Hypertension Flashcards
What is systemic circulation?
provides nutrients and blood to entire body + removes waste products
Circulatory System
regulates body temperature and hormone/immune system components in body
Arterial BP
Normal: 120 mmHg (Systolic Pressure: maximum pressure when heart contracts) / 80mmHg (Diastolic Pressure: minimum pressure when heart relaxes)
How does arterial BP change at night?
diurnal variation (highest in the afternoon and lowers at night
How is arterial BP controlled?
Cardiac Output + Peripheral Resistance
What controls CO?
HR + SV
What controls SV?
myocardial contractility + size of vascular compartment (the more fluid = the higher the BP)
What controls peripheral resistance?
vascular structure / supply / function
What are the ranges for normal HR?
Adult: 60-80bpm
Child: 80-100bpm
Infant: 100-120bpm
it gets lower with age !
What is HTN?
More than 120/80mmHg on an average of 2+ visits
Usually asymptomatic
What are the risk factors of HTN?
Stroke + MI, HF, Kidney Damage, Retinopathy, Peripheral Arterial Disease
What are the categories for arterial BP?
Normal: <120 and <80 Elevated: 120-129 and <80 Pre-HTN: 130-139 and 80-89 HTN Stage 1: >140 and >90 HTN Stage 2: >180 and >120
What is primary HTN and how it affects autonomic NS, RAAS, and salt?
90-95% of cases; no underlying cause or disease
Heterogenous etiology and gradual development
Autonomic NS: increased sympathetic stimulation and increased resting pulse rate
RAAS: regulates blood volume via renin (kidney and adipose tissue)
Abnormal Salt Handling (35%): increased intracellular sodium and increased sensitivity to sympathetic NS
How do you treat primary HTN?
Lifestyle modifications and Meds
Goal: <130/80
What is secondary HTN?
5-10% of cases but is more severe and etiology can be determined
it is secondary to other cause like renal disease, pheochromocytoma, primary aldosteronism, CS, Hyperthryoid + pre-eclampsia
What is a HTN crisis - urgency and its symptoms?
> 180/120 with NO end-organ damage
severe HA/anxiety and SOB + nosebleed
Recommend: immediate PCP evaluation
What is a HTN crisis - emergency and its symptoms?
> 180/120 WITH end-organ damage
Chest pain, SOB, back pain, weak, change in vision*, difficulty speaking
Recommend: IMMEDIATE hospitalization (GO TO ER)
79% mortality rate without treatment
Complications: stroke, pulmonary edema, lose consciousness/memory, MI, eye/kidney damage, angina, eclampsia, and aortic dissection
Arteriosclerosis
narrowing or thickening of arteries
Arteriolosclerosis
narrowing or thickening of hardened arterioles
Atherosclerosis
Arteriosclerosis + cholesterol deposits
What is HTN retinopathy?
most common ocular manifestation of HTN (50-80%)
usually asymptomatic or may lose vision
Grade 1-2: 35% increase risk of stroke
Grade 3-4: 137% increase risk of stroke
what is the 1st sign of HTN retinopathy
retinal microvasculature changes and gradual decrease in blood flow in retina
What is grade 1 HTN retinopathy
Attenuation of retinal arterioles, decreased A/V ratio, and increased ALR
what is grade 2 HTN retinopathy
grade 1 + tortuosity of veins + A/V crossings
what is grade 3 HTN retinopathy
grade 2 + flame-shaped hemorrhages + cotton wool spots
What is grade 4 HTN retinopathy
grade 3 + swollen optic disc, retinal edema, and macular star