Hypertension Update Flashcards
HTN =
High BP defined as SBP >140 or DBP >90
Having been told at least 2 times by health care provider that one has HBP
PreHTN
Gray area of 120-139/80-89
Develops into HTN in 50% of population within 4 yrs
Should be monitored annually
Benefit of lowering BP
Reduction in incidence of stroke, MI, HF
Mechanisms for development of HTN
Complex interplay of individual’s heart and BP
Major Players: CNS, kidneys, Local endothelial factors, genetic, lifestyle
Pathophysiology
In some cases, the arteriolar constriction may be due to some secondary underlying disorder.
CNS and ANS regulate blood pressure through stimulation of alpha and beta receptors on the arterioles and venules.
Kidneys also provide humeral response to maintain blood pressure in the presence of decreased blood flow to the kidneys - results in the release of renin and its subsequent vasoconstrictors, angiotnesin and aldosterone.
Pathologic disruption in any of these systems can lead to hypertension.
Classification
Classification SBP DBP
Normal 160 OR >100
CVD Risk Factors
Hypertension*
Cigarette smoking
Obesity* (BMI >30 kg/m2)
Physical inactivity
Dyslipidemia*
Diabetes mellitus*
Microalbuminuria or estimated GFR <60 ml/min
Age (older than 55 for men, 65 for women)
Family history of premature CVD
(men under age 55 or women under age 65)
*components of metabolic syndrome
Factors that Increase Susceptibility to HTN
Age Ethnicity Less educated Lower socioeconomic status Cigarette smoking Sedentary lifestyle Obesity
Protective Factors Against HTN
Not smoking
Low-fat, low sodium diet
Genetics
Objectives for Eval of pts with Documented HTN
- Assess lifestyle and identify other CV risk factors or concomitant disorders that affects prognosis and guides treatment.
- Reveal identifiable causes of high BP.
- Assess the presence or absence of target organ damage and CVD.
Target Organ Damage
Heart Left ventricular hypertrophy Angina or prior myocardial infarction Prior coronary revascularization Heart failure Brain Stroke or transient ischemic attack Chronic kidney disease Peripheral arterial disease Retinopathy
Symptoms of early HTN
May be asymptomatic
Blurred vision Chest pain Dizziness Dyspnea Fatigue Flushing Headaches Hematuria Muscle cramps Palpitations
Identifiable/secondary Causes of HTN
Sleep apnea Drug-induced or related causes Chronic kidney disease Primary aldosteronism Renovascular disease Chronic steroid therapy and Cushing’s syndrome Pheochromocytoma Coarctation of the aorta Thyroid or parathyroid disease Gout Toxemia of Pregnancy
Drug-induced causes of HTN
Oral contraceptives Steroids NSAIDs Nasal decongestants/cold remedies Appetite Suppressants Sodium bicarbonate products (antacids) Licorice Tricyclic antidepressants Monamine oxidase inhibitors Cyclosporine Erythropoietin
Fam Hx
There is a higher incidence in children who exhibit other risk factors for cardiovascular disease or have hypertensive parents Ask Fam Hx of: Premature Coronary artery disease Peripheral vascular disease Diabetes mellitus Hypertension Stroke, TIA, or seizures Renal disease Dyslipidemia
Dietary History, especially Sodium Cholesterol Fat Alcohol use
