Hypertension Part 1 Flashcards
What is hypertension? What do you need to diagnose it? What is the exception to this diagnosis?
RECURRENT, not one reading.
It is a quantitative reading that measure the force of blood against arterial walls - must have two or more seated BP readings during outpatient/ in home readings.
Only caveat is a hypertensive emergency.
What patient risks can cause different levels?
Based on mobility/mortality
DM status
What is the systolic vs diastolic BP rubber band analogy?
Systolic (where a rubber band is stretched)
Diastolic (where it is relaxed like letting go of a rubber band)
What is the general difference between primary vs secondary
primary: just HTN
secondary: due to another underlying cause
What are some lifestyle ways to reduce HTN
Exercise
Losing weight
DASH diet (low salt)
Alcohol/caffeine reduction
What are the blood pressure classification for ACC/AHA
Highest number wins (if you have one of the higher numbers, that will dictate the stage of HTN)
Normal <120 AND <80
Elevated 120-129 AND < 80
HTN
Stage 1: 130-139 OR 80-90
Stage 2: 140 or more OR 90 or more
In general, how much does one med reduce BP by?
10 mmHg - which is why you need to be more aggressive with higher stages of HTN
What are some primary HTN? How common is this?
Genetic (multifactorial) no single, reversible cause identified
Accounts for 95% of cases
What are some secondary causes of HTN?
DEFINABLE cause:
1. Meds - birth control, stimulants
2. CKD (should look at BMP or CMP)
3. Renal artery stenosis (does not get enough perfusion, and then it uses the RAAS, jacking up BP)
4. Cushing disease (striae, cushinoid facies)
5. Coarctation of the aorta (because the aorta is occluded)
6. Pheochromocytoma (rare)
7. Hyperaldosteronism
8. Obstructive sleep apnea (d/t not enough oxygen, really important to get undercontrol)
9. Hyper or hypothyroidism (should get a TSH and T4)
How would you approach primary vs secondary?
Changing meds
Lifestyle changes
Manage the blood pressure with meds for both most of the time
How does age affect BP? How is this different for patients <50 vs > 60? Does this change treatment?
Older patients >60
- Vessels do not stretch as they used to
- Lumen narrows because of plaque build-up
Systolic BP rises, without rise in diastolic pressure
Predominantly caused by arterial stiffness
Not associated with OSA
Young patients <50
Systolic and diastolic BP increase
Often associated with OSA
No distinction for treatment, but sometimes older patients get hypotensive, so there are often managed differently
What are some causes of isolated systolic hypertension in older vs younger patients?
systolic BP is >140, but diastolic is <90
Occurs more often in older patients
Results from arterial stiffness and atherosclerosis
Can occur in younger patients
MC in athletic males
Likely due to high stroke volume.
Is systolic or diastolic reading more important for long term outcomes? Why? Is this different for younger patients?
Systolic in older patients - because it shows how hard your heart is working.
Diastolic in a younger patient
Now thought that DBP is a better predictor for patients <45 y/o and SBP is a better predictor for patients >60 y/o
What is white coat hypertension? How do you manage this? Who is it more common in?
Persistently elevated BP > 140/90 in the office, but a lower value outside of the clinic.
Research suggest as long as numbers are within range at home*, treatment is not necessary
Long-term monitoring required!
Cuff comparison key!
MC in older patients
What is Masked hypertension? Should you treat?
Opposite of white coat hypertension. Rare. Normal BP in the office, but elevated values at home.
Often an error in giving the information, usually lifestyle (alcohol use, tobacco use, caffeine consumption, etc.) problem or cuff problem.
What is psedohypertension? What are the s/s of this?
Not getting an accurate reading from the cuff d/t calcification of peripheral vessels.
High blood pressure readings, but inside the blood vessel is low because of how calcified vessels.
High BP but have hypotension s/s
What populations tend to have HTN? Men/women?
- Most populations have HTN
- SBP is higher in men in early adulthood
- Age-related rise in BP higher in women
How does DBP change as we age? What does this result in?
What race has the highest incidence of HTN? How does that change treatment?
Non-hispanic blacks d/t difference in kidneys.
Typically start on calcium channel blockers or thiazides as they are more potent.
What is the equation for BP?
BP = CO x systemic vascular resistance
What are the general pathogensis of primary HTN?
complex interactions between multiple genetic, endogenous, and environmental factors
What are the 5 different specific pathogenesis of primary hypertension?
- Sympathetic nervous system hyperactivity
- Renin-angiotensin system activity
- Defect in natriuresis (sodium excretion)
- Abnormal cardiovascular or kidney development
- Elevated intracellular calcium and sodium levels
What causes Sympathetic Nervous System Hyperactivity leading to HTN? Who is it MC in?
Fight or Flight”
Acetylcholine and norepinephrine release
Most apparent in younger patients
Typically present with tachycardia and elevated cardiac output
How does the renin-angiotensin system lead to HTN? How do we stop this?
Retention of sodium
ACE inhibitors that stop Angiotensin I going to Angiotensin II
How does the Pathogenesis of HTN - Natriuresis Defect
↑ salt intake triggers ↑ in BP which promotes ↑ natriuresis to bring BP values back into normal range
Defects in this process result in HTN
