Hypertension/Hypotension Flashcards
What are some reversible risk factors for hypertension?
smoking, obesity, excessive alcohol intake, physical inactivity, renal disease, dyslipidemia, and Diabetes
What are non-reversible risk factors for hypertension?
Age, race, family history of a male <65 y.o. that had a heart attack or stroke
Define Systole
-phase of cardiac cycle in which ventricles CONTRACT -point of maximal arterial pressure
Define Diastole
-phase of cardiac cycle in which the ventricles RELAX -point of lowest arterial pressure
Essential Hypertension
-The cause of the hypertension is unknown
Secondary Hypertension
- high blood pressure that’s caused by another medical condition
Causes of Secondary Hypertension (Endocrine Disorders)
Endocrine disorders -Pheochromocytoma -Cushing’s Syndrome -Primary Aldosteronism -Congenital Adrenal Hyperplasia -Hyperparathyroidism -Hyperthyroidism, Hypothyroidism
Causes of Secondary Hypertension
Endocrine, Renal, Mechanical, Medication-Induced, “White Coat” Hypertension
Causes of Secondary Hypertension (Renal)
-Renovascular disease (stenosis) -Preeclampsia -Renal parenchymal disease
Causes of Secondary Hypertension (Mechanical)
-Coarctation of Aorta -A/V Fistula, Patent ductus arteriosus
Causes of Secondary Hypertension (Medication-Induced)
-Stimulant use -Corticosteroids -SSRIs -Abrupt withdrawal of medication -Oral contraceptives -Black Licorice
White Coat Hypertension
-Falsely elevated blood pressure secondary to measurement in a clinical setting -20-25% of patients will have false mild elevation of pressure -Pearl: LOOK AT DIASTOLIC PRESSURE -Key word: MILD -Can be clarified by ambulatory monitoring
Malignant Hypertension
-SBP ≥180 or DBP ≥120 -Most often w/ long-standing, uncontrolled HTN -Multiple other causes (see secondary HTN) -Can lead to hypertensive encephalopathy Symptoms: Headache, nausea, vomiting, non-localizing neurologic symptoms (restlessness, confusion) -Urgency/Emergency, treatment based on symptoms and exam findings -Risk for seizures and/or coma if not treated
What damage can occur with the Brain in association with HTN
Stroke Transient ischemic attack reversible ischemic neurological deficit
What damage can occur with the eye in association with HTN
Retinopathy - Papilledema - A/V Nicking - Hemorrhage - Exudates - Cotton Wool Spots
What damage can occur with the heart in association with HTN
Left Ventricular Hypertrophy
What damage can occur with the kidney in association with HTN
Proteinuria Renal insufficiency
What damage can occur with the vascular system in association with HTN
Peripheral Arterial Disease
What can cause orthostatic hypertension?
- ANS Disorders:
- Multiple sclerosis
- Parkinson’s disease
- Peripheral Neuropathy (diabetic or other)
- Guillain-Barre syndrome
- Raynaud’s syndrome
- Reflex sympathetic dystrophy (RSD)
- Other:
- Drugs (antihypertensives, vasodilators, antidepressants)
- Physical deconditioning
- Sympathectomy
- Decreased blood volume (GI bleed, dehydration, adrenal insufficiency)
- Idiopathic postural hypotension (familial)
- Advanced Age
What are some characteristics of Orthostatic Hypotension?
- Significant drop in arterial blood pressure with position change
- Represents a defect in vasomotor reflexes
- Frequent cause of syncope in elderly
- Prominent feature in many ANS disorders
How do you diagnose Orthostatic Hypotension?
- Orthostatic Testing
- Measure BP and HR from supine-standing
- Lying —> Sitting —> Standing
- Wait 2 minutes between position changes
- Sustained drop of SBP >20mmHg or DBP >10mmHg
- Absence of compensatory HR increase (15bpm) suggests neurogenic etiology
- Compensatory HR increase suggests non-neurogenic etiology
- Upright Tilt Table Testing
How do you manage Orthostatic Hypotension?
- Reduce/eliminate offending drugs
- Caution patient on position changes
- Elevate head of bed
- Compressive stockings
- Some patients require high sodium diets
- May require drug therapy
