Hypertension Flashcards
What is hypertension
- high blood pressure
define systolic BP, and Diastolic BP
- SBP: arterial pressure when the heart is contracting
- DBP: arterial pressure when the heart is relaxing
Which artery used to take BP
- brachial artery
Why is a high bp dangerous
- a high BP is a serious pb for the blood vessels
- in can cause wear and tear on the endothelial cells -> causing damage to the endothelial cells (like tiny cracks) -> which can cause: myocardial infarction, aneurysm, stroke
State the different stages of HTN
- normal: 120mmHg / <80mmHg
- elevated: 120-129mmHg / <80mmHg
- Stage 1: 130-139 mmHg / 80-89mmHg
- Stage 2: >140 mmHg / DBP > 90 mmHg
Is it possible to only have SBP or DBP elevated ?
- yes, called Isolated systolic HTN, or isolated diastolic HTN
State the different types of hypertension
- Essential hypertension (primary hypertension)
- Secondary hypertension
- Malignant hypertension
- hypertensive crisis: hypertensive urgency, hypertensive emergency
Essential hypertension: C
- 90% of hypertensions
- no clear causes
- overtime, pressure in the arteries increases
Essential hypertension: RF
- old age
- obesity
- salt heavy diet
- sedentary lifestyle
All can be improved with lifestyle changes
Secondary hypertension
- has an underlying cause
Secondary hypertension: C: low renal blood flow
- Low renal blood flow (ex: atherosclerosis, vasculitis, aortic dissection)
- > kidney senses a low RBF -> stimulates the renin secretion -> causes water retention -> increases fluid volume -> causes HTN
- other renal causes: DM nephropathy, glomerulonephritis, renovascular disease, pyelonephritis
Secondary hypertension: C: primary hyperaldosteronism (aldosteronoma)
- too much aldosterone -> increases Na+ and water reuptake -> causes HTN
- Conn’s, Cushing, pheochromocytoma, acromegaly, hyperthyroidism
Secondary hypertension: other causes
- pregnancy HTN (pre-eclamplsia)
- obesity
- licorice intake
- drugs
Symptoms of primary, secondary HTN and HTN emergency
- Primary: usually none, referred to as silent killer
- Secondary: has a variety of symptoms associated with the underlying cause
- HTN emergency: confusion, drowsiness, chest pain, breathlessness
Hypertensive crisis, definition
- if the BP gets really high, really fast
- SBP > 180mmhg, DBP > 120 mmHg
Hypertensive crisis: subdivision
- hypertensive urgency: no damage to the end organs (brain, heart, kidneys, lungs)
- hypertensive emergency: damage to the end organs -> presence of new retinal hemorrhages, exudates, or papilledema (optic disc swelling caused by increased intracranial pressure, swelling is bilateral), cerebral infarction, pulmonary edema, CHF, hypertensive encephalopathy
- Malignant hypertension is a type of hypertensive emergency, requires immediate treatment
HTN: RF
- Age: M>55, W>65
- smoke
- dyslipidemia
- high glucose
- obesity
- peripheral artery disease
- carotid artery thickening
HTN: Diagnosis
- BP taken in both arms, twice per day, for 3 days, with an ambulatory monitor
- look for end damage organ
Treatment options:
- lifestyle changes
- drugs
Treatment: Lifesytle changes
- change in diet, exercise, stress reduction
- decrease salt intake
- limit alcohol
- aerobic exercise
- DASH diet: Dietary Approach to Stop Hypertension -> fruits, less fats, grains, fish, beans, seeds, and decrease sweets and added sugars
- stop smoking
Treatment: Drugs
- Thiazide diuretics, calcium antagonists, ACE inhibitors, Angiotensin receptor antagonist, Beta Blockers
- Monotherapy: CCB, ACEi, ARB, BB
- Combinations: ACEi + CCB + Thiazide
Treatment: for gestational HTN
“hypertensive mums love nifedipine”
- Hydralazine
- Alpha-methyldopa
- Labetalol
- Nifedipine
Considerations regarding the T
- the cardiovascular risks, Renal, DM, presence of organ damage, presence of coexisting disorders that may limit the use of certain drugs, drug interactions, costs
Considerations: Thiazides
- Thiazide, a diuretic used to treat hypertension
- effective, cheap, 1st line treatment,
- isolated HTN in elderly
- HF
Considerations: Loop diuretics
- end stage renal disease and heart failure
Considerations: Ca antagonists
- Dihydropyridine
- Verapamil
Hypertensive heart diseases, what is it
- refers to heart problems caused by high blood pressure
Hypertensive heart diseases: cause
The heart working under increased pressure causes some different heart disorders.
- systemic HTN (concentric LVH)
- Pulmonary HTN (RVH and dilation)
Hypertensive heart diseases: pathomechanism
- myocyte hypertrophy is an adaptive response and there are limitations to this adaptive capacity
- Persistent HTN -> will cause dysfunction, cardiac dilation, CHF and SCD
Hypertensive heart diseases: Conditions caused by HTN
- CHD
- IHD
- hypertrophy
- congestive HF
- hypertensive cardiomyopathy
- arrhythmia
- renal damage or cerebrovascular stroke
Hypertensive heart diseases: symptoms:
- fatigue
- irregular pulse
- feet swelling
- dyspnoea
- weight gain
- nausea
- shortness of breath
- difficulty sleeping
- bloating
- greater need to urinate
