Hypertension Part 1 Flashcards
What are the major forms of CD? (HIP-HA)
Hypertension Ischemic heart disease Peripheral vascular disease Heart failure Atherosclerosis
What is the leading cause of death in Canada? Second leading cause?
Cancer
CVD
Why are CVD now second leading?
CVD much better diagnosed, better medications and medical treatment
What was they key point in the graph comparing men and women and prevalence of HTN?
- Men linearly increases
- Women increase, but flatten over time
Why are both trends upwards in HTN and gender?
Probably associated with the increase in obesity, as obesity is a major cause of hypertension
Are most people aware of their HTN?
Yes 65% treated and aware, but 18% unaware - meaning that the prevalence of HTN could actually be greater
Development of HTN is very much based on what?
Age
Stat of HTN and Age?
Lifetime risk for adults aged 55-65 y/o with NORMAL BP to develop HTN is 90%
HTN Affect …
1/5 of Canadians
22% of adults > 20 y/o
HTN risk similar between ….
Men and post-menopausal women
1 reason of doctor visits Canada?
HTN
Rates of HTN increase and decrease in which ethnicities?
Increase in blacks
Decrease in chinese, korean
BP=
Cardiac output x peripheral resistance
CO=
Heart rate x stroke volume
PR=
Length of vessel x viscosity of blood / radius ^4
How is radius determined?
By vasonconstriction or vasodilation of blood vessels
An increase in ____ will increase BP
- Heart rate
- Stroke volume
- Viscosity of blood
- Length of vessel
A decrease in ___ will increase BP
-Radius of blood vessel
What are some major factors involved in the regulation of Mean Arterial Blood Pressure?
- Sympathetic nervous system
- RAAS
- Renal function
- Epi, vasopressin, Ang II
Explain what influences cardiac output (SRC-B)
Primarily determined by heart rate and stroke volume. heart rate influenced by nervous system (sympathetic and parasympathetic), where the stroke volume is influenced by SNS and venous return, Venous return influenced by skeletal muscle, respiratory, cardiac suction and blood volume.
Explain what influences peripheral resistance
Radius is under local metabolic control which is influenced by skeletal muscle, and extrinsic vasoconstriction control which is mediated by SNS and epi, vasporessin, Ang II which will influence RAAS system. Viscosity will be determined by hydration status and # of RBCs.
Main effects of increase SNS and Epi
- Increase HR
- Increase SV
- Increase extrinsic vasoconstriction
- Decrease radius
- Increase BP
Explain RAAS in 3-4 sentences
Decrease in sodium in ECF and circulation - where baroreceptors in Kindey detects decrease in BP. Kidneys secrete renin, allow for conversion of ANG (Liver) –> Ang I. Ang-1 –> Ang II possible by ACE-1 released by lungs. ANG-II is a potent vasoconstrictor, will increase BP.
Effects of ANG II
- Stimulate adrenal cortex to release aldosterone (increase sodium pumps)
- Vasonstriction
- Thirst
- Pituitiary to release vasopressin (more water reabsorption, increase BV_
HTN is ….
Asymptomatic
Primary HTN
Unknown etiology or gene/environment, dietary, behavioural causes
Secondary HTN
Symptom from another disease - renal, endocrine, neurological
Non-modifiable risk factors?
- Age < 60y/o
- Men, post-menopausal women, ethnicity
- Family history
Modifiable risk factors?
- Smoking
- Sedentary
- Abdominal Obesity
- Excessive Sodium
- Poor diet quality
- Stress
Normal SBP
90-119
Pre HTN SBP
120-139
Stage 1 SBP
140-159
Stage 2 SPB
160-179
Stage 3 SBP
> 180
Normal DBP
60-79
Pre HTN DBP
80-89
Stage 1 DBP
90-99
Stage 2 DBP
100-109
Stage 3 DBP
> 110
What is TOD?
Target Organ Damage
What kind of major TOD may result from HTN or may put patients at a higher risk for HTN complications?
- Coronary Artery Disease
- Left-ventricular hypertrophy
- Heat Failure
- Stroke
- Transient Ischemic Attack
- Hemorrhage
- Demential
What kind of mino TOD may result from HTN or may put patients at a higher risk for HTN complications?
Retinopathy
Peripheral Artery Resistance
Nephropathy (Albuminuria, Chronic Kidney Disease)
What classifies a high risk patient?
One or more of the following:
- Clinical or subclinical CVD risk
- Chronic Kidney Disease
- FRS global CVD risk >15%
- Age >/= 75
What is considered Chronic Kidney Disease?
- Non-diabetic neuropathy
- Proteinuria <1g/dl
- GFR 20-59 ml/min/1.73m^2
What classifies a moderate/high risk patient?
-Multiple CVD risk FACTORS
and FRS global CVD risk >15%
What classifies a low risk patient?
-No CVD risk factors or TOD
How is DM classified?
High Risk
Initiation of treatment for High Risk patient
130 SBP
Initiation of treatment for DM patient
130/80
Initiation of treatment for Mod/High risk patient
140/90
Initiation of treatment for Low risk patient
150/100
Target for High Risk Patient
120 SBP
Target for DM
130/80
Target for Mod/High risk
140/90
Target for Low risk
140/90
(T/F) BP Threshold and targets for High Risk patient based on non-AOBP
False, based on AOBP
(T/F) BP Threshold targets for DM, Mod/High and Low risk patient based on non-AOBP
True