hypertension

Question 1

blood pressure

Answer 1

• force of blood against arteries & the force of arteries against blood
• -“the force exerted against the walls of the arteries and veins by the blood as it’s being pumped from the heart; it’s also the pressure exerted by the walls of the arteries and veins against the blood”

Question 2

hypertension

Answer 2

• a systolic BP >140mmHg or a diastolic BP >90 mmHg of the average of at least 3 different readings
• 120-139 and/or 80-89= prehypertensive
• 140-159 and/or 90-99 = stage 1 hypertension
• > 160 and/or >100= stage 2 hypertension

Question 3

hypertension stats

Answer 3

• called “silent killer”
• the WHO identifies it as being responsible for 62%of cerebrovascular incidents and 49% of ischemic heart disease
• CDC estimates that approximately 1 in 4 adults are hypertensive. many do not realize

Question 4

BP cont

Answer 4

• systolic pressure is the highest amount of pressure exerted on the arterial wall at the peak of ventricular contraction
• diastolic pressure is the lowest pressure exerted during ventricular relaxation

Question 5

Mean Arterial Pressure

Answer 5

-average amount of pressure exerted throughout cardiac cycle
-measured as CO multiplied by the vascular resistance
MAP=COxPVR
MAP= [SBP + 2DBP] / 3

Question 6

Why is MAP important?

Answer 6

-gives us a picture of the cardiac cycle
-monitors perfusion of organs
-MAP 70-110 is normal
> 60 is enough to perfuse all organs
-less than 60 or greater than 110 could lead to multiple organ death

Question 7

how is BP controlled/ maintained?

Answer 7

• Sympathetic nervous system: baroreceptors in the carotid arteries can activate SNS
• Vascular Endothelium: produces several vasoactive substances
• Renal System: controls extracellular fluids; renin, angiotensin, aldosterone system; prostaglandins= vasodilators

Question 8

primary HTN

Answer 8

-elevated BP without a single identified cause
no one direct cause
contributing factors:
-elevated SNS activity (like chronic pain)
-increased body weight
-diabetes
-tobacco/alcohol consumption
-elevated sodium retaining/ vasoconstricting hormones

Question 9

secondary HTN

Answer 9

• elevated BP with specific cause which can be identified and corrected
• congenital heart defects; etc

Question 10

preeclampsia

Answer 10

elevated BP during pregnancy, usually after 20 weeks. possible organ damage especially kidneys. very dangerous

Question 11

risk factors

Answer 11

• age
• body weight
• diet
• exercise
• genetics
• sex
• ethnicity/socioeconomic status
• alcohol/tobacco
• stress

Question 12

manifestations

Answer 12

• early on; only high BP
• headache
• nocturia
• mental status changes later on
• nausea, vomiting
• visual changes, papilledema (swelling of optic nerve)

Question 13

secondary

Answer 13

• coarctation or congenital narrowing of aorta
• side effects of drugs or hormones (corticosteriods, estrogen, etc)
• traumatic brain injury, tumors
• glomerulonephritis, kidney disease
• cirrhosis

Question 14

hypertensive crisis/ emergency

Answer 14

• develops over several hours, days, or even weeks
• situation when BP rises to severe levels (180/120 in book, could be higher)
• the rate of rise is more important then the end value however (pts. with chronic HTN can usually tolerate higher BPS normally)
• typically in pts with Hx of HTN who do not adhere to medical regimen or whose BP is undermediated
• can aslo result from drug use (cocaine, LSD)

Question 15

HTN crisis manifestations

Answer 15

• encephalopathy (increased cerebral capillary permeability) -headace, N/V, seizure, coma, confusion
• renal insufficiency
• angina, MI, chest pain, SOB

Question 16

HTN crisis treatment

Answer 16

• aimed at lowering BP immediately
• nitroprusside sodium: vasodilator given IV in HTN crisis, must be closely monitored and tightly titrated
• labetalol-mixed alpha ad beta adrenergic blocker given IV

Question 17

prevention/treatment

Answer 17

• modify diet
• increase activity/exercise, decrease weight
• stress reduction
• diet-DASH diet
• drugs:vasodilators, diuretics, ACE inhibitors, alpha & beta adrenergic blockers, calcium channel blockers
• will depend on individual and the cause(s) of their HTN

Question 18

DASH diet

Answer 18

• Dietary Approaches to Stop Hypertension
• lots of fruit, veggies, wholes grains, low fat dairy, fish, poultry, nuts
• very few sugary foods, sugary drinks, red meats, added fats

Question 19

beat adrenergic receptor blockers

Answer 19

• HTN med
• atenolol, metoprolol
• make the heart beat slower and with less force

Question 20

angiotensin converting enzyme inhibitors

Answer 20

• HTN med
• enalapril, lisinopril
• pril
• stops veins from vasoconstricting

Question 21

diuretics

Answer 21

• HTN med
• furosemide, hydrochlorothiazide
• makes you pee, lose fluids
• potassium sparing- spironolactone

Question 22

Your patient has been prescribed metoprolol for the treatment of HTN. Which changes do you expect to occur in your pt as a result?
A) decreased HR
B) increased urine output
C) decreased blood glucose levels
D) decreased serum sodium levels

Answer 22

A) decreased HR

Question 23

HTN often goes undetected until symptoms of major organ failure begin to appear. Which of the following would be the most likely to occur in the pt with HTN?
A) cerebrovascular incident
B) MI
C) liver failure
D) pulmonary edema

Answer 23

A) cerebrovascular incident

Question 24

Your pt has been prescribed a vasodilator for the treatment of HTN. which side effect do you want to monitor your pt for? 
A) tachycardia
B) elevate temp
C) confusion & irritability
D) decreased deep tendon reflexes

Answer 24

A) tachycardia