Hypertension Q2L Flashcards
What is the prevalence of HTN in the US?
15% or 60 million people (pg 227)
What are the long term complications of HTN?
Cerebrovascular accidents (strokes), congestive heart failure, myocardial infarction, and renal damage. (pg 227)
What stage of HTN is 121/101?
Stage ll (pg 228). Remember we always classify it in the higher stage (systolic vs diastolic). Here, diastolic is just barely into stage II.
What are the different categories of hypertension?
Primary or indirect (essential), >90%, ex: smoking, obesity, hyperlipidemia, diabetes
Secondary or direct, <10%, ex: kidney disease
How does HTN affect the heart? Blood vessels?
Makes the heart work more to pump against a higher resistance (after load). Can create blocked arteries and cause heart failure. Heart enlarges with the increased load (hypertrophy) and may cause low O2 and nutrients (low perfusion) to the cells in the middle of the thicker muscle.
Stretch and small tears of vessels which turn to scar tissue; damage of endothelial cells of vessels. It also speeds up hardening of arteries (atherosclerosis). Hypertensive retinopathy, nephropathy.
How is arterial BP regulated? Where are the baroreceptors?
BP is sensed from baroreceptors (in aortic arch and carotid sinuses) and via neural signals shift effector mechanisms (ex: renin-angiotensin-aldosterone, shifts of ions in kidney to change blood volume, or even simple vessel constriction/dilation). Change cardiac output and peripheral resistance.
How does the body achieve compensatory rise in BP?
Sympathetic innervation has increased heart rate via beta receptors, contract smooth muscle for increased peripheral resistance. (vasoconstriction)
Kidney ‘recognizes low blood flow’ and increases blood volume (increased water and salt retention and release of renin).
What does lifestyle modification entail?
Eating less salt (ex: DASH diet) and exercising more. Also, lowering primary risk factors (e.g. cessation of smoking). Nuts, whole grains, fruits, veggies
Why patient compliance is low in treating HTN? Why is it similar to glaucoma therapy?
Patients may not comply w/o experiencing symptoms. Drugs cost money and have side effects without providing any immediate and appreciative gain.
What are risk factors for hypertension?
Family history, blacks have essential hypertension four-fold more frequently than whites, more frequent in middle aged males than middle aged females, obesity, increased age, stressful lifestyle, high sodium intake and smoking. (pg 228)
What is lifestyle modification? When is it recommended?
Reducing risk and possible causes of hypertension. Recommended when patient is prehypertensive or greater. If familial, a patient may want to modify lifestyle before signs/symptoms occur.
What is usually the first line therapy for HTN?
Thiazide Diuretics
What are the different classes of diuretics and their MOAs?
Loop diuretics—works on ascending limb of the loop of Henle to inhibit sodium and chloride reabsorption
K+ sparing diuretics—inhibit sodium reabsorption in the collecting duct (normally it would reabsorb Na+ by exchanging it for K+)
Thiazide—Inhibition of reabsorption of Na+ and Cl- in the distal convoluting tubule, resulting in retention of water in tubule (Most commonly used diuretic for HTN)
What is MOA for BBs? Why is B1B preferred? What are SE of BBs?
Decrease heart rate as blocking beta receptors to slows the heart.
B1B (beta 1 blockade) are more specific to heart : metoprolol
SE: hypotension, fatigue, sexual dysfunction, bradycardia, insomnia
What is MOA for ACEi? SEs?
ACE inhibitors block angiotensin I from turning into angiotensin II which would normally increase BP.
SE: dry cough, skin rash, fever, hyperkalemia (high K+), hypotension
