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Physical & Health Assessment (Spring '24) - 1 > Hypertension (Exam IV) > Flashcards

Hypertension (Exam IV) Flashcards

1
Q

How many people have HTN in the US?

A
  • 100 million people

African Americans are more affected.

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2
Q

Women over the age of _____ will have a greater prevalence of hypertension than men.

A
  • 60 years
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3
Q

Worldwide, hypertension is the leading risk factor for _________ and __________.

A
  • Morbidity
  • Mortality
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4
Q

The clinical consequences of chronic ___________have been well characterized and underscore a high age-related association with ischemic heart disease, CVA, renal failure, retinopathy, peripheral vascular disease, and overall mortality.

A
  • Hypertension
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5
Q

In anesthesia, hypertension increases pulse pressure which will lead to ________ and ___________.

A
  • Intraoperative hemodynamic instability
  • Adverse post-op outcomes
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6
Q

Definition of Hypertension

A
  • Sustained systolic BP > 130 mm Hg
  • Sustained diastolic BP > 80 mm Hg
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7
Q

Definition of Isolated systolic hypertension

A
  • Systolic > 130 mm Hg
  • Diastolic < 80 mm Hg
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8
Q

Definition of Isolated diastolic hypertension

A
  • Systolic < 130 mm Hg
  • Diastolic > 80 mm Hg
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9
Q

Definition of Combined systolic and
diastolic hypertension

A
  • Systolic > 130 mm Hg
  • Diastolic > 80 mm Hg
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10
Q

Normal BP
SBP
DBP

A

Normal
SBP: <120 mmHg
DBP < 80 mmHg

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11
Q

Elevated BP
SBP
DBP

A

Elevated BP
SBP: 120-129 mmHg
DBP: < 80 mmHg

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12
Q

Stage 1 Hypertension
SBP
DBP

A

Stage 1 Hypertension
SBP: 130-139 mmHg
DBP: 80-89 mmHg

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13
Q

Stage 2 Hypertension
SBP
DBP

A

Stage 2 Hypertension
SBP: >140 mmHg
DBP: > 90 mmHg

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14
Q

Contributing Factors to Primary HTN

A
  • Dysregulation of SNS activity
  • Dysregulation of RAAS
  • Deficient production of endogenous vasodilators
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15
Q

What receptors regulate our BP and give us acute control of CO, vascular resistance, and blood volume?

A
  • Cardiac Stretch Receptor
  • Vascular Baroreceptor
  • Peripheral Chemoreceptor
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16
Q

Chronic inflammation will disrupt the _________ and cause autonomic dysfunction leading to hypertension.

A
  • Blood Brain Barrier
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17
Q

Oxidative stress and inflammation within the brain will
* _______SNS output
* increase_________ release
* _________ baroreflex regulation

A
  • ↑ SNS output
  • Increase Vasopressin release
  • Inhibits baroreflex regulation
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18
Q

RAAS has acute and sustained control over what factors?

A
  • ECF volume
  • Peripheral Vascular Resistance
  • BP
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19
Q

What is the result of dysregulated renin release?

A
  • Elevated renin levels → ANG II overproduction → Increase aldosterone → HTN
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20
Q

The vascular endothelium produces what vasoactive substances that are major regulators of vascular tone?

A
  • Nitric oxide
  • Endothelin
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21
Q

What other vasoactive substances does the vascular endothelium produce that will cause vasodilation and blunt RAAS?

A
  • ANP
  • BNP
  • CNP
  • Urodilatin
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22
Q

What are the results of oxidative stress on the endothelium?

A
  • Impaired endothelial function
  • Disruption of natriuretic peptide release or receptor response → HTN
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23
Q

Secondary hypertension has a correctable cause that may be __________ or ____________.

______% of the population has secondary hypertension.

A
  • Age-dependent
  • Drug-induced
  • 5%
24
Q

What herbal drugs will cause elevated BP?

A
  • Ephedra
  • Ginseng
  • Ma Huang
25
What illicit substance can elevate BP?
* Cocaine * Meth *Cancel the case if the patient used meth/coke that morning.*
26
70% to 85% of children who develop secondary hypertension is result from what two conditions?
* Renal parenchymal disease * Coarctation of the aorta
27
Pathophysiology of chronic hypertension.
* Remodeling of small and large arteries * Endothelial dysfunction * Irreversible end-organ damage 
28
HTN will lead to vasculopathy (inflamed/damaged blood vessels). What could result from vasculopathy? (Long List/ Common Sense)
* IHD * LV hypertrophy * CHF * CVA * PVD * Aortic aneurysm * Nephropathy 
29
Resistant hypertension, defined as uncontrolled blood pressure despite ______ or more antihypertensive drugs of different classes,
* 3
30
__________ Hypertension is defined as 4 or more drugs to achieve BP control.
* Control-resistant
31
________ Hypertension, defined as uncontrolled blood pressure on 5 or more drugs. This affects 0.5% of the population.
* Refractory *At this point, there may be some drug intolerance or pseudo-resistant HTN*
32
Lifestyle modification for HTN.
* Weight reduction * Moderation of alcohol intake * Increased aerobic exercise * Smoking cessation * ↑ Dietary intake of K+ and Ca2+ * Salt restriction
33
ACC/AHA Guidelines: Pt with what conditions should be placed on BP meds when SBP >130 mmHg and DBP > 80 mmHg.
* IHD * Cerebrovascular Disease * CKD * ↑ Risk of Atherosclerotic CV disease
34
ACC/AHA Guidelines: Non-black hypertensive population (w/ or w/o DM) should be placed on what type of BP meds?
* ACE inhibitors * ARBs * CCBs * thiazide-type diuretics
35
ACC/AHA Guidelines: Black hypertensive population w/o HF nor CKD (w/ or w/o DM) should initiate treatment w/ what type of BP meds?
* CCB * thiazide-type diuretics
36
ACC/AHA Guidelines: CKD hypertensive patients should be placed on what BP meds?
* ACE inhibitors * ARBs
37
First-line antihypertensive therapy
* Diuretics * CCBs * ACE inhibitors * ARBs
38
When will β-blockers be added to antihypertensive therapy?
* CAD or tachydysrhythmia patients * Multi-drug therapy in resistant HTN
39
What are some procedures/surgeries done to treat secondary hypertension?
* Correction of renal artery stenosis * Direct arterial repair * Adrenalectomy
40
Medications for secondary hypertension.
* ACE-inhibitors or in combination with diuretics
41
Patient with chronic hypertension (180/100) w/ no symptoms: urgent or emergent hypertensive crisis?
* Urgent *Emergent Hypertensive Crisis is usually acute and involves progressive end-organ damage.*
42
Hypertensive Emergencies that may present in the perioperative setting include manifestations of _______ injury, _________ injury, and _________ insult.
* Central nervous system injury * Kidney injury  * Cardiovascular insult *These need immediate attention and treatment.*  
43
Women w/ Pregnancy- Induced HTN (PIH) may show evidence of end-organ dysfunction by showing signs of ____________. What BP in pregnant patients will require immediate attention and treatment?
* Encephalopathy * SBP > 160 mmHg and/or DBP >110 mmHG
44
First-line drug for peripartum hypertension
* Labetalol
45
Medication to give for Aortic dissection
* β-blocker (esmolol, labetalol) plus arteriolar dilator
46
What medication will cause rapid arterial dilation and BP reduction?
* Sodium nitroprusside infusion
47
What is a CCB that is a selective arteriolar vasodilator?
* Clevidipine *This drug has a short half-life, making it very easy to titrate.*
48
_________, is a second-gen dihydropyridine CCB that has a longer half-life and is less titratable than clevidipine.
* Nicardipine
49
Pre-op evaluation with hypertensive patients.
* Consider the white coat effect * Evaluate vasculopathy and end-organ functions * Consider whether to cancel or delay surgery *Surgery is usually canceled if the SBP > 180 mmHg*
50
Antihypertensive meds are continued on the day of the surgery, except what meds?
* High-dose ARBs * ACE-inhibitors *These drugs will lead to profound hypotension with anesthesia.*
51
Induction consideration with hypertensive patients.
* Consider the drop in BP w/ the induction agent and gas * Consider the increase in BP during intubation * Consider A-line placement * Consider transient β-blockade w/ esmolol * Check for volume depletion
52
Peri-operative considerations What does hypertension increase?
* Increase Blood loss * Increase in Incidence of MI * Increase cerebrovascular events
53
Hypertensive Patient Peri-operative Considerations Volume depletion, loss of vascular elasticity, and baroreceptor desensitization combined w/ antihypertensive treatment will result in intraoperative _____________.
* hemodynamic volatility *You will be chasing your tail.*
54
Too much of a drop in BP in chronic hypertensive patients will result in what injuries?
* Renal and myocardial injury
55
What is the most common cause of secondary HTN for middle age adults (40-64 years old)?
* Hyperaldosteronism * Thyroid dysfunction * OSA * Cushing syndrome * Phenochrmocytoma

Physical & Health Assessment (Spring '24) - 1 (27 decks)

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