Hypertension Flashcards
What is a normal BP
Normal Blood pressure is now (2019) defined as under 120/80 mmHg
Blood pressure must be measures carefully on two separate occasions.
Hypertension is: AKA elevated BP
Hypertension is the persistent elevation of:
Systolic blood pressure > 129 mmHg. meaning almost stage 1
OR
Diastolic blood pressure > 80 mmHg
OR
Current use of antihypertensive medication or medications
Hypertension in a geriatric patient?
Systolic > 150 mmHg OR Diastolic blood pressure > 89 mmHg in the geriatric patient
How is BP calculated ?
Blood Pressure = Cardiac Output x Systemic Vascular Resistance
BP = CO x SVR
Mechanisms that regulate blood pressure? Short-term mechanisms: 3 things
- Sympathetic nervous
system - Baroreceptors
- Vascular endothelium (In healthy blood vessels, the endothelial cell lining of blood vessels (the endothelium) controls vascular reactivity (and hence blood pressure) by releasing chemicals
Mechanisms that regulate blood pressure? Long term mechanisms:
Renal system
What are Baroreceptors and what do they do ?
Baroreceptors are a type of mechanoreceptors allowing for relaying information derived from blood pressure within the autonomic nervous system. Information is then passed in rapid sequence to alter the total peripheral resistance and cardiac output, maintaining blood pressure within a preset, normalized range.
Baroreceptors
Stimulated by ↑ BP or ↓ BP
How does the Vascular endothelium regulate BP?
in healthy blood vessels, the endothelial cell lining of blood vessels (the endothelium) controls vascular reactivity (and hence blood pressure) by releasing paracrine signaling molecules, such as nitric oxide (NO) and prostacyclin.
How does the Renin angiotensin system RAAS work ?
Paper use !
Is a the renal system a long term regulating system ?
yes, Renal System
Renin-angiotensin, aldosterone, system (RAAS)
Note: People with heart failure their heart can’t deliver blood to the kidneys so the kidneys think that they are dehydrated so they activate the RAAS system which makes HBP even worse.
Stages of Hypertension. Elevated Blood Pressure (Pre-hypertension):
Elevated Blood Pressure (Pre-hypertension): Systolic BP 120-129. and diastolic less than 80
We do not treat it with medications. We mostly recommend lifestyle changes.
Stages of Hypertension. Stage 1 HTN:
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
Stages of Hypertension. Stage 2 HTN:
Stage 2 HTN: Systolic BP >140 mmHg or Diastolic BP >90 mmHg
Stages of Hypertension. Hypertensive crisis
Systolic over 180 and Diastolic over 120
Aldosterone Keeps NA and gets rid of K+ which increases the contractions causing the heart to beat faster and stronger. Action potentials
OUI
Primary (essential or idiopathic)
hypertension
Elevated BP without an identified cause
90% to 95% of all cases
It basically means that you have hypertension but we don’t know why. We try treat it by modifying the life style and if that does not work we use medications.
Secondary hypertension?
Secondary hypertension
Elevated BP with a specific cause
5% to 10% of adult cases
Some know causes of primary hypertension ? New studies have shown that it mainly has to do with epigenetic.
Primary (essential or idiopathic) hypertension
Contributing factors:
- ↑ SNS activity (sympathetic nervous system)
-↑ Sodium-retaining hormones and vasoconstrictors - Diabetes mellitus
- lack of Ideal body weight
- ↑ Sodium intake
- Excessive alcohol intake
Causes of Secondary hypertension
Contributing factors:
- Coarctation (constriction) of aorta
- Renal disease (too much NA retention or renin production)
- Endocrine disorders (too much epinepherine)
- Neurologic disorders (autonomous goes crazy)
- Cirrhosis (Portal hypertension is a leading side effect of cirrhosis. Your body carries blood to your liver through a large blood vessel called the portal vein. Cirrhosis slows your blood flow and puts stress on the portal vein. This causes high blood pressure known as portal hypertension)
- Sleep apnea: Lack of sleep and lack of O2 causes vasoconstriction because if the tissues sense that they are not getting enough blood they make the BV constrict to get better perfusion
Causes of Secondary hypertension
Contributing factors:
- Coarctation of aorta
- Renal disease
- Endocrine disorders
- Neurologic disorders
- Cirrhosis
- Sleep apnea: Lack of sleep and lack of O2 causes vasoconstriction.
what is Isolated Systolic HTN (ISH)?
Isolated systolic hypertension is when your systolic blood pressure is high, but your diastolic blood pressure is normal.
Isolated systolic hypertension happens when the diastolic blood pressure is less than 80 millimeters of mercury (mm Hg) and the systolic blood pressure is 130 mm Hg or higher. Isolated systolic hypertension is the most common form of high blood pressure in people older than age 65. Because they need to perfuse remember
What is 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.
is a condition in which indirect blood pressure (BP) measured by the cuff method overestimates the true intra-arterial BP. [1] It should be suspected if a patient develops dizziness after the start of antihypertensive or following dose escalation.
Pseudohypertension, also known as pseudohypertension in the elderly, noncompressibility artery syndrome, and Osler’s sign of pseudohypertension is a falsely elevated blood pressure reading obtained through sphygmomanometry due to calcification of blood vessels which cannot be compressed.
Modifiable risk factors
for hypertension ?
Cigarette smoking, obesity, stress, excessive alcohol consumption, increased dietary salt intake, diabetes mellitus, medications (NSAIDS, oral contraceptives, antidepressants and nasal decongestants)
- Also dyslipidemia which is high fat in your blood
Dyslipidemia is the imbalance of lipids such as cholesterol, low-density lipoprotein cholesterol,
Health impacts of HBP?
