Hypertension I Flashcards
What does blood pressure measure?
The force of blood against the arterial walls
Why is the definition of hypertension important clinically?
It refers to value where medical therapy reduces morbidity and mortality related to BP
How many BP readings do you need to qualify as having hypertension?
2+ accurate, seated BP readings during 2 or more outpatient visits
Exception: hypertensive emergency
What classifies as elevated blood pressure according to the ACC/AHA?
120-129 AND <80
What classifies as stage 1 hypertension according to the ACC/AHA? Stage 2?
130-139 OR 80-89
140+ OR 90+
What is the difference between primary and secondary hypertension?
We do not know the cause of primary hypertension and secondary has a definable cause
What are examples of causes of secondary hypertension (9)?
CKD
Renal artery stenosis
Cushing Disease
Coarctation of the Aorta
Drug-induced HTN
Pheochromocytoma
Hyperaldosteronism
OSA
Thyroid dysfunction
When young patient have hypertension, how does it present differently?
Both systolic and diastolic BP usually rise
Predominantly due to hormonal activation
Associated with OSA
Tx initiated when BP >140/90 (JNC)
When older patients have hypertension, how do they present differently?
Systolic BP rises without rise in diastolic
Predominantly due to arterial stiffness
Not associated with OSA
Tx initiated when SBP according to JNC
A patient presents with systolic BP >140, but diastolic <90. What is this called?
Isolated systolic hypertension
What patient population is more likely to have isolated systolic hypertension and why?
Older patients; arterial stiffness and atherosclerosis
Why would a younger patient have isolated systolic hypertension?
MC in athletic males, most likely due to high stroke volume
Is systolic or diastolic BP a better predictor of risk?
SBP is better predictor of risk in elderly (>60)
DBP is better predictor of risk for patients <45
A patient consistently has elevated BP >140/90 in the office, but a lower value outside of the clinic. What condition do they have?
White Coat Hypertension
Which patient population is more likely to have white coat hypertension?
Older patients
How is white coat hypertension treated?
Treatment not necessary as long as within range at home
A patient has a normal BP in the office, but elevated values at home. What condition do they have?
Masked Hypertension
What causes masked hypertension? How should these patients be treated?
Lifestyle: alcohol, tobacco, caffeine use
Same as normal hypertension if work-up doesn’t show outside cause
An elderly patient has elevated BP but feels hypotensive. What condition should you be aware of? How would you verify this?
Pseudohypertension, invasive intra-aortic reading
What is the cause and complication of pseudohypertension?
Calcification of peripheral vessels results in falsely elevated BP
Leads to symptomatic over treatment
Which epidemiological factors predispose a patient to BP?
Very common and present in nearly all populations!
SBP higher in men in early adulthood
Greater rise in women with aging
Non-Hispanic blacks > non-Hispanic whites > non-Hispanic Asians > Hispanic Americans
High prevalence >65 y/o
As we age, what happens to diastolic BP?
Increases until about 55 y/o, then decreases causing wider pulse pressure after age 60
HTN is a major risk factor for ______
Heart disease and stroke
Blood pressure = ____ x _____
Cardiac output x systemic vascular resistance
