Hypertension Directed Study Flashcards
8/2/13
Hypertension?
usual blood pressure of 140/90 mmHg or higher
delay diagnosis and treatment?
asymptomatic
variability in bp
cause non adherence?
pill burden, prescription drug costs, med side effects,insufficient time for patient education
is age dependent rise in bp an essential part of human biology?
no, in less developed countries, bp remains low and does not rise with age
People who develop hypertension before 50?
usually have combined systolic and diastolic hypertension
people who develop hypertension after 50?
isolated systolic hypertension
cause both systolic and diastolic?
main hemodynamic fault is vasoconstriction of resistance arterioles
cause isolated systolic?
decrease distensionability of large conduit arteries, collagen replaces elastin in the lamina of the aorta
under 50 yo more common in men or women?
men, more common in women after 50/ menopause
primary hypertension?
single reversible cause of the elevated BP cannot be identified
however some things can be identified- habitual excessive calorie consumption, salt or alcohol
secondary/ identifiable hypertension?
discrete mechanism can be identified
BP of <80
Normal
BP of 120-139/80-89
Prehypertension
BP of 140-159/90-99
Stage 1 hypertension
BP of >=160/>=100
Stage 2 hypertension
How to obtain an accurate BP?
measured at least 2 after 5 min of patient seated, back supported, arm bare at heart level
tobacco/ caffeine avoided for at least 30 min prior
measured in both arms to exclude coarction of aorta
and after 5 min of standing to exclude postural fall, particularly in older persons and persons with dabetes or other conditions that predipose to autonomic insufficiency
Home blood pressure monitoring?
help obtain a clear picture of person’s usual bp
2/3 readings should be taken in morning and a night for 1 week with a total of 12 readings being averaged before making clinical decisions
target treatment goal is 135/85
Ambulatory blood pressure
provides automated measurements on bp during a 24 period while patients are engaged in their usual activities, including sleep
superior to office visit in predicting fatal/nonfatal MI and stroke
recommended daytime 135/85 and night time 120/70 and a 24 hr bp below 130/80
only way to detect hypertension during sleep
lab testing for hypertension?
determination of blood electrolyte, fasting glucose,and serum creatinine levels, fasting lipid panel, hematocrit, spot urinalysis, resting 12 lead electrocardiogram
most common cause of secondary hypertension?
chronic kidney disease
mechanism for chronic kidney disease hypertension?
expanded plasma volume and peripheral vasoconstriction
resistant hypertension?
high bp despite treatment
why spot urine test for chronic kidney disease?
microalbuminuria (higher levels of albumninuria indicate more advanced kidney disease)
screen for GFR below 60 ml/min/1.73m2
Renovascular hypertension?
2 mani cause of renal artery stenosis
aterosclerosis and fibromuscular dysplagia
Diagnosis fibromuscular dysplagia?
string of beads on a CT scan in the midportion of a renal artery
Most common cause of primary aldosteronism?
unilateral aldosterone producing adenoma and bilateral adrenal hyperplasia
hypokalemia
