LEC 3: Hypertension Flashcards
What causes arterial blood pressure to rise?
For arterial blood pressure to rise, there is either an INCREASE in:
- Cardiac Output
- Systemic Vascular Resistance
What is considered to be a high normal blood pressure?
Hight Normal:
- Systolic Blood Pressure: 130 to 139 mmHg
- Diastolic Blood Pressure: 85 to 89 mmHg
*Follow up in 1 hour
When would you re-check a patients blood pressure if they where high normal?
Follow up in 1 hour
What is considered persistent elevation of blood pressure?
- Systolic Blood Pressure: Greater than or equal to 140 mmHg
- Diastolic Blood Pressure: Greater than or equal to 90 mmHg
*Need to do 2 or more readings after initial screening
How many more reading do you need to do when the patient has persistent elevation of blood pressure?
Need to do 2 or more readings after initial screening
Hypertension Increases With:
a. Age
b. Ethnicity
- African
- Indigenous
c. Family history/ genetics
d. Gender
- Men until age 55
- Women after age 55
e. Lifestyle
- Smoking
- ETOH
- Obesity
- SES
- Stress
- Inactivity
f. Diabetes
Hypertension Decreases With:
a. Prevention measures/ awareness
b. Medications
c. Lifestyle changes
Pathophysiology of Hypertension
- Heredity: 40% of family history
- Na and H2O retention
- Stress and increased SNS activity: Flight or Fight
- Altered Renin-Angiotension-Aldosteron mechanism
- Insulin resistance and hyperinsulinemia
What are the two types of hypertension?
- Primary (essential) hypertension
2. Secondary hypertension
Primary Hypertentsion
- Referred to as the “silent killer” because patients are frequently ASYMPTOMATIC until target organ disease occurs
- Symptoms are often secondary to target organ disease and can include:
- Fatigue, reduced activity tolerance
- Dizziness
- Palpitations, angina
- Dyspnea
- Headache - Elevated blood pressure WITHOUT in identified cause
- 90 to 95% of patients
Secondary Hypertension
- Elevated blood pressure WITH a specific cause that can be identified and corrected
- 5 to 10% of patients
- Some causes of increased blood pressure are:
- Coarctation of the aorta
- Renal artery stenosis
- Brain tumors - Treatment is to eliminate cause
What are the target organ damage that occur with hypertension?
- Cardiac disease
- Cerebrovascular disease
- Peripheral vascular disease
- Renal damage
- Retinal damage
Collaborative Care: Assessment & Diagnosis
- Health history
- Head to toe assessment
- Multiple blood pressure readings over several weeks
- Labe test:
- Urinalysis
- K+
- Na+
- Creatinine
- Fasting glucose
- Cholesterol & triglyceride levels - ECG
Collaborative Care: Nursing Interventrions
- Assess the risk
- Monitor blood pressure regularly - Encourage lifestyle modifications
- Physical activity
- Weight reduction
- Reduced alcohol intake
- Health eating/ low sodium diet
- Relaxation therapy
- Smoking cessation - Patient adherence to treatment plan
- Drug therapy
What are the two main factors of drug therapy in hypertension?
- Reduce systemic vascular resistance
2. Decrease circulating blood volume
What do diuretics do?
Decrease blood volume
What do vasodilators do?
Dilate blood vessels, which allows blood to flow more easily. They’re used to treat or prevent high blood pressure (hypertension)
What are examples of vasodilator drugs?
- Beta blockers
- Calcium channel blockers
- Angio retention blockers
What is the goal of drug therapy in patients with hypertension?
- Get blood pressure below 140/90 mmHg
- Goal in diabetic patients: get blood pressure below 130/80 mmHg
- Goal in patients at high risk for CAD complications: Get systolic blood pressure below 120 mmHg
Drug Treatment of Hypertension
a. Lifestyle modification
b. Initial drug therapy
* Usually start with beta blocker or diuretic
- Thiazide diuretic
- ACE-I
- ARB (angiotensin receptor blocker)
- Long acting CCB (calcium channel blocker)
- Beta blocker
c. Dual combination
* Give the beta blocker or diuretic a few months to see if it works, may add a second medication, wait etc.
d. Triple or quadruple therapy
What are the key points to hypertension?
- Hypertension is a persistent elevation of blood pressure
- Most commonly primary hypertension
- Symptoms often asymptomatic until target organ damage
- Overall goal is to achieve and maintain target blood pressure
- Lifestyle modifications and drug therapy often both needed to achieve target blood pressure
- Adherence to drug therapy an issue
