Lust 3

Question 1

HTN in the US

Answer 1

• HTN
  
  • major risk factor for
    
    • heart disease (3x to die from)
      
      • # 1 cause of death
    • stroke (4x to die from)
      
      • # 4 cause of death
  • 1 in 3 adults have high BP
  • 1,000 deaths per day
  • w/ 1st heart attack-69%
  • w/ 1st stroke-77%
  • w/ Chronic Heart Failure-74%

Question 2

BP Categories

Answer 2

Question 3

2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults

Answer 3

• Newer guidelines, no prehypertensiveness
• increased responsiveness of providers
• Get BP several times, including out of office

Question 4

Where does HTN develop?

Answer 4

• CNS
  
  • increase sympathetics or decrease parasympathetics
  • reduce sensitivity of receptors
• Vessels
  
  • increase endothelin: Contributes to better contractility
  • hypertrophy associated w/Type 2 diabetes

Question 5

If BP is increased, at least one must be present:

Answer 5

• increased Cardiac Output
• Increased Vascular Resistance
• Increased Fluid Volume

Question 6

What impacts BP

Answer 6

• HR = heart rate
• SV = stroke volume
• CC = cardiac contractility
• VR = venous return/ preload
• PSNS = parasympathetic nervous system
• SNS = sympathetic nervous system

Question 7

how can we manage BP

Answer 7

• drugs decrease BP

Question 8

Why do we worry about HTN as a disease

Answer 8

• Wearing out the heart higher O2 requirement
  
  • heart failure
  • ischemia and infarction
  • injury and repair leads to athlersclerosis
• elevated pressure weaknes walls
• most individuals dont have regular health check-ups

Question 9

What are the characteristics of primary essential Hypertension:

Answer 9

• 80-95% cases of elevated BP
• complex interaction- multiple genetic and enviromental factors
  
  • race
  • gender
  • Dietary Salt
  • Weight
  • Diabetes
  • EtOH
  • Smoking
  • Activity Level

Question 10

Characteristics of Secondary Hypertension:

Answer 10

• 5-20% cases of elevated BP
• Specific underlying disorder
  
  • renal artery stenosis
  • renal parenchymal disease
    
    • Glomerulonephritis
    • polycistic kidney disease
  • Endocrine
    
    • increased aldosterone
  • Steroids
  • Contraceptives
  • NSAIDs

Question 11

What are the first line drugs for Hypertension?

Answer 11

• For CAD, MI, heart failure=ACE Inhibitors
  
  • But in renal artery stenosis, ACE inhibitors
    
    • new onset renal failure
    • Increase in plasma creatinine after drug is started
      
      • Why? prevents efferent constriction=GFR decreases

Question 12

How does Angiotensin help with Renal artery stenosis?

Answer 12

• Efferent Arteriole constricts

Question 13

Stroke: Epidemiology

Answer 13

• # 3 cause of death in US
• 600,000+ new or recurrent strokes/year
• over half significant disability
• risks:
  
  • Age:
    
    • >70% of strokes in 65+
  • atherosclerotic risk factors
  • 70% of strokes associated with HYPERTENSION
  • Sex and Race
    
    • < 60: Female>Male
    • >60: Male> Female
    • AA>>Caucasian
      
      • both genders
      • incidence and mortality

Question 14

Strokes: Risk Score Card

Answer 14

• High Risk >3
  
  • make appointment today
  • talk to healthcare provider immediately
  • ask about stroke prevention plan
• Caution: 4-6
• Low risk 6-9