Hypertension- Felner Flashcards
4 phases of diastole
- isovolumic relaxation
- rapid filling
- diastasis
- atrial contraction
________% lifetime risk of HTN
90%
which number is higher, controlled or uncontrolled HTN?
wwho would be the most likely to have TN?
- uncontrolled-
- a non-hispanic black woman who’s above 60 years old
how does CVD mortality relate to BP?
- doubles with each 20 mmHg increase in systolic BP over 115/75
Define BP
The force exerted by blood on the arterial walls and the force of the arterioles as they resist blood flow
T/F: diastolic BP is a stronger predictor of CV mortality than Systolic
F… systolic
what’s the one thing to avoid while taking BP
- avoid auscultatory gap
- avoid taking BP after recent alcohol, caffeine, tobacco, or exercise
what local forces affet TPR
- autoregulation
2. pH/hypoxia
Give some determinants of BP
- heredity defects
- genetic makeup
- environment
- age
- obesity
What is the role of kidneys in controlling BP
- regulating vascular volume via RAAS/ANF
Where are the two baroreceptors located? what CN’s are at each location and where do they transmit signals to?
- aortic arch; transmits via vagus to medulla
2. carotid sinus: transmits via IX
what happens after barorecceptors are signaled?
- increase adrenergic tone to increase sympathetics to decrease parasympathetics
- leads to vasoconstriction; incrased HR and increased LV contractility to increase BP
What is considered too wide ofa pulse pressure and what are some causes?
greater than 55-60
- increase stroke volume (AR
- decreased compliance (elderly)
- Decrased diastolic blood pressure (Fever- dilates distal vessels)
What is considered too narrow of pulse pressure?
less than 20-25 mmHG
- LVOT obstruction (As)
- Decreased stroke volume (heart failure)
- Decreased LV volume (mitral stenosis, diuretics)
what’s another name for primary HTN
essential/idiopathic (95%!)
- includes isolation hypertension (either systolic or diastolic), potentially sodium/renin-mediated
Give causes of Secondary hypertension
ABCDEs
A- aldosteronism, OSA
B- Bruits (renal artery stenosis)
C- CKD, Coarcation, Catecholamines, Cocaine
D- Drugs (NSAIDs/OCP’s, decongestants)
E- endocrine (thyroid, adrenal, Cushing’s, parathyroid)
What population has higher BP
- PREGNANT WOMEN
- those with lifestyle perturbation (obesity, alcohol, salt)
How do you define hypertension
- an increased blood pressure that leads to increased risk of CV events and TARGET ORGAN DAMAGE
give formula for MAP
2/3 DBP + 1/3 SBP
what is the main pathophys of HTN
- imbalance of CO and PVR
- initally, SNS gives increased CO, but eventually we get compensatory PVR
What is masked HTN
- normal in clinic, hypertensive outside.. mainly in AA with CD, or young children with hypertension
What are the two acute forms of BP
- accelerated (BP> 240/120); rapidly progressive with TOD
2. Malignant: BP> 170/110; rapid with TOD, but no LVH ( too acute)… activates coag cascade
What is the main concern in the plan/work up/ assessment of HTN?
What is the goal of work-up/assessment/plan
- detect if there’s any TOD!!
- ACHIEVE IDEAL, not NORMAL, BP (less than or equal to 120/80)
why with a hypertensive patient would you test BP standing?
- because you’re planning on treating them…… treatment is decreasing blood pressure, so you don’t want to do it too strongly so they become hypotensive
Name some simple labs for CV
- urinalysis/FBS/Hgb
- Na/K/Ca
- BUN/creatinine
- Lipid
- ECG
contrast dipper v non dipper
- dipper: BP decreases 10-20% at night, in both normal and HTN patients
- non dippers: doesn’t dip… increased CVD risk
Name some organs involved in TOD
- heart
- aorta (dissection)
- Brain (stroke)
- kidney
- peripheral arteries
- retina
LVH is an adaptation to _______
pressure overload
Pathologic hypertrophy is iniitally ________, but eventually ______
- beneficial; deleterious
LVH heart sound
- sustained systolic with an S4 heart sound (stiff, hypertrophic ventricle)
Name 3 sequale of LVH
- Diastolic dysfunciton FIRST (cavity is smaller… decreased compliance and need more atrial contraction)
- myocardial ischemia (decreased coronary blood flow, in relation to ventricle’s need for blood since it’s hypertrophied)
- Late—> Systolic dysfunction
trio of symptoms for aortic stenosis
SAD
syncope
angina
dyspnea upon exertion
upper limits of BP for:
age < 60
age greater than 60
DM
CKD
<140/90
<150/90
<140/90
<140/90
Describe method, result, and complication of Sprint study
Sprint medicine: getting 1 group to SBP < 120 with 3 meds (intensive), and another decrease to <140 with 2 meds (standard)
Result: decrease death and CVD, but incrase risk of syncope and Acute Kidney Disease
What 3 patient groups would you want to treat HTN immediately for?
- BP > 180/110 mm Hg
- Evidence of end-organ damage
- secondary hypertension
