Hypertension Flashcards
Normal blood pressure
Less than 120/80
Elevated blood pressure
120-129 / <80
Hypertension stage 1
130-139 / 80-89
Hypertension stage 2
> or equal to 140/ or equal 90
Hypertensive crisis
> 180/ >120
If someone’s systolic pressure was 125/ 82 what would be their blood pressure classification?
They would be in hypertensive crisis stage 1 because their diastolic pressure is between the 80-89 range.
Correlate clinical manifestations of primary hypertension to pathological processes.
Primary hypertension is about 90% to 95% of adults with hypertension.
The cause with primary hypertension cannot be determined although probably result from environmental, lifestyles, and genetic factors.
Correlate clinical manifestations of secondary hypertension to pathophysiological process’s.
Secondary hypertension is about 5% to 10% of all adults with hypertension.
Reason for secondary hypertension: kidney disease, thyroid disease, adrenal disease
Hypertension is a silent killer because people who have it are often symptom free.
True or False
TRUE!
With prolonged high blood pressure, it damages the blood vessels (endothelium).
Inflammation in the endothelium causes atherosclerosis disease (dyslipidemia) which contributes to Myocardial Infarction, cerebrovascular accident and chronic kidney disease.
One of the functions of the kidney is to regulate blood pressure by sending impulses to the RAAS.
True/ False
TRUE!
Activation of the RAAS increases blood pressure
Aging with hypertension
1) Damage of the endothelium results in atherosclerosis
This makes it easier for fat deposits of cholesterol to stick in the endothelium, creating coronary artery disease and cerebrovascular disease.
This also increases the risk for aortic aneurysms.
Aging with hypertension
2) Increased systolic blood pressure will also cause changes in the heart structure itself.
This can cause left ventricular hypertrophy because the heart has a harder, increased workload.
(It’s harder for the heart to pump the blood because of the stiffening (loss of elasticity) of the artery)
Aging with hypertension
3) With hypertrophy there’s enlargement of the muscle, but a narrowing of the space that occupies the blood.
This results in a diastolic dysfunction and makes it harder for the heart to pump blood that is now systolic dysfunction and eventually leads to heart failure.
Aging with hypertension
4) Decreased cardiac output minimizes the kidneys 25% of cardiac output.
Renal insufficiency occurs because the nephrons aren’t getting enough oxygen from the heart, less blood coming from the heart therefore the RAAS will be activated.
Discuss the management of hypertension amongst older adults.
Elevated systolic blood pressure in isolation among older adults.
- Decreased elasticity and the accumulation of atherosclerotic plaque in the major blood vessels.
- Volume expansion associated with structural and functional changes in the kidney.
- Changes in the strength of cardiac contraction (left ventricular systolic dysfunction).
Consider target blood pressure control to less than 130/80 in all adults including older adults with hypertension.
- Start low and go slow when starting antihypertensive medication among older adults
- As you grow older there will be an increase in systolic and diastolic blood pressure.
- Carefully monitor for orthostatic hypotension, falls, and reduced renal function.
- A less aggressive blood pressure target for older adults with multiple comorbidities, limited life expectancy, frequent falls and cognitive impairment; those who are 60 years or older with HX of stroke/ TIA, a target of systolic blood pressure of 140 is recommended to reduce the risk of recurrent stroke.
What’s the usual blood pressure range for older adults?
Less than 130/80
Risk factors of hypertension:
- Advancing adult age
- African American
- Chronic kidney disease-
- Diabetes
- Alcohol (more than 2 drink a day for men and more than 1 drink a day for women)
- Family history
- Gender: men have a greater risk until 64 yr of age. Women have a greater risk at age 65 and older.
- Hyperholesterolemia
- Overweight/obesity
- Poor diet habits, particularly if it includes or much salt, as well as limited intake of vegetables, fiber, fish fats, and potassium.
- Sedentary lifestyle
- Use of tobacco, nicotine products, and exposure to second hand smoke.
- Stress
- Sleep apnea
Common causes of secondary hypertension:
- Chronic kidney disease
- Cushing syndrome
- Hyperaldosteronism
- Hypo - Hyperthyroidism
- Medical abuse (NSAIDs, alcohol, cocaine, amphetamines)
- Obstructive sleep apnea
- Pheochromocytoma
- Preeclampsia
- Renal artery stenosis
- Polycystic kidney disease
Low blood pressure/ orthostatic hypotension maybe related to impaired cardiovascular reflexes secondary to diuretics and other medication interactions.
True/ False
TRUE!
With impaired CV reflexes it’s harder for older adults to compensate right away when there’s a drop in blood pressure
Gerontological considerations
- Be aware of finances, poly pharmacy, and inability to remember treatment plan.
- Make sure older adults understand, see, and read medication instructions as well as being able to open their medication containers and get Rx refills. (Caregivers should be included in the plan of care to encourage older adults adherence to treatment plan).
- Ensure regular follow up visits are followed (remind them to bring BP log and machine)
- Ask about potential medication-related problems such as orthostatic hypotension (dizziness/lightheadedness)
- Counsel how to be safe and prevent falls.
Increased cardiac output =
Increased blood pressure
- Increase in BP is related to increased cardiac output and constriction of the blood vessels.
- Increased cardiac output is associated with volume expansion.
Clinical manifestations of hypertension
When specific signs and symptoms appear, they usually indicate vascular damage, with specific manifestations related to the organs served by the involved vessels. These specific manifestations of pathophysiologic changes in various organs as a consequence of hypertension are referred to as target organ damage.
Retinal changes such as hemorrhages, exudates (fluid accumulation), arteriolar narrowing, and cotton-wool spots (small infarctions) may occur. In severe hypertension, papilledema (swelling of the optic disc) may be seen.
Coronary artery disease with angina and myocardial infarction (MI) are common consequences of hypertension. LVH occurs in response to the increased workload placed on the ventricle as it contracts against higher systemic pressure. When heart damage is extensive, heart failure follows.
Pathologic changes in the kidneys (indicated by increased blood urea nitrogen [BUN] and serum creatinine levels) may manifest as nocturia. Cerebrovascular involvement may lead to a transient ischemic attack (TIA) or stroke, manifested by alterations in vision or speech, dizziness, weakness, a sudden fall, or transient or permanent hemiplegia (paralysis on one side). Cerebral infarctions account for most of the strokes in patients with hypertension
Describe the lifestyle modifications for hypertension
These lifestyle changes could include weight loss, dietary changes, physical activity modifications, decreased alcohol consumption, and smoking cessation. In particular, the Dietary Approach to Stop Hypertension (DASH) diet has been one of the most effective diets in lowering BP; if used in conjunction with weight loss, this diet can lower SBP by 11 to 16 mm Hg.
In addition to this dietary advice, patients should be counseled to incorporate a low sodium (less than 2 g/day), high potassium (3500 to 5000 mg/day) diet; this dietary combination is more effective than following either a lone low sodium or high potassium diet.
A high potassium diet must be avoided in patients with chronic kidney disease
Physical activity for lifestyle mods in hypertension:
Engage in:
Regular aerobic activity such as brisk walking 90-150 min weekly.
Regular dynamic resistance training 90-150 min weekly.
Regular isometric resistance training at least three times weekly.
Describe the medication therapy for hypertension
The first line antihypertensives to prevent CV disease are Thiazide or thiazide-like diuretics, ACE inhibitors, ARBs, and calcium channel blockers.
What meds do we give to African Americans without heart failure or chronic kidney disease?
Thiazide-like diuretics or calcium channel blocker as a first line hypertensive med.
NOT ACEs or ARBs because they have a low renin profile
Gentorologic considerations of hypertensive medications
Thiazide/loop diuretics- have a high risk for orthostatic hypotension
ACE inhibitors- require reduced dosages and the addition of a loop diuretic when there is a renal dysfunction.
Hypertensive urgency =
No evidence of target organ damage
Meaning no signs or symptoms
Ex: no chest pain, no headache, no double vision, no TIA, no kidney issues
We give a fast acting antihypertensive agent orally
Hypertensive emergency =
Life-threatening blood pressure that requires immediate treatment to prevent target organ damage.
There is target organ damage.
Ex: Myocardial infarction, intracranial hemorrhage
Meds are given through IV
In a hypertensive emergency why do we taper the blood pressure down slowly instead of brining it back to a normal BP immediately?
Use of intravenous vasodilators to gradually decrease SBP by no more than 25% within the 1st hour; 160/100mmHg within 2 to 6 hours; normal/controlled BP within 24-48 hours.
Because the body was used to the level of perfusion it was receiving with the high blood pressure. We don’t wan to drop it immediately to prevent injury and decreased tissue perfusion.
What should hypertensive clients limit their daily sodium intake to?
No more than 2000 mg daily
What are the lab values in kidney damage?
Creatinine in the blood = high
Creatinine in the urine = low
Protein in the blood = low
Protein in the urine = high
Indication of protein in the urine means kidney damage
Assessment & diagnostic findings of hypertension
- The first step of diagnosing HTN is an accurate blood pressure measurement.
It’s important to use an average of at least two blood pressure readings on at least two occasions to confirm the diagnosis
The exception is when a patients average BP is greater than or equal to 160/100mmHg, confirmed by at least two accurate readings
Estrogen is thought to be a protective agent against cardiovascular disease in women
True/False
TRUE!
Women have a greater risk at 65 yrs or older for CV disease due to menopause.
Pathophysiology of hypertension
1) Increased sympathetic nervous system activity (increase in epinephrine = increase in blood)
- Peripheral vascular disease
2) Increased renal reabsorption of sodium, chloride and water
- Cardiac output
3) Increased activity of the RAAS
- Peripheral vascular disease and cardiac output
4) Decreased vasodilation of the arterioles ( nitric oxide- natural substance in endothelium that vasodilators the blood vessels)
- Peripheral vascular disease
5) Resistance in insulin action (insulin resistance for diabetic patients with increased BP)
- Inflammatory
6) Activation of the innate and adaptive components of the immune response (constant stress/constant inflammation = increase in BP)
- Inflammatary
Hypertension is a result of a complex interaction between behavioral-social-environmental risks and genetics.
True/False
TRUE!
