Hypertension Etiology and Tx Flashcards
list the steps in diagnosing HTN
Should be based on several readings
IF: initial screen shows BP is elevated by not dangerous
THEN: measurement should be taken on two subsequent office visits, at least five minutes apart, and patient should be seated in a chair with feet flat on the floor and high readings should be confirmed in the contralateral arm.
IF: mean of all readings shows SBP greater than 130 mmhg and DBP greater than 80 mmhg
THEN: make diagnosis of HTN.
list and describe non drug (lifestyle) factors that should be encouraged to manage essential hypertension, regardless of the drug.
sodium restriction, DASH diet, alcohol restriction, aerobic exercise, smoking cessation, weight loss, maintenance of potassium/calcium intake
describe the sympathetic baroreceptor reflex in regulation of BP
- baroreceptors in the aortic arch and carotid sinus sense BP and relay this information to the brainstem
- IF: BP perceived as too low, brainstem sends signals along sympathetic nerves to stimulate heart vessels.
- THEN: BP becomes elevated by: activation of beta, 1 receptors in the heart–resulting in increased cardiac output AND ALSO activation of vascular alpha receptors, resulting in vasoconstriction
- the reflex switches off when BP has been restored to an acceptable level by stopping sympathetic stimulation of the heart and vascular smooth muscle.
- SENSE
- ACTIVATE
- ELEVATE & FIX
- OFF
review RAAS in elevation of BP and targets for drug intervention
RAAS is an enzymatic system that naturally elevates the bp, negating the hypotensive effects of some drugs.
some drugs will work to stop some parts of RAAS to lower bp.
state the factors for initial choice of an antihypertensive drug
patients without compelling indications (only HTN) are usually started on a thiazide diuretic or ACE inhibitor
patients with compelling indications (HTN plus comorbidities–heart failure/diabetes and etc)
usually start on an ACE inhibitor
state the BP control to expect by increasing the dosage of one antihypertensive drug
and also by adding drugs in other classes
Adding drugs in other classes is critical so that adverse effects of the first drug can be MINIMIZED, and so the drugs can have different mechanisms of action (would be ineffective if they had the same mechanism)
increasing the dosage SLOWLY promotes the therapeutic outcome of getting the bp down. no need to bolus anything in non-emergent situations or give a high loading dose bc HTN is a CHRONIC disease, meaning it poses no immediate threat.
how is HTN therapy individualized for people with renal disease?
lower BP to slow renal damage, use ACE inhibitor or ARB (angiotensin 2) for best results. Use a thiazide diuretic too.
DON’T USE a potassium-sparing diuretic
BEWARE OF CONTRAINDICATIONS
How is HTN therapy individualized for people with diabetes?
target BP is same (120/80)
prefer: ACE inhibitors, ARBs, CCBs, and low dose diuretics.
NOTES:
beta blockers can mask early signs of hypoglycemia–CAUTION with them
thiazides and loop diuretics promote hyperglycemia–CAUTION with them
How is HTN therapy individualized for African Americans?
diuretics are first choice drug
CCBs and alpha/beta blockers are also effective, but must be combined because monotherapy with betablockers is less effective in POC.
How is HTN therapy individualized for older adults?
initial doses should be low (half of a younger adult’s dose)
dosage escalation should be done slowly.
Use reserpine, alpha 1 blockers and alpha/beta blockers with CAUTION bc of the risk of orthostatic HTN.
LOW AND SLOW
how would you promote adherence to HTN management?
patient education
- teach self monitoring
- minimize side effects
- establish a collaborative relationship
- simplify the regimen
- give positive reinforcement, involved family members when appropriate, follow up, visits at convenient times.
