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
