Hypertension Flashcards
As BP increases so does the risk of: 5 things
i. MI
ii. Heart failure
iii. Stroke
iv. Renal disease
v. Retinopathy
All ethnicities: Three factors for decreased prevalence
Born outside US
Doesn’t speak English
Limited time living in US
African Americans has (3 things)
Highest prevalence
More resistant HTN
More nocturnal non dipping BP
African Americans are less responsive to
renin inhibiting meds
Better control with: calcium channel blockers & diuretics
African Americans are at an increased risk of
Angioedema (allergy deep in skin) with ACE inhibitors
Men & HTN
more common before middle age
Women & HTN
increased 2-3x with oral contraceptives
Preeclampsia
More common after menopause
Harder to control for women
Normal BP
Systolic <120
Dystolic <80
Elevated (pre-hypertension) BP
SBP 120-129
DBP <80
Hypertension stage 1
SBP 130-139
DBP 80-89
Hypertension Stage 2
SBP 140 or higher
DBP 90 or higher
Hypertension Crisis
SBP higher than 180
DBP higher than 120
Two types of hypertension
Primary & secondary hypertension
Primary hypertension
also called essential/idiopathic HTN
Elevated BP of unknown cause
90-95%
Contributing factors to primary hypertension (8 things)
Altered endothelial function increased SNS activity increased Na+ intake overproduction of Na+ retaining hormones overweight diabetes tobacco excess alcohol
Secondary hypertension
elevated BP with specific cause; sudden development
5-10%
Clinical findings relate to underlying cause (secondary hypertension)
Cirrhosis;
aortic problems;
drug-related;
endocrine, neurologic, or renal problems; pregnancy-induced, or sleep apnea
Secondary hypertension treatment is
aimed at removing or treating cause
Increased BP=
Increased CO or SVR
Persistently increased SVR
Risk Factors for Primary Hypertension
a. Age
b. Alcohol use
c. Tobacco use
d. Diabetes
e. Elevated serum lipids
f. Excess dietary sodium
g. Gender
h. Family history
i. Obesity
j. Ethnicity
k. Sedentary lifestyle
l. Socioeconomic status
m. Stress
Different sets of genes regulate
BP at different times
Research of primary hypertension genetic link
endothelial dysfunction
Hypertension Clinical Manifestations (S&S)
“Silent Killer” asymptomatic until severe & target organ disease occurs
Symptoms of severe hypertension (6 things)
Fatigue Dizziness Palpitations Angina Dyspnea Nocturia
Target organ diseases occur most frequently in:
♡ , brain, peripheral vascular disease, kidney, eyes
What occurs in the ♡ from HTN?
- Coronary artery disease; atherosclerosis
- Left ventricular hypertrophy
a. Large & thickening - Heart failure
What occurs in the brain from HTN?
Cerebrovascular disease
TIA/Stroke; atherosclerosis
Hypertensive encephalopathy
What occurs in peripheral vascular disease?
i. Atherosclerosis leads to PVD, aortic aneurysm, aortic dissection
ii. Intermittent claudication
Kidney
Nephrosclerosis leads to chronic kidney disease (CKD)
Eyes-retinal damage
Blurry or loss of vision; retinal hemorrhage
Damaged retinal vessels indicate concurrent damage to
in heart, brain, and kidneys
Labs are done for hypertension too:
- Identify or rule out secondary HTN
- Evaluate target organ disease
- Determine CV risk
- Establish baselines before starting therapy
Hypertension lab names:
Renal function, U/A, BMP, CBC, serum lipid profile, uric acid, ECG, ophthalmic exam
Ambulatory blood pressure monitoring (ABPM); avoids
“white coat” HTN
Noninvasive, fully automated system that measures BP at preset intervals over 12 to 24-hour period
Ambulatory BP monitoring
Teaching for ABPM
Teach patient to hold arm still while device reads BP and keep diary of activities
Other applications for use of ABPM
- Antihypertensive drug resistance
- Hypotensive symptoms with antihypertensive therapy
- SNS dysfunction
- Episodic HTN (spiking during different times of the day)
- Diurnal variability; nondippers; reverse dippers
Lifestyle modifications, AHA life’s simple 7
- Manage BP
- Control cholesterol
- Reduce blood sugar
- Get active
- Eat better
- Lose weight
- Stop smoking
Overall goals of HTN care
i. Achieve and maintain goal BP
ii. Reduce CV risk factors and target organ disease
Lifestyle modifications
Weight reduction
i. Weight loss of 1 kg (2.2lbs) will decrease SBP by 1 mm Hg
ii. Calorie restriction and physical activity
DASH eating plan
i. Fruits, vegetables, fat-free or low-fat milk/milk products, whole grains, fish, poultry, beans, seeds, and nuts
ii. Calcium & Magnesium
Sodium for healthy adults
less than 2300 mg/day
Sodium for blacks, middle-aged and older, those with hypertension, diabetes, or chronic kidney disease
less than 1500 mg/day
Salty Six (AHA)
bread/rolls, lunch and cured meats, sandwiches, pizza, soup, poultry
Moderation of Alcohol Intake
Men: 2 drinks/day; women: 1 drink/day
Physical Activity
Moderate-intensity aerobic activity, at least 30 minutes, most (at least 5) days of the week for goal of 150 minutes/week
Nicotine causes
vasoconstriction and elevated BP
Smoking cessation reduces risk factors
within 1 year
Two primary actions of hypertension
i. Decrease circulating blood volume
ii. Reduce SVR
Patient teaching
i. If a drug is not tolerated, then another classification will be used
ii. Monthly follow-up visits until at goal BP; then 3 to 6 months
Patients should:
report all side effects & different meds may be tried if severe
Common side effects of drug therapy
Orthostatic hypotension
sexual problems
dry mouth
frequent voiding
Failure to reach goal BP with appropriate therapy and drug
Resistant Hypertension
Resistant hypertension increases the risk for
stroke of MI
Causes of resistant hypertension
- Improper BP measurement
- Volume overload
- Drug-induced or other causes
- Associated conditions
- Secondary HTN
Primary prevention of HTN
- Lifestyle modification—DASH, decreased Na+
2. Education regarding dangers of HTN
Individual patient evaluation and education (4 things)
i. Screening programs
ii. Identify risk factors for HTN and CAD
iii. BP measurement; health assessment
iv. Drugs and/or previous treatment
Assess for orthostatic hypotension
i. BP and HR after supine for 5 minutes
ii. Assist to standing
iii. Measure BP and HR at 1 minute and 3 minutes of position change
Normal orthostatic hypotension
SBP decreased (less than 10 mm Hg) DBP and HR increased slightly
Abnormal orthostatic hypotension
SBP decreased 20 mm Hg or more
- DBP decreased 10 mm Hg or more
- HR increased 20 beats/min or more
Most patients start with
diuretic