Hypertension Flashcards
population of people with HTN in America and worldwide
60 million; 1 billion
the relationship between BP and risk of CVD is
continuous, consistent, and independent of other risk factors
the higher the BP
the greater the risk of MI, HF, CVA, and kidney disease
antihypertensive therapy is associated with
35-40% reduction in stroke incidents
20-25% reduction in MI
>50% reduction in HF
main organs damaged from HTN
Heart (LV hypertrophy), brain (CVA or TIA), chronic kidney disease, peripheral arterial disease
HTN with no identifiable cause and percent of cases
primary essential HTN; 95%
HTN with identifiable cause and percent of cases
secondary HTN; 5%
causes of secondary HTN
sleep apnea, drug-induced, chronic kidney disease, chronic steroid therapy and cushing syndrome, coarctation of the aorta, pregnancy–preeclampsia and eclampsia, estrogen use, thyroid/parathyroid disease, white coat syndrome
drugs that affect BP
cocaine, tricyclic antidepressant, NSAIDs, nicotine
one of the most common causes of maternal and fetal morbidity and mortality
preeclampsia (HTN) and eclampsia (sever HTN causing seizures)
people who would have secondary HTN
folks who exhibit HTN at an early age and have been reasonably well controlled and them become refractory to tx
causes of primary HTN
unknown…COMPLEX INTERACTION B/W MULTIPLE GENETIC AND ENVIRONMENTAL FACTORS
percentages of essential HTN in white and black adults and the onset of age
10-15% white adults
20-30% black adults
onset between ages 25-55
risk factors associated with development of essential HTN
obesity, sleep apnea, excess alcohol, cigarette smoking, NSAIDS
sx of essential HTN
asymptomatic
PE findings
BP: elevation bilaterally
retinal changes: microaneurysms and exudates
Heart: hypertrophy to LV
Pulses: equal strength and time
what is a major cause of morbidity and mortality in essential HTN
cardio complications
HTN complication–heart
MI, Angina, HF, LV hypertrophy, ventricular arrhythmias
does LVH regress with tx
yes; related to the degree of systolic pressure reduction
HTN complication–brain
hemorrhagic and ischemic stroke
what mental disease is HTN associated with
dementia of both vascular and Alzheimer types
HTN complication–kidney
nephrosclerosis particularly in AA pts
Labs tests
CBC with diff- RBC–Hgb/hematocrit
Urinalysis- microalbuminuria
BUN and Creatinine
Fasting Blood Glucose
Plasma Lipid- HDL, LDL, total
Electrolytes- Na+, K+
Diagnostic tests
EKG- LVH–primary finding with sustained HTN
Echo- evaluate for cardiac disfunction and visualize septum size
HTN targets (<60 >60, chronic kidney or diabetes any age)
<60- 140/90mmHg
>60- 150/90mmHg
chronic kidney/diabetes- 140/90mHg
when dx HTN
two or more properly measured seated blood pressure readings, taken on two or more office visits
verified in contralateral arm
white coat syndrome
phenomenon where pt exhibits HTN in clinical setting but not at home d/t anxiety during clinic visit
lifestyle modification
weight loss
DASH diet (fruits, veggies, low dairy/fats)
decrease salt intake
increase physical activity
alcohol moderation
pharmacological medications
diuretics, beta blockers, ACE inhibitors
diuretics
decrease plasma volume by increasing voiding
adverse effect of voiding electrolytes
lasix, hydrochlorothiazide
beta blocker
decrease HR and cardiac output
metoprolol, atenolol, lopressor
ACE inhibitors
inhibition of renin-angiotensin-aldosterone system
lotensin, accupril, ramipril
ultimate public health goal of antihypertensive tx
reduction of cardiovascular and renal morbidity and mortality
achieving BP goal may require
use of two or more hypertensive medication; second drug should be of a different class
African Americans with HTN compared to whites/Hispanics
get HTN earlier in life
more sever HTN
more likely to be aware that they have HTN and should get tx
less likely than whites to achieve target control levels
higher rates of early death from HTN related problems
gender prevalence of HTN
equal
