Hypertension Overview - Chapter 28 Flashcards
Nearly ____ of American adults have hypertension
Half
Most hypertension is ____
Asymptomatic
Uncontrolled hypertension puts patients at a greater risk of ______
Heart Disease
Stroke
Kidney Disease
90% of patients have _____ hypertension
Primary (essential)
10% of patients have ______ hypertension
Secondary
Underlying causs of secondary hypertension include:
Renal disease
Adrenal disease
OSA
A hypertension diagnosis should be based on the average of ____ BP readings on _____ seperate occassions
2; 2
Normal BP
SBP <120
DBP <80
Elevated BP
SBP 120-129
DBP <80
Stage 1 Hypertension
SBP 130-139
OR
DBP 80-89
Stage 2 Hypertension
SBP 140 or greater
DBP 90 or greater
Lifestyle Management to lower BP
Weight Loss
Heart-healthy diet
Decrease Potassium intake
Reduce Sodium Intake
Routine Physical activity
Limit alcohol consumption
What diet is ideal for patients with Hypertension?
DASH
What is the goal sodium intake for patients with hypertension?
<1500 mg daily
At what stage of hypertension should you start a patient on pharmacological therapy
Stage 1 IF:
- Clinical CVD
- 10-year ASCVD risk
-Does not meet BP goal with 6 months of lifestyle modifications
First Line treatment for pregnancy
Labetalol
Nifedipine ER
Methyldopa
Which medications have a BBW for pregnancy?
ACEs and ARBs
Thiazides MOA
Inhibit sodium reabsorption in the distal convoluted tubule, which causes an increase in excretion of sodium, chloride, water, and potassium
DHP Calcium Channel Blockers MOA
Blocks the calcium ions from entering the vascular smooth muscle which causes peripheral arterial vasodilation causing a decrease in SVR and BP. DHP are more selective for vascular smooth muscles
Non-DHP Calcium Channel Blockers MOA
Blocks the calcium ions from entering the vascular smooth
ACEi MOA
Block the conversion of angiotensin 1 to Angiotensin 2 which causes a decrease in vasoconstriction and decrease aldosterone secretion. It also in turn blocks the break down of bradykinin, which helps with vasodilation
ARB MOA
Block Angiotensin 2 from binding to the angiotensin 2 type 1 receptor on the smooth muscle which prevents vasoconstriction
Potassium Sparing Diuretics MOA
Directly blocks sodium channels in the late distal convoluted tubule and collecting duct of the nephrons
Selective Beta-1 Blockers MOA
Decreases heart rate and myocardial contractility by acting on the beta cells in the heart
Non-Selective Beta Blockers MOA
Decreases heart rate and myocardial contracility by acting on beta cells. Also effects the beta-2 cells in the lungs, which can lead to many different side effects
Alpha-2 adrenergic agonists MOA
Stimulates presynaptic alpha-2 adrenergic receptors in the brain, which decreases the outflow of norepinephrine, leading to a reduced SVR, BP, and HR
Direct Vasodilators
Works directly on the vasulator causing dilation of the arterioles, which causes a decrease in SVR and BP
Hypertensive emergency
BP >180/120 mmHg with end organ damage
How do you treat hypertensive emergency
IV meds only
How much should you decrease a patient’s BP in an emergency situation?
Decrease no more than 25% in the first hour, and then slowly decrease over the next 2-6 hours
Hypertensive Urgency
A high BP but with no end organ damage
How do you treat a hypertensive urgency?
With short acting oral medications
What is the approach for treating an urgency?
Slowly decrease the BP over 24-48 hours
