Hypertension Flashcards
what does he have?
48 yr old Bronco football fan
30% above ideal body weight
2 beers/day (12 not 64 oz); chair to TV for exercise; fast food( not ‘sprouts and grasses’)- no more than 4 times/week
50 pk/yrs of cigarettes
Mother and Father died in their early 50’s of CVD
BP 160-170/85-95 mmHg over 3 weeks
HOW WOULD YOU TREAT HIM?
primary or essential hypertension
drugs and lifestyle modifications BOTH
prevalence of HTN in US
50-60 million people
life time risk of developing HTN
people normotensive at 55 have 90% lifetime risk for developing HTN
why is it bad if 60 million people are hypertensive
starting at 115/75, CVD (stroke, HF, MI) risk doubles with each increment of 20/10
which is more important
systolic vs. diastolic BP
> 50 y/o, SBP more important than DBP
which is more difficult to control
systolic vs diastolic BP
systolic BP
equation for MAP
MAP = CO x SVR
Guyton Hypotehsis of Essential hypertension
1) defect in …
2) incr in ..
3) incr in ..
4) autoreg incr in ..
5) incr in …
IN KIDNEY
1) Primary defect in renal Sodium Excretion
2) Increase in Plasma Volume
3) Increase in Cardiac Output, incr perfusion
4) Autoregulatory Increase in Systemic
Vascular Resistance so organs not overperfus
5) Increase in BP (and afterload-mediated normalization of CO)
cellular hypothesis of essential HTN
in VSMC
1) Na transport inhib thru Na/K ATpase
so elev cell Na
2) decr Na/Ca exchange due to high Na inside so incr cell Ca
3) incr in SVR
4) incr BP
JNC 7 BP classification normal pre HTN stage 1 stage 2
normal = 120/80
prehypertension = 120-139/80-89
Stage 1 HTN = 140-159/90-99
Stage 2 HTN = 160/100
BP 120-140, % risk of getting HTN
30-50% risk of
getting HTN within 4 yrs
a
a
a
a
a
a
BP measurement technique
1) ambulatory BP monitoring
2) self measurement
for “white coat” HTN
absence of 10-20% BP decr during sleep –> incr CVD risk
2) self measurement = info on response to therapy and adherence to therapy and eval for white coat HTN
3 objectives for eval patient with HTN
- Assess lifestyle and identify other CV risk factors or concomitant disorders that affects prognosis and guides treatment.
- Reveal identifiable causes of high BP.
- Assess the presence or absence of target organ damage and CVD.
CVD risk factors
1) HTN
2) obesity
3) dyslipidemia
4) diabetes mellitus
5) microalbuminuria or estimated GFR
causes of HTN
- sleep apnea
- Drug-induced or related causes
- Chronic kidney disease
- Primary aldosteronism
- Renovascular disease
- Chronic steroid therapy and Cushing’s syndrome
- Pheochromocytoma
- Coarctation of the aorta
- Thyroid or parathyroid disease
target organ damage
Heart
1) LVH
2) angina or prior MI
3) prior coronary revasc
4) HF
target organ damage
brain
stroke or transient ischemic attack
incr risk of dementia with TIA’s
target organ damage
kidney
CKD
periph artery disease
retinopathy
Lab tests for HTN
1) ECG
2) UA
3) blood glucose and HCT
4) serum K, creatinine or GFR, Ca
5) lipid profile with HDL, LDL, triglycerides
6) urinary albumin excretion or albumin/creatinine ratio
in stage 1 HTN (SBP 140-160) and additional CVD risk factors, a sustained 12 mmHg reduction in SBP over 10 yrs will …
prevent 1 death per 11
goal of therapy
1) treat to BP 50 y/o
