hypertension Flashcards
hypertension
Systolic blood pressure > 129 mmHg.
OR
Diastolic blood pressure > 80 mmHg
hypertension for older ppl - numbers (Older than 150 yrs is hyper)
Systolic > 150 mmHg OR Diastolic blood pressure > 89 mmHg in the geriatric patient
blood pressure is (my BP in CO is severe)
Blood Pressure = Cardiac Output x Systemic Vascular Resistance
BP = CO x SVR
in early hypertension, CO is
normal. in older, it’s predominant.
Short term mechanisms
that regulate bp
Sympathetic nervous system
Baroreceptors
Vascular endothelium
long term mechanisms
that regulate bp
Renal, Na+
aldosterone lowers what electrolyte?
K+, which raises the bp
Sympathetic nervous system - what neutransmitter/hormone
Norepinephrine
alpha-1 (the alpha constricts)
Vasoconstrict, ↑contractility
alpha-2 (alpha 2nd in line constricts)
vasoconstrict
beta-1 (better one increase my heart, Renin)
↑ contractility, HR, conduction, renin secretion
beta-2 (Bettoo is wide)
vasodilation
dopamine - dilates or constricts? (happy when you’re open)
vasodilation
Baroreceptors in carotid
Baroreceptors
Stimulated by ↑ BP or ↓ BP
Vascular endothelium
Vasoactive substances (prosty with nitrous vasoactivates)
Nitric oxide
Prostacyclin
Endothelian (ET-1, ET-2, ET-3)
Elevated Blood Pressure (Pre-hypertension) (121 minutes elevated me)
Systolic BP 121-129
Stage 1 HTN
Systolic BP 130-139 mmHg or Diastolic BP 80-89 mmHg
Can be treated with lifestyle modifications and if needed, a thiazide diuretic
Stage 2 HTN (so close)
Systolic BP >140 mmHg or Diastolic BP >90 mmHg
Having or being at risk developing cardiovascular disease
( < 10% in next 10 years) also determines course of interventions
hypertension crisis - and what is diastolic? (the crisis is 180 degrees)
systolic above 180, or diastolic above 120
hypertension crisis - target organs, or organs most at risk (just 3)
heart, eyes, kidneys
Primary (essential or idiopathic) hypertension
Elevated BP without an identified cause
90% to 95% of all cases
Secondary hypertension
Elevated BP with a specific cause
5% to 10% of adult cases
Primary (essential or idiopathic) hypertension
Contributing factors
↑ SNS activity
↑ Sodium-retaining hormones and vasoconstrictors
Diabetes mellitus
> Ideal body weight
↑ Sodium intake
Excessive alcohol intake
can be genetic and how that interacts with environment.
Secondary hypertension - causes - (The second I hint at the narrowing pass, my kidneys, brain, thyroid and liver can’t sleep)
Coarctation (narrowing) of aorta
Renal disease (number 1 cause aside from obesity and alcohol)
Endocrine disorders
Neurologic disorders
Cirrhosis
Sleep apnea
thyroid, oral contraceptives
Isolated Systolic HTN (ISH) (isolated at age 55)
SBP > mmHg, DBP < 90 mmHg
Diostolic BP rises until age 55 then declines
Pseudo hypertension
Cuff measurement overestimates the true intraarterial blood pressure
Clue can be a + Osler’s Sign
Patient has a palpable although pulseless radial artery while the BP cuff is inflated above the systolic pressure
Modifiable risk factors - what about diabetes?
Cigarette smoking, obesity, stress, excessive alcohol consumption, increased dietary salt intake, diabetes mellitus, medications (NSAIDS, oral contraceptives, antidepressants and nasal decongestants)
Non-modifiable risk factors - what about arteriosclerosis?
Hereditary predisposition, advancing age, African-American race, arteriosclerosis, renal disease and pregnancy.
Socioeconomic status
COVID-19
Essential workers
Closer living conditions
Use of public transportation
Healthcare disparities
Environment
Food deserts
ETOH
Access to care
Pollution
Racism & Discrimination
Causes increased and chronic stress
Causes “weathering”
Increase in stress response
Decrease of lifespan
Shortening of telomers