Lecture 29: Hypertension Flashcards
Determinants of arterial pressure equation
MAP = CO x TRP
Arterial pulse wave
Systolic pressure at top, pulse pressure is systolic-diastolic pressure, diastolic pressure at bottom
Systemic resistance: the balances what?
Constrictors (alpha agonists, etc) vs dilators (beta 2 antagonists)
What happens when aorta/large arteries get stiffer?
Larger pulse pressure/systolic pressure
Normal BP
Less than 120/80
High-normal
120-139 / less than 90
White coat hypertension
Clinic >140/90, home or day less than 135/85
Masked hypertension
Clinic less than 140/90, home or day >135/85
Sustained hypertension
Both clinic and home elevated
Resistant hypertension
Clinic and home elevated >140/90 despite adequate treatment of 3+ drugs
What three factors play a role in converting pre-hypertension to hypertension?
Age, weight gain, high salt intake
By the time someone is 90 years old, what % has HT?
90%
What two fatal diseases is HT associated with?
Stroke and ischemic heart disease
What are other consequences of HT
Cardiac disease (CHD, LV hypertrophy, CHF, arrhythmias, SCD); impaired renal function; atherosclerotic pathology; aorta dissection; vascular dementia
What do you consider when evaluating a hypertensive patient?
Average BP (clinic, home); risk factors (smoking, lipids, diabetes); target organ damage indicators; identifiable causes (rare)
Identifiable common HT causes (2)
Obesity, sleep-apnea syndrome (these are associated)
Identifiable less common HT causes (3)
Renal artery stenosis, primary aldosteronism, chronic renal disease
Identifiable rare HT causes (5)
Drugs (diet pills, cocaine), genetic syndromes (Liddle’s), Cushing’s syndrome, Pheochromocytoma, polycystic kidney disease
What is the physical finding for renal artery stenosis?
Bruit in upper abdomen
Genetic disease causing HT: describe. Is it frequent? Name of disease?
Gain of function mutation of Na+ channel in collecting duct leading to increased # channels –> too much Na+, K+ excreted –> high BP; very rare; Liddle’s Syndrome
HT treatment: lifestyle improvement
Weight reduction and lower salt intake via diet and exercise; smoking cessation, stress reduction
Take home message about lifestyle improvement
Most with sustained hypertension will benefit from drug treatment; life style improvement is helpful, but rarely enough
Drug classes approved for HT treatment (6)
- Diurects; 2. RAS blockers (ACE-I, AII receptor blockers, direct renin inhibitors); 3. Ca2+ channel blockers; 4. Catecholamine receptor blockers (alpha/beta receptor blockers); 5. Direct vasodilators; 6. Centrally acting agents
T/F: Hypertensive medication is not very effective
False! They work well, often in combination. Reduce stroke and MI, even if very old patients
