

nah bro you good

Question 19

*discuss primary (essential) hypertension

Answer 19

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

Question 20

what is the path behind primary HT?

Answer 20

Primary HT occurs because there is an increase in either cardiac output or systemic vascular resistance

Question 21

what are clinical manifestations of primary HT?

Answer 21

symptoms are ASYMPTOMATIC until they become severe

sever HT occurs because of heavy workload on the heart

basically tired, dizzy, angina etc..

Question 22

discuss secondary hypertension

Answer 22

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

Question 23

what are clinical manifestations of primary HT?

Answer 23

symptoms are ASYMPTOMATIC until they become severe

sever HT occurs because of heavy workload on the heart

basically tired, dizzy, angina etc..

Question 24

what Is the diagnostic test for HT?

Answer 24

doesnt rely on only one reading but MULTIPLE over several weeks

Question 25

what are interprofessional care for HT?

Answer 25

risk stratification - periodic, home and ambulatory monitoring then when BP stabilizes once every 3-6 months

nutrition - DASH diet; low fat dairy products

Question 26

what is the primary intervention for HT?

Answer 26

lifestyle modifications as majority of hypertension is diagnosed on routine screening

Question 27

how do they measure BP for diagnosing it?

Answer 27

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

Question 28

?what are some age related considerations when taking BP for the old peeps?

Answer 28

1) wide auscultatory gap
2) older ppl have impaired baroreceptors
3) orthostatic occurs often

Question 29

discuss hypertensive crisis

Answer 29

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

Question 30

what to do if someone has hypertensive crisis

Answer 30

MEDICAL EMERGENCY aka organ damage lol

Question 31

what is hypertensive crisis clinical manifestation?

Answer 31

hypertensive encephalopathy

Question 32

what is hypertensive urgency?

Answer 32

elevation of BP but no evidence of target organ damage