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Clinical Exercise Prescription > Hypertension > Flashcards

Hypertension Flashcards

1
Q

defintion

A

SBP>140mmHg

DBP>90mmHg

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2
Q

primary hypertension

A

unkown cause

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3
Q

secondary hypertension

A

phenochromocytome - tumour on adrenal gland

renal artery stenosis

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4
Q

Blood pressure

A

the pressure exerted on teh arterial walls during systole and diastole
rate presure product - HRxSV

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5
Q

measuring arterial BP

A

place cuff on arm
will not be able to hear anthing
increase cuff pressure to 160
slowly release pressure, note when you can start hearing tapping sound
continue decreasing pressure until tapping sound cant no longer be heard

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6
Q

effect on the population

A

all cause death - 9.4mil/year

no 1 physiloigical cause of global mortaility

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7
Q

prevalance

A

874 million adults worldwide are hypertensive

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8
Q

pre-hypertension

A

120-140mmHg
prevent hypertension occuring
as you get about 120, the risk increases quickly as a sliding scale

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9
Q

risk of a heart attack depending on BP

A

if you are hypertensive you are 7.4x more likely to have a MI

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10
Q

risk factors - unmodifiable

A

family history
age
sex
ethnicity

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11
Q

risk factors - modifiable

A 
PA
diet 
weight 
smoking 
sleep 
alcohol 
stress
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12
Q

repsonse to high BP

A

increase in VR, increase stretch on right atria through baroreceptors
bainbridge reflex - increase VR = increase HR
increase ANP release by atria
increase BNP
act on kidenys
increase Na+ excretion - increase water excretion
increase GFR
act on hypothalumus to decrease thrist
increase vasodilation via increase smooth muscle cGMP
decrease sympathetic tone

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13
Q

responce to low BP

A

decrease VR - no firing of baroreceptors
decrease ANP & BNP
afferent and efferent arteroile in JGA detect decrease
release renin
- convert angiotensinogen to angiotension I
- angiotension I to angiotension II via ACE
- increase vasoconstriction
- increases sypathetic activity
- decrease Na+ excretion via aldosterone from adrenal gland
- increase ADH (pituartry gland) - increase collecting duct absorption
increase thirst

= increase water absorption + increased BP

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14
Q

pharamalogical interventions

A

reduce BP
- ACE inhibitors
beta blockers - slow HR
diurectics

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15
Q

BP equation

A

QxTR=BP

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16
Q

what is heart rate variability

A

measure the difference between sympathetic and parasympathetic
you want high HR variability

17
Q

nervous system response to increase BP

A

increases PNS, decrease SNS
SA node to reduce HR
relax ateriole smooth muscle to casue vasodilation, reducing TPR
ventrcular myocardium to decrease force of contraction to decrease Q

18
Q

vascular resistance and aterial stiffnes with BP

A

arteries expand during systole
relax during diastole
when arteries bceom stiff, no longer able to move - makes heart work harder as no longer natural pushing of blood
creates turbulant flow - increases fatty streaks

19
Q

how does central aortic stiffness lead to reduced end diastolic volume

A 
increased LV afterload
mycocardal hypertrophy
impaired relaxation 
diastolic dysfunction
reduced EDV
20
Q

how does central aortic stiffness lead to damaged arteries

A

arteriole endothelial dysfunction
increased SBP
microvascular damage

21
Q

Why is hypertension a strong risk factor for mortality/morbidity?
Heart

A 
Heart 
– Diastolic dysfunction 
– MI and aneurysm 
– Ventricular hypertrophy 
– Heart failure 
– Atrial fibrillation 
– Ventricular fibrillation 
– Increased risk of ischaemia
22
Q

Why is hypertension a strong risk factor for mortality/morbidity?
other organs

A

brain
kidney
eyes

23
Q

effect of PA

A

reduce SBP by 5-7mmHg
reduced CVD risk by 20-30%
matches effect of pharamlogical interventions

24
Q

why does PA reduce BP

A
  • “Resetting” of the baroreceptors (change in BRS)
  • Cardiac remodelling
  • Fall in TPR
25
Q

effect of PA on vascular health

A
  • Increased endothelial function
  • Decreased arterial stiffness
  • Increase in arterial diameter
  • Increase in vascular growth (angiogenesis)
  • Improved perfusion (myocardial)
26
Q

PA consideration for hypertensive patients

A
  • Those with stage II hypertension (160/100 mmHg) should add moderate aerobic exercise only after initiating drug therapy
  • Termination criteria for any exercise = 250/115 mmHg
  • Some antihypertensives may impair thermoregulation, so be cautious of signs of heat intolerance
  • Consider co-morbidities (e.g. retinopathy/vision)

Clinical Exercise Prescription (12 decks)

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