Hypertension Flashcards
what is systemic blood pressure a product of?
cardiac output (CO) and systemic vascular resistance (SVR), and its regulated by the SNS and RAAS
Angiotensin II
a vasoconstrictor in the RAAS system that causes aldosterone to be released which helps with sodium retention
define systemic hypertension
persistent elevation of systemic blood pressure where the systolic is >160 mm HG
what is the most common cause of systemic hypertension in cats and dogs?
Secondary conditions that increase CO or SVR are the cause of >80% of cases
what blood pressure method is the most practical, what is the gold standard?
Indirect (doppler or oscillometric ) is the most practical while direct is the gold standard
Blood pressure cuffs width should be __% of the circumference. If the cuff is too bug then it falsely __ BP and if the cuff is too small then it falsely __ BP
Blood pressure cuffs width should be 30-40% of the circumference. If the cuff is too big then it falsely lowers BP and if the cuff is too small then it falsely heigthens BP
T/F: anxiety induced situational hypertension can be marked
T
how many blood pressure measurements should you take?
5-7 consecutive measurements
what are possible ares of target organ damage from systemic hypertension?
eyes: retinopathy/choroidopathy
kidneys: CKD
brain: encephalopathy stroke
heart and vasculature: left ventricular hypertrophy, left sided congestive heart failure, aortic aneurysm
normotensive
minimal TOD risk, SBP <140 mm Hg
prehypertensive
low TOD risk, SBP 140-159 mm Hg
hypertensive
moderate TOD risk, SBP 160-179 mm Hg
severely hypertensive
high TOD risk, SBP >180 mm Hg
secondary causes of hypertension in cats
CKD, hyperthyroidism, adrenal disorders, medications
secondary causes of hypertension in dogs
kidney disease, hyperadrenocorticism, diabetes mellitus, pheochromocytoma, hyperaldosteronism
when should you without a doubt treat hypertension?
- severe hypertension
- evidence of TOD with moderate to severe hypertension
- persistent blood pressure > 160 mmHg with disease associated with hypertension
T/F: BP values above 180 mm Hg are likely from the white coat effect
F, they are less likely to be due to the white coat effect
a dog comes in with prehypertension with no clinical signs, should you treat it?
no, monitor BO during future visits
amlodipine
a calcium channel blocker that is the first line of treatment in cats and dogs with severe hypertension. It typically reduced blood pressure by 30-50 mm Hg
ACE Inhibitors
These inhibit ACE which results in decreased production of angiotensin II and vasodilates the efferent arteriole of glomerulus (decreases GFR) and reduces proteinuria. It provides minimal control of hypertension in cats (10 mm Hg reduction) in cats but is often the first line of treatment in dogs except with severe hypertension
This includes benazepril and enalapril
Angiotensin II Receptor Blockers
These drugs inhibit RAAS by blocking action of angiotensin II and is used for moderate hypertension in cats and dogs. Its an alternative treatment to ACE inhibitors and reduces proteinuria.
Telmisartan is the drug name
when should emergency drugs be used for hypertension?
rarely needed, only used with severe life threatening hypertension
Alpha Adrenergic Antagonists
Typically used for pheochromocytomas
phenoxybenzamine and prazosin
spirnolactone
Diuretic that acts as an aldosterone antagonist reducing sodium and water reabsorption
treatment goals for hypertension
- gradual decrease in BP
- Reach systolic BP between 110-140 mm Hg with a minimal goal to <160 mm Hg
- Systolic BP <120mm Hg with clinical findings of weakness, syncope, or tachycardia is suggestive of hypotension then decrease the dose
when should you recheck BP if TOD is present vs if not present?
If present then recheck BP in 3 days and if not present every 7-10 days. Once its stable check it every 3 months
