Hypertension Flashcards
What are we really measuring when we taking someone’s BP?
Force of the blood on the arterial wall and vice versa
Why does BP go up when we are in pain?
Increased O2 demand
What’s happening to our bodies when our BP is too high?
Stroke is most common or MI
How do we define HTN?
- Systolic BP over 140
- Diastolic BP over 90
Pre-HTN
120-139 and/or 80-89
Stage 1 HTN
140-159 and/or 90-99
Stage 2 HTN
over 160 and/or over 100
HTN aka …
The Silent Killer
WHO identifies HTN as…
being responsible for 62% of cerebrovascular dz and 49% of ischemic heart disease
CDC estimates…
that appox. 1 in 4 adults are hypertensive. Many do not realize
What is BP?
Force exerted against the walls of the arteries and veins by the blood as its being pumped from the heart
-Remember your physics: also the pressure exerted by the walls of the arteries and veins against the blood
Systolic pressure
highest amount of pressure exerted on the arterial wall at the peak of ventricular contraction
Diastolic pressure
lowest pressure exerted during ventricular relaxation
MAP
Mean Arterial Pressure
-avg amount of pressure exerted throughout cardiac cycle
MAP is measured..
as the cardiac output, multiplied by the peripheral vascular resistance
COxPVR=MAP
Pulse Pressure
SBP-DBP=PP
Why is MAP important?
- gives us a picture of the entire cardiac cycle
- monitors the perfusion of organs
- MAP 70-110 is normal, over 60 is enough to perfuse all organs, less is potentially bad
Sympathetic Nervous System BP control
baroreceptors in the carotid arteries can activate SNS
Vascular endothelium
produces several vasoactive substances
Renal System BP control
- controls extracellular fluid
- renin, angiotensin, aldosterone
- prostaglandins - vasodilators
Primary HTN
elevated BP without a single identified cause
Secondary HTN
elevated BP with specific cause which can be identified and corrected
Preclampsia
elevated BP during pregnancy, usually after 20 weeks
-possible organ damage esp kidneys. Very dangerous.
Contributing factors of Primary HTN
- Elevated SNS activity
- Elevated sodium retaining/vasoconstricting hormones
- Increased body weight
- Diabetes
- Tobacco/alcohol consumption
Risk factors for HTN
- Age
- Body weight
- Diet
- Exercise
- Genetics
- Sex
- Ethnicity
- Alcohol/Tobacco
- Stress
Manifestations of HTN
- Early on, asymtomatic, only high BP
- HA
- Nocturia
- Mental status changes later on
- N/V
- Visual changes, papilledema (swelling of optic nerve)
altered kidney function
leads to excess fluid volume and retention
CHF and HTN
Increased workload, ventricles stretch, hypertrophy, muscle thickens, fluid backs up, increased BP even more
Diabetes and HTN
Increased blood visocity, increased fluid volume
Secondary HTN
- coarctation or congential narrowing of aorta
- S/E of drugs or hormones
- Traumatic brain injury, tumors
- Glomerulonephritis, kidney dz
- cirrhosis
HTN Crisis/ Emergency
- develops over several hours, days, or even weeks
- situation when BP rises to severe levels
- rate of rise is more important than the end value however pts with chronic HTN typically tolerate higher BPS normally
HTN Crisis Manifestations
- Encephalopathy
- Renal insufficiency
- Angina, MI, chest pain, SOB
Encephalopathy
increased cerebral capillary permeability
- HA
- N/V
- seizures, confusion, edema
HTN Crisis Tx
- Aimed at lowering BP immediately
- nitroprusside sodium
- labetalol
Nitroprusside sodium
vasodilator given IV in HTN crisis, must be closely monitored and tightly titrated
Labetalol
mixed alpha and beta adrenergic blocker given IV
Prevention/Tx of HTN Crisis
- Modify diet
- Increase activity, exercise, decrease weight
- stress reduction
- dash diet
- drugs
- will depend on individual and the cause of their HTN
DASH Diet
- Dietary approaches to Stop HTN
- Lots of fruits, veges, whole grains, low fat dairy, fish, poultry, nuts
- very few sugary foods, sugary beverages, red meats, added fats
Beta Adrenergic Receptor Blockers
- Atenolol
- Metoprolol
Make the heart beat slower and with less force
Angiotensin Coverting Enzyme Inhibitors
- Enalapril
- Lisinopril
Stops veins from vasocontricting
Diuretics
- Furosemide
- Hydrochlorothiazide
Makes you pee
K+ sparing, Spironolactone
Your patient has been prescribed Toprol XL (Metoprolol) for the treatment of Hypertension. Which change do you expect to occur in your patient as a result of this new prescription?
Decrease in HR
HTN often goes undetected until symptoms of major organ system failure begin to appear. Which of the following would be the most likely to occur in the patient with HTN?
Cerebrovascularaccident
Your patient has been prescribed a vasodilator (Hydralazine) for the treatment of HTN. Which side effect do you want to monitor your patient for?
Tachycardia
Whats happening to our bodies when our BP is too high?
Blood vessels are under stress and loses elasticity
