Hypertension

Question 1

Normal BP

Answer 1

<120 systolic and <80 diastolic

Question 2

Elevated BP

Answer 2

120-129 systolic and <80 diastolic

Question 3

Stage 1 Hypertension

Answer 3

130-139 systolic or 80-89 diastolic

Question 4

Stage 2 Hypertension

Answer 4

≥140 systolic or ≥90 diastolic

Question 5

Hypertensive Crisis

Answer 5

> 180 systolic or >120 diastolic

Question 6

Primary Hypertension

Answer 6

• 90-95% of htn diagnoses in adults
• lifestyle, environmental, genetic factors

Question 7

Secondary Hypertension

Answer 7

• 5-10% of all htn diagnoses in adults
• identifiable underlying cause (kidney disease, endocrine disorders, drug or alcohol use)

Question 8

Why is hypertension considered a silent killer?

Answer 8

• typically no symptoms
• prolonged high bp causes damage to the blood vessels

Question 9

What does inflammation in the endothelium lead to?

Answer 9

• atherosclerotic disease which contributes to MI, CVA and chronic kidney disease

Question 10

Gerontologic Considerations

hypertension

Answer 10

• ⬇️ elasticity and the accumulation of atherosclerotic plaques in major blood vessels
• volume expansion associated with changes in the kidneys
• changes in strength of cardiac contraction
• target bp <130/80
• monitor carefully for orthostatic hypotension

Question 11

Gerontologic Considerations cont

hypertension

Answer 11

• be aware of finances, drug interactions, inability to remember treatment plan
• include caregivers in plan of care
• fall prevention
• blood pressure log

Question 12

Pathophysiology

hypertension

Answer 12

⬆️ BP = ⬆️ CO x ⬆️ PVR (peripheral vascular resistance)

Question 13

Early physiologic changes that lead to hypertension

Answer 13

• increased sympathetic nervous system activity
• increased renal reabsorption of sodium, chloride, and water
• increased activity of the RAAS system
• decreased vasodilation
• resistance in insulin action
• activation of the innate and adaptive components of the immune response

Question 14

Risk factors

hypertension

Answer 14

• stress
• kidney disease
• diabetes
• low potassium diet or high salt diet
• sleep apnea
• alcohol misuse and smoking
• obesity
• sedentary lifestyle
• family history, african american descent

Question 15

diagnostic results

hypertension

Answer 15

• two accurate bp readings on two different occasions
• home blood pressure measurement is considered more accurate
• health assessment: palpation of pulses, carotid bruits, distended veins or enlarged thyroid, listen for S4 heart sound, include eye examination

Question 16

non pharmacologic management of hypertension

Answer 16

• dietary plan (DASH diet)
• 4-5 daily servings of fruits + veggies, 7-8 daily servings of grains
• limit sodium to no more than 2000mg/day (1tsp)
• high potassium of 3500-5000mg/day
• 150 minutes of moderate intensity aerobic activity/week AND 3x/week muscle strengthening activity (isotonic/isometric)
• alcohol consumption in moderation

Question 17

pharmacologic management of hypertension

Answer 17

• first line: thiazide diuretics, ACEIs, ARBs, CCBs
• african american: without HF or kidney disease should only use diuretic or CCB, not ACE or ARB
• gerontologic considerations: thiazide/loop diuretics carry risk for ortho hypotension; ACE inhibitors require reduced dosages and addition of loop diuretics when there is renal dysfunction

Question 18

Hypertensive Emergency

Answer 18

• life-threatening bp that requires immediate treatment to prevent target organ damage (MI, intracranial hemorrhage)
• use of IV vasodilators to gradually decrease SBP by no more than 25% within the 1st hour; 160/100mmHg in 2-6hrs and normal bp within 24-48hrs

Question 19

Hypertensive Urgency

Answer 19

• bp is elevated but no evidence of target organ damage
• non adherence to therapy is primary cause
• fast-acting oral hypertensive is recommended