Hypertension Flashcards
True or False: Men generally have higher blood pressure in younger populations but after age 65 women generally have higher blood pressure.
True
What are common diseases attributed with hypertension?
heart failure stroke retinopathy aortic aneurysm PVD myocardial infarction coronary heart disease kidney failure
What is the leading factor for CVD mortality?
hypertension
In pts in the 25-79 age group what can every 10% increase in hypertension treatment prevent?
an additional 14,000 deaths per year
True or false: nearly 2 in every 5 patients that have a mobility limitation also have HTN
True
Roughly what percentage of home health pt population has pre-HTN or HTN measurements? How many have a known diagnosis of HTN?
75%
43%
What is the fastest system in the body that regulates blood pressure?
Baroreceptors (aortic arch and carotid sinuses)
What are the slower systems in the body that regulate blood pressure?
Renin-Angiotensin System (kidneys)
Natriuretic peptides (ANP and BNP in the heart)-acts as a counter to RAAS system
What is the role of norepinephrine for regulation of arterial blood flow?
responds to sympathetic neural activity to redistribute blood to areas of need
-released by arterioles and attaches to alpha-1 receptors and causes VASOCONSTRICTION
How do you calculate cardiac output?
heart rate x stroke volume
What is the typical range of mean arterial pressure?
85-100 mmHg in adults
What do baroreceptors respond to?
stretching of the arterial wall and forms a negative feedback loop with the vagus and glossopharyngeal nerves
Are aortic arch receptors more or less sensitive than carotid sinus receptors?
Less sensitive
carotid sinus responds to pressures ranging from 60-180 mmHg and aortic arch receptors have a higher threshold pressure
How do Baroreflexors regulate arterial pressure?
- Arterial pressure decreases
- decreased baroreceptor firing
- increases sympathetic activity in medulla
- Increases cardiac output and stroke volume
- increases arterial pressure
What stimulates release of Renin from the kidneys?
- sympathetic nerve activation
- renal artery hypotension
- decreased sodium delivery to the distal tubules of the kidney
How does Renin effect blood pressure?
- Renin released from kidney
- Renin turns angiotensinogen to angiotensin 1
- ACE turns angiotensin 1 to angiotensin 2
- angiotensin 2 causes arteriole vasoconstriction/increased sympathetic activity/ADH secretion (which retains water and increases BP)
What is essential and secondary hypertension?
Essential- accounts for 95-99% of cases and is the interaction between environmental factors and genetics
Secondary-accounts for 1-5% of cases and is the result of some biochemical or mechanical pathology, potentially reversible
What are common contributors for hypertension?
- diet
- inactivity
- obesity
- abnormalities of adrenal cortex
- sleep apnea
- kidney disease
- symp. nervous syst. activity
- congenital vascular disorders
- recreational drugs and alcohol
What is considered a normal BP?
Prehypertension BP?
Hypertension stage 1?
Hypertension stage 2?
Hypertensive Crisis?
Normal-less than 120 syst. AND less than 80 diast.
Pre-HTN=120-139 syst. OR 80-89 diast
HTN St. 1= 140-159 syst. OR 90-99 diast.
HTN st. 2= 160 or higher syst OR over 100 diast
HTN crisis= over 180 syst. OR higher than 110 diast.
True or False: Hypertensive crises represented more than 25% of all medical urgencies-emrgencies
True
How many hyptertensive crisis events are an emergency? What qualifies as an emergency?
24%
When BP is over 180/120 mmHg and pts show signs of organ damage
How many hypertensive crisis evens are only an urgency not an emergency? What qualifies as an urgency?
76%
BP over 180/110 and no signs of organ damage
What are some different types of hypertensive urgencies?
What are some hypertensive emergencies?
- headache (most common)
- epistaxis (nose bleed)
- faintness
- agitation
Chest pain (most common) Dyspnea Neurological deficit
What is common organ damage with HTN?
acute pulmonary edema acute left ventricular dysfunction acute coronary syndrome cerebral infarction hypertensive encephalopathy
Severe HTN may also cause acute injury to the kidneys (acute hypertensive nephrosclerosis)
-the kidney can demonstrate focal small hemorrhages (hematuria)
What is a normal Pulse Pressure?
What does a low pulse pressure indicate?
What does an elevated PP indicate?
around 40-60 mmHg
indicates pulse narrowing
associated with higher CVD morbidity and mortality rates
True or False: Systolic blood pressure is a better predictor of CV risk than pulse pressure.
False, Pulse Pressure is a better predictor and more reflective of micro-circulation dysfunction
True or False: Higher heart rates are independently associated with increased risks of all-cause and CV mortality
True, the risk of all-cause and CV mortality increases by 9% and 8% for every 10 bpm resting HR increases (especially over 90 bpm)
What are common errors with brachial blood pressure?
- may not be an accurate reflexion of central pressure
- a lot of cuffs underestimate syst. and overestimate diast.
- measured BP is only a snapshot and doesn;t reflect response to load
- might be best to assess response to low to moderate exercise
Is ambulatory BP more accurate than home readings?
Yes, it is more expensive but more accurate and gives a reading every 20 mins instead of only 4 times a day
What is white coat syndrome?
elevated BP in the clinic (140/90 mmHg) despite normal ambulatory and home reading BP
What are common confounding variables that will effect a BP measurement? How much higher does each variable make a BP measurement appear?
- a full bladder (10-15 mmHg)
- unsupported back or feet (5-10 mmHg each)
- crossed legs (2-8 mmHg)
- cuff over clothing (10-40 mmHg)
- unsupported arm (10 mmHg)
- talking (10-15 mmHg)
What is a normal response to BP when painful stimuli is present?
Systolic BP increases by 15-25 mmHg
Diastolic BP increases by 10-20 mmHg
values greater than normal are considered to be hyper-reactive and have increased risk of developing HTN RR 1.37 (prevalence 10-31%)
How does chronic pain effect hemodynamics?
- diminshes BP response and baroreflex to painful stimuli
- increases rate of HTN
- diminishes tolerance to painful stimuli
- lower parasympathetic and higher sympathetic activity (signifcantly lower HR volume)
What are abnormal events with exercise blood pressure?
Exercise hyper/hypotension Pulse Narrowing (VERY BAD) Adverse Effects ( VERY VERY BAD)
What is considered a Hypertensive response to exercise?
Systolic BP over 220 for men and over 190 for women and a diastolic increase over 10 mmHg or reading over 90 mmHg
demonstrated in normal and HTN pts and can be predictive of future HTN diagnosis
Can also be useful for unmasking HTN in clinical settings if present at low or moderate intensities
What is considered a hypotensive response to exercise?
Low ExBP was associated w. increased risk regardless of clinical presentation, exercise mode or intensity
10 mmHg decrease in exercise SBP is shown to have higher risk for fatal and non-fatal CV events and all-cause mortality
True or False: Vascular profiling may enhance the risk assessment and clinical reasoning process for manual therapists
True, elevated PP have been associated w/ increased arterial stiffness and the development of atherosclerosis
What risk factors are associated with an increased risk of either internal carotid or vertebrobasilar arterial pathology and should be thoroughly asses during the pt history?
- Past history of trauma to C spine
- history of migraines
- HTN
- hypercholesterolemia
- diabetes
- Cardiac disease
- history of smoking
- recent infection
- blood clotting disorders
If a pt. presents w/ a resting BP reading of 140/90 what clinical considerations should be used?
Contact PCP and monitor closely but proceed w/ usualy care
If a pt. presents w/ a resting BP reading of 160/100 what clinical considerations should be used?
Contact PCP and monitor closely while also holding back on resistance training and consider aerobic exercise
If a pt. presents w/ a resting BP reading of 180/110 what clinical considerations should be used?
Hold the exam! Examine for organ damage, contact PCP, and consider contacting EMS
Why would eccentric training be indicated for HTN pts.?
improves strength comparable to concentric training but does so with lower RPE, stroke volume, oxygen consumption, cardiac index, and HR at similar workloads
however it may increase chance of DOMS
True or False: Patients w/ CVD have an increased risk for adverse events following C-spine manual therapy but C-spine manual therapy is the only effective way of treating neck pain and so it is worth the risk to manipulate
False, we can use thoracic spine manual therapy to treat neck pain and thoracic MT has very little response to hemodynamics or autonomic system
What questionnaires can be used for investigating health history for HTN patients?
PARQ
Duke Activity Status Index (DASI)
AHA/ACSM physical questionnaire
True or False: We only need to take vitals on new patients that are over 45 years old or have a risk of falls.
False, we should take vitals for every new patient and check for arrhythmias or murmurs and need to report any undiagnosed or new findings to their PCP
