Hypertension

Question 0

Prehypertension

-Definition

Answer 0

1. Systolic BP: 120-139 mm Hg
   or
2. Diastolic BP: 80-89 mm Hg

Question 1

Hypertension

-Definition

Answer 1

1. Persistent elevation of:
   - Systolic BP ≥140 mm Hg
   - Diastolic BP ≥90 mm Hg
   - Current use of antihypertensive medications TEST

Question 2

Blood Pressure

-Equation

Answer 2

1. Cardiac Output X Systemic Vascular Resistance

Question 3

Cardiac Output

-Equation

Answer 3

1. HR X SV

Question 4

Mean Arterial Pressure (MAP)

-Equation

Answer 4

1. Cardiac Output X Total Peripheral Resistance

2. SBP + 2(DBP) / 3 = MAP

Question 5

Cardiac Output

-Myocardial Contractility (How it contributes to CO)

Answer 5

1. cardiac Beta1 receptors
2. SNS
3. Circulating epinephrine/norepinephrine

Question 6

Cardiac Output

-Blood Volume (How it contributes to CO)

Answer 6

1. RAAS
2. Atrial and Brain natriuretic peptides
3. ADH / Vasopressin

Question 7

Systemic Vascular Resistance

-Vessel Diameter (How it contributes to SVR)

Answer 7

1. Smooth muscle tone

2. Vascular alpha-1 receptors

Question 8

Systemic Vascular Resistance

-Vessel Compliance (How it contributes to SVR)

Answer 8

1. Arteriosclerosis
2. Adrenomedullin
3. Local mediators

Question 9

Primary (Essential) HTN

-Etiology

Answer 9

1. Elevated BP w/out an identified cause

2. 90% to 95% of all cases

Question 10

Primary (Essential) HTN

-Contributing Factors

Answer 10

1. Increase SNS activity
2. Increase RAAS
3. Diabetes Mellitus
4. > ideal body weight
5. Increased sodium intake
6. Excessive alcohol intake

Question 11

Primary (Essential) HTN

-Diabetes.. How it plays into HTN??

Answer 11

1. Predisposes person to arteriosclerosis and works on vessels

Question 12

Secondary HTN

-Etiology

Answer 12

1. Elevated BP with a specific cause

2. 5% to 10% of adult cases

Question 13

Secondary HTN

-Contributing Factors TEST

Answer 13

1. Coarctation of aorta ( narrowing)
2. Renal Dz (RAAS, build up of sodium)
3. Endocrine disorders (Hyperthyroid, Adrenal Gland-cushing, theocromocytoma)
4. Neurologic Disorders (increase ICP, Spinal trauma)
5. Drug Use (Oral Contraceptives, Estrogen, Cocaine, meth)T
6. Pregnancy (10% of women)
7. Cirrhosis (portal vein htn)
8. Sleep apnea

Question 14

Hypertension

-SBP TEST

Answer 14

1. For persons over 50 years of age:
   - SBP is more important than DBP as a CVD risk factor
2. Persons who are normotensive at 55 years of age have 90% lifetime risk for developing HTN

Question 15

HTN

-Pathophysiology

Answer 15

1. Interaction of
   - Environmental factors
   - Demographic factors
   - Genetic factors
2. Water and sodium retention

Question 16

HTN

-Insulin Resistance & Hyperinsulinemia

Answer 16

1. High insulin concentration stimulates SNS activity and impairs nitric oxide - mediated vasodilation

Question 17

HTN

-Clinical Manifestations

Answer 17

1. Symptoms are often secondary to target organ disease and can include:
   - Fatigue, reduced activity tolerance
   - Dizziness
   - Palpitations, angina
   - Dyspnea

Question 18

HTN

-Clinical Manifestations before Target Organ damage?

Answer 18

1. Most patients will be asymptomatic before target organ damage has occurred.

Question 19

HTN

-Complications

Answer 19

1. Target Organ diseases occur most frequently in the:
   - Heart
   - Brain
   - Peripheral vasculature
   - Kidney
   - Eyes

Question 20

HTN Complications

-Hypertensive Heart Disease

Answer 20

1. Coronary artery disease (CAD)
2. Left ventricular hypertrophy
3. HF

Question 21

HTN

-First Organ to show Target Organ Damage?

Answer 21

1. The eyes are the first place where evidence of target organ damage can be seen.

Question 22

HTN

-Diagnostic Studies

Answer 22

1. Eye exam
2. BP measurements in both arms
   - Use arm with higher reading for subsequent measurements
   - BP highest in early morning, lowest at night

Question 23

HTN

-BP readings to show HTN

Answer 23

1. 3 separate readings at different times that indicate HTN

Question 24

HTN Diagnostic Studies

-Creatinine clearance

Answer 24

1. Shows kidney function

Question 25

HTN Diagnostic Studies

-Electrolytes

Answer 25

1. Low K+ might show with hypoaldostronism

Question 26

HTN

-White Coat Phenomenon

Answer 26

1. When a person’s BP is higher in the clinical setting but normal elsewhere
2. May precipitate the need for ambulatory blood pressure monitoring

Question 27

HTN

-Treatment

Answer 27

1. Everyone gets lifestyle modification

2. First line of medication is Diuretic

Question 28

HTN

-Over the Counter Meds

Answer 28

1. Avoid decongestants and other over the counter meds that can increase BP

Question 29

Hypertensive Crisis

Answer 29

1. Severe, abrupt increase in BP
   - SBP > 180 mmHg, DBP > 120 mmHg
2. PT MUST ALSO BE SYMPTOMATIC FOR IT TO BE A CRISIS TEST

Question 30

Hypertensive Crisis

-Clinical Manifestations

Answer 30

1. Hypertensive Emergency = EVIDENCE OF AUTE TARGET ORGAN DAMAGE
   - Hypertensive encephalopathy, cerebral hemorrhage
   - Acute Renal Failure
   - MI
   - HF w/ pulmonary edema

Question 32

Hypertensive Crisis

-Treatment

Answer 32

1. Use Nitrates and IV drugs

2. Use MAP to lower BP. Don’t lower more than 25% per hour TEST

Question 33

HTN

-Thiazide Diuretics

Answer 33

1. Inhibit NaCl reabsorption in distal convoluted tubule
2. Watch for hypokalemia
   - Hydrochlorothiazide (Hydrodiuril)
3. Lowers BP moderately in 2-4 weeks

Question 34

HTN

-Loop Diuretics

Answer 34

1. Inhibit NaCl reabsorption. Increase excretion of Na & Cl
2. More potent effect than thiazides
3. Wastes Potassium
   - Lasix & Bumex

Question 35

HTN

-Potassium Sparing Diuretics

Answer 35

1. Inhibit Na+ retaining and K+ excreting effects of aldosterone
   - Hyperkalemia

Ex.
Spirinolactone (Aldactone)