Hypertension Flashcards
Normal BP
<120 systolic and <80 diastolic
Elevated BP
120-129 systolic and <80 diastolic
Stage 1 Hypertension
130-139 systolic or 80-89 diastolic
Stage 2 Hypertension
≥140 systolic or ≥90 diastolic
Hypertensive Crisis
> 180 systolic or >120 diastolic
Primary Hypertension
- 90-95% of htn diagnoses in adults
- lifestyle, environmental, genetic factors
Secondary Hypertension
- 5-10% of all htn diagnoses in adults
- identifiable underlying cause (kidney disease, endocrine disorders, drug or alcohol use)
Why is hypertension considered a silent killer?
- typically no symptoms
- prolonged high bp causes damage to the blood vessels
What does inflammation in the endothelium lead to?
- atherosclerotic disease which contributes to MI, CVA and chronic kidney disease
Gerontologic Considerations
hypertension
- ⬇️ 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
Gerontologic Considerations cont
hypertension
- be aware of finances, drug interactions, inability to remember treatment plan
- include caregivers in plan of care
- fall prevention
- blood pressure log
Pathophysiology
hypertension
⬆️ BP = ⬆️ CO x ⬆️ PVR (peripheral vascular resistance)
Early physiologic changes that lead to hypertension
- 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
Risk factors
hypertension
- 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
diagnostic results
hypertension
- 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
non pharmacologic management of hypertension
- 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
pharmacologic management of hypertension
- 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
Hypertensive Emergency
- 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
Hypertensive Urgency
- bp is elevated but no evidence of target organ damage
- non adherence to therapy is primary cause
- fast-acting oral hypertensive is recommended
