Hypertension Flashcards
Prehypertension
-Definition
- Systolic BP: 120-139 mm Hg
or - Diastolic BP: 80-89 mm Hg
Hypertension
-Definition
- Persistent elevation of:
- Systolic BP ≥140 mm Hg
- Diastolic BP ≥90 mm Hg
- Current use of antihypertensive medications TEST
Blood Pressure
-Equation
- Cardiac Output X Systemic Vascular Resistance
Cardiac Output
-Equation
- HR X SV
Mean Arterial Pressure (MAP)
-Equation
- Cardiac Output X Total Peripheral Resistance
2. SBP + 2(DBP) / 3 = MAP
Cardiac Output
-Myocardial Contractility (How it contributes to CO)
- cardiac Beta1 receptors
- SNS
- Circulating epinephrine/norepinephrine
Cardiac Output
-Blood Volume (How it contributes to CO)
- RAAS
- Atrial and Brain natriuretic peptides
- ADH / Vasopressin
Systemic Vascular Resistance
-Vessel Diameter (How it contributes to SVR)
- Smooth muscle tone
2. Vascular alpha-1 receptors
Systemic Vascular Resistance
-Vessel Compliance (How it contributes to SVR)
- Arteriosclerosis
- Adrenomedullin
- Local mediators
Primary (Essential) HTN
-Etiology
- Elevated BP w/out an identified cause
2. 90% to 95% of all cases
Primary (Essential) HTN
-Contributing Factors
- Increase SNS activity
- Increase RAAS
- Diabetes Mellitus
- > ideal body weight
- Increased sodium intake
- Excessive alcohol intake
Primary (Essential) HTN
-Diabetes.. How it plays into HTN??
- Predisposes person to arteriosclerosis and works on vessels
Secondary HTN
-Etiology
- Elevated BP with a specific cause
2. 5% to 10% of adult cases
Secondary HTN
-Contributing Factors TEST
- Coarctation of aorta ( narrowing)
- Renal Dz (RAAS, build up of sodium)
- Endocrine disorders (Hyperthyroid, Adrenal Gland-cushing, theocromocytoma)
- Neurologic Disorders (increase ICP, Spinal trauma)
- Drug Use (Oral Contraceptives, Estrogen, Cocaine, meth)T
- Pregnancy (10% of women)
- Cirrhosis (portal vein htn)
- Sleep apnea
Hypertension
-SBP TEST
- For persons over 50 years of age:
- SBP is more important than DBP as a CVD risk factor - Persons who are normotensive at 55 years of age have 90% lifetime risk for developing HTN
HTN
-Pathophysiology
- Interaction of
- Environmental factors
- Demographic factors
- Genetic factors - Water and sodium retention
HTN
-Insulin Resistance & Hyperinsulinemia
- High insulin concentration stimulates SNS activity and impairs nitric oxide - mediated vasodilation
HTN
-Clinical Manifestations
- Symptoms are often secondary to target organ disease and can include:
- Fatigue, reduced activity tolerance
- Dizziness
- Palpitations, angina
- Dyspnea
HTN
-Clinical Manifestations before Target Organ damage?
- Most patients will be asymptomatic before target organ damage has occurred.
HTN
-Complications
- Target Organ diseases occur most frequently in the:
- Heart
- Brain
- Peripheral vasculature
- Kidney
- Eyes
HTN Complications
-Hypertensive Heart Disease
- Coronary artery disease (CAD)
- Left ventricular hypertrophy
- HF
HTN
-First Organ to show Target Organ Damage?
- The eyes are the first place where evidence of target organ damage can be seen.
HTN
-Diagnostic Studies
- Eye exam
- BP measurements in both arms
- Use arm with higher reading for subsequent measurements
- BP highest in early morning, lowest at night
HTN
-BP readings to show HTN
- 3 separate readings at different times that indicate HTN
HTN Diagnostic Studies
-Creatinine clearance
- Shows kidney function
HTN Diagnostic Studies
-Electrolytes
- Low K+ might show with hypoaldostronism
HTN
-White Coat Phenomenon
- When a person’s BP is higher in the clinical setting but normal elsewhere
- May precipitate the need for ambulatory blood pressure monitoring
HTN
-Treatment
- Everyone gets lifestyle modification
2. First line of medication is Diuretic
HTN
-Over the Counter Meds
- Avoid decongestants and other over the counter meds that can increase BP
Hypertensive Crisis
- Severe, abrupt increase in BP
- SBP > 180 mmHg, DBP > 120 mmHg - PT MUST ALSO BE SYMPTOMATIC FOR IT TO BE A CRISIS TEST
Hypertensive Crisis
-Clinical Manifestations
- Hypertensive Emergency = EVIDENCE OF AUTE TARGET ORGAN DAMAGE
- Hypertensive encephalopathy, cerebral hemorrhage
- Acute Renal Failure
- MI
- HF w/ pulmonary edema
Hypertensive Crisis
-Treatment
- Use Nitrates and IV drugs
2. Use MAP to lower BP. Don’t lower more than 25% per hour TEST
HTN
-Thiazide Diuretics
- Inhibit NaCl reabsorption in distal convoluted tubule
- Watch for hypokalemia
- Hydrochlorothiazide (Hydrodiuril) - Lowers BP moderately in 2-4 weeks
HTN
-Loop Diuretics
- Inhibit NaCl reabsorption. Increase excretion of Na & Cl
- More potent effect than thiazides
- Wastes Potassium
- Lasix & Bumex
HTN
-Potassium Sparing Diuretics
- Inhibit Na+ retaining and K+ excreting effects of aldosterone
- Hyperkalemia
Ex.
Spirinolactone (Aldactone)
