Module 10: Hypertension and Kidney Disease Flashcards
Management of ____ has been one of the success stories leading to the decline in morbidity and mortality of CVD
hypertension
Hypertension is a significant risk factor for
- CVD
- CAD
- congestive heart failure
- renal failure
- peripheral vascular disease
- dementia
- atrial fibrillation
Describe the systolic and diastolic BP for the European Society of Hypertension Classification of Blood Pressure:
- Optimal
- Normal
- High-normal
- Grade 1 (mild hypertension)
- Grade 2 (moderate hypertension)
- Grade 3 (severe hypertension)
- Isolated Systolic Hypertension (ISH)
- Optimal: <120 and/or <80
- Normal <130 and/or <85
- High-normal: 130-139 and/or 85-89
- Grade 1 (mild hypertension): 140-159 and/or 90-99
- Grade 2 (moderate hypertension): 160-179 and/or 100-109
- Grade 3 (severe hypertension): >/ 180 and/or >/110
- Isolated Systolic Hypertension (ISH): >/140 and <90
Describe the systolic and diastolic BP for the JNC (American) Classification of Blood Pressure
- Optimal
- Normal
- High-normal
- Stage 1 (mild hypertension)
- Stage 2 (moderate to severe hypertension)
- Isolated Systolic Hypertension (ISH)
- Optimal: <120 and/or <80
- Normal <130 and/or <85
- High-normal: 130-139 and/or 85-89
- Stage 1 (mild hypertension): 140-159 and/or 90-99
- Stage 2 (moderate to severe hypertension): >/160 and/or >/100-109
- Isolated Systolic Hypertension (ISH): >/140 and <90
What is MRFIT
Multiple Risk Factor Intervention Trial
Determined from a cohort of 347 978 men screened for the Multiple Risk Factor Intervention Trial (MRFIT) and followed for an average of 12 yrs, is SBP or DBP a stronger predictor of death from CAD?
SBP
Describe the Impact of High-Normal Blood Pressure on the Risk of Cardiovascular Disease
Background:
Info limited regarding the risk of CVD in persons with high normal BP (SBP of 130-139 mm Hg, DBP of 85-89 mm Hg, or both).
Conclusions:
High-normal BP is associated with an inc risk of CVD. Our findings emphasize the need to determine whether lowering high-normal BP can reduce the risk of CVD
Describe the auscultatory method
a
What is the most common method to measure BP?
oscillometric method
What is the oscillometric method
uses an electronic sensor to detect blood flow
Describe the steps to use the oscillometric method
- The cuff is inflated to a pressure initially in excess of the systolic arterial pressure, and then reduces to below diastolic pressure over a period of about 30 secs
- The values of systolic and diastolic pressure are computed, not actually measured from the raw data, using an algorithm; the computed results are displayed.
During what 2 occasions in the oscillometric method is the cuff pressure essentially constant
When blood flow is nil (cuff pressure exceeding systolic pressure) or unimpeded (cuff pressure below diastolic pressure)
What happens to the cuff pressure when BF is present?
When blood flow is present, but restricted, the cuff pressure, which is monitored by the pressure sensor, will vary periodically in synchrony with the cyclic expansion and contraction of the brachial artery, i.e., it will OSCILLATE.
Most automatic blood pressure cuffs use _____ method.
oscillometric
almost all clinical studies looking at the prognosis value of hypertension and treatment outcomes use the _____ methodology
auscultatory
Oscillometric monitors may produce inaccurate readings in patients with what kind of heart and circulation problems
- atherosclerosis
- arrhythmia
- pre-eclampsia
- pulsus alternans
- pulsus paradoxus
Because different oscillometric BP cuffs may have different readings, what must be done?
Therefore, it is important to calibrate these automatic BP machine’s readings with the auscultatory method.
What is the most accurate way of measuring blood pressure?
put a catheter into the artery and measure the pressure with a pressure transducer
Problem with measuring BP using a catheter and pressure transducer?
invasive procedure and is usually reserved for patients requiring careful and instantaneous monitoring of blood pressure
It is increasingly recognized that B{ recorded in the ambulatory setting is more accurate in determining outcomes. How to measure BP outside of a healthcare professional’s office?
Either a 24-hour ambulatory BP recording device or the patients can use a home device. As these devices use oscillometric methodology to measure blood pressure, it is important to calibrate these devices against the auscultatory methodology.
In patients without diabetes, hypertension is defined by the Canadian Hypertension Society and the UK National Institute for Health and Clinical Excellence as
greater than 140/90
The classification of BP is based on how many measurements?
the average of two or more properly measured BP values from two or more clinical encounters
Patients with high blood pressure and the following conditions are considered to have hypertension urgency/emergency and should be sent to the emergency room for evaluation:
- Systolic BP>200 diastolic BP>130
- Accelerated or malignant hypertension with papilledema
- Hypertensive encephalopathy
- Intracranial or subarachnoid hemorrhage
- Acute aortic dissection
- Acute refractory LV failure
- Renal crises from collagen vascular disease
- Pheochromocytoma
- Rebound hypertension from cessation of clonidine
- Eclampsia (rare but serious condition where high BP results in seizures during pregnancy)
- Severe hypertension in patients requiring emergency surgery
- Severe epistaxis
In patients with diabetes, the threshold for diagnosis is set at what BP?
lower at 130/80