Module 2: Hypertension Flashcards

Question

Primary HTN Pathophysiology - Endothelial Dysfunction

Answer 1

Endothelial dysfunction  Prolonged vasoconstriction response or reduced vasodilation response  Impaired response to nitric oxide (NO) leads to vasodilation  Elevated endothelin (ET) leads to vasoconstriction

Answer 2

Target organ diseases occur most frequently in  Heart * Coronary artery disease; atherosclerosis * Left ventricular hypertrophy * Heart failure  Brain—cerebrovascular disease * TIA/Stroke; atherosclerosis * Hypertensive encephalopathy; changes in autoregulation

Answer 3

Peripheral vascular disease * Atherosclerosis leads to PVD, aortic aneurysm, aortic dissection * Intermittent claudication  Kidney * Nephrosclerosis leads to chronic kidney disease (CKD)  Eyes—retinal damage * Blurry or loss of vision; retinal hemorrhage  Damaged retinal vessels indicate concurrent damage to vessels in heart, brain, and kidneys

Answer 4

Measurement of BP Labs to: 1) identify or rule out secondary HTN 2) evaluate target organ disease 3) determine CV risk 4) establish baselines before starting therapy Renal function, U/A, BMP, CBC, serum lipid profile, uric acid, ECG, ophthalmic exam Other: Echo, LFTs, TSH

Answer 5

Noninvasive, fully automated system that measures BP at preset intervals over 12 to 24-hour period. Teach patient to hold arm still while device reads BP and keep diary of activities  Other applications for use: * Antihypertensive drug resistance * Hypotensive symptoms with antihypertensive therapy * SNS dysfunction * Episodic HTN * Diurnal variability; nondippers; reverse dippers

Answer 6

Achieve and maintain goal BP  Reduce CV risk factors and target organ disease  Lifestyle modifications * AHA Life’s Simple 7 (1) Manage BP (2) Control cholesterol (3) Reduce blood sugar (4) Get active (5) Eat better (6) Lose weight (7) Stop smoking

Answer 7

Weight reduction  Weight loss of 1 kg will decrease SBP by 1 mm Hg  Calorie restriction and physical activity  DASH eating plan  Fruits, vegetables, fat-free or low-fat milk/milk products, whole grains, fish, poultry, beans, seeds, and nuts Dietary sodium reduction  Less than 2300 mg/day for healthy adults  Less than 1500 mg/day for * Blacks, middle-aged and older, those with hypertension, diabetes, or chronic kidney disease * Salty Six (AHA): bread/rolls, lunch and cured meats, sandwiches, pizza, soup, poultry  Read labels food, OTC meds, and health products (e.g., toothpaste with baking soda) Moderation of Alcohol Intake  Men: 2 drinks/day; women: 1 drink/day  Physical activity  150 minutes moderate or 75 minutes vigorous exercise/wk  Combine moderate and vigorous activities  Age-associated guidelines  Muscle-strengthening activities at least 2 times/wk  Flexibility and balance exercises 2 times/wk; especially older adults (decreased falls) Avoid tobacco products  Nicotine causes vasoconstriction and elevated BP  Smoking cessation reduces risk factors within 1 year

Answer 8

1. Decrease circulating blood volume 2. Reduce SVR (systemic vascular resistance) - resistance to blood flow from systemic vasculature, except for pulmonary vasculature

Answer 9

Give 1st dose at bedtime to reduce first dose BP drop  Watch for syncope * 30-90 minutes after 1st does * Too-rapid increase in dose * Given with other antihypertensive agent(s)  Severe hypotension can occur with phosphodiesterase inhibitors

Answer 10

Meds that inhibit actions of the adrenergic (sympathetic) nervous system Examples: alpha blockers, beta blockers, Alpha 2 agonists, combined alpha and beta blockers Decrease SNS stimulation; work centrally on vasomotor center and peripherally to inhibit NE release or block adrenergic receptors on blood vessel

Answer 11

Prevent conversion of angiotensin I to angiotensin II; reduce vasoconstriction and sodium and water retention (stands for angiotensin conversion enzyme inhibitors) They work by relaxing blood vessels and making it easier for heart to pump blood. ACE inhibitors are often chosen because they not only reduce blood pressure but also have protective effects on the heart and kidneys, especially beneficial in patients with diabetes or mild-to-moderate kidney diseases.

Answer 12

Prevent angiotensin II (a chemical in your body that narrows blood vessels) from binding to receptors in blood vessel walls. This leads to relaxation of blood vessels and a decrease in blood pressure. ARBs are particularly beneficial for patients who experience side effects with ACE inhibitors, as they provide similar benefits but are often better tolerated. They are also an important treatment option for protecting the kidneys in patients with diabetes.

Answer 13

increase Na+ excretion and cause arteriolar vasodilation by preventing the movement of extracellular Ca into cells They work by preventing calcium from entering cells of the heart and blood vessel walls, leading to relaxation of the blood vessels and a decrease in heart rate. This helps lower blood pressure and can improve blood flow.

Answer 14

relax vascular smooth muscle and reduce SVR Directly relax the muscles in the walls of blood vessels, leading to their dilation (widening). This dilation reduces blood pressure by decreasing the resistance against which the heart has to pump

Answer 15

reduce plasma volume by increased sodium and water excretion and reduce vascular response to catecholamines often called "water pills," are a class of medications that promote the elimination of salt (sodium) and water from the body through the urine. They are widely used to treat high blood pressure (hypertension), heart failure, kidney disorders, and sometimes edema (swelling) caused by various conditions. Diuretics work by acting on the kidneys to increase urine production.

Answer 16

nonpharmacologic treatment + 1 first line pharmacologic drug

Answer 17

nonpharmacologic therapy + 2 antihypertensives from two different classifications  If a drug is not tolerated, then another classification will be used  Monthly follow-up visits until at goal BP; then 3 to 6 months  Stage 2 HTN or comorbidities—more frequent

Answer 18

Failure to reach goal BP with appropriate therapy and drug regimen: increased risk of stroke or MI  Causes * Improper BP measurement * Volume overload * Drug-induced or other causes * Associated conditions * Secondary HTN  Treatment: determine cause * Overactive renal nerve - renal nerve ablation

Answer 19

SBP >180 mmHg and/or DBP >120 mmHg  Hypertensive emergency * Target organ damage * Requires hospitalization * Very severe problems can result if prompt recognition and treatment is not obtained  Encephalopathy, intracranial or subarachnoid hemorrhage, HF, MI, Renal failure dissecting aortic aneurysm or retinopathy * Untreated = 79% mortality in one year Hypertensive urgency—more common  No evidence of target organ disease  Hospitalization usually not required  Associated with chronic stable disorders * Stable angina, chronic HF, prior MI or CVA  Hypertensive crisis * History of HTN; not adherent or undermedicated * Cocaine, amphetamines, PCP, LSD leads to seizures, stroke, MI, or encephalopathy

Answer 20

Hypertensive encephalopathy - syndrome  Severe headache, nausea/vomiting, seizures, confusion, coma; retinal changes  Renal insufficiency  Cardiac decompensation - MI, HF, pulmonary edema, chest pain, dyspnea  Aortic dissection - Sudden severe chest and back pain, reduced/absent peripheral pulses

Answer 21

*Treatment related to BP and evidence of target organ disease (When high blood pressure has caused damage to organs like the heart, brain, kidneys, or eyes (known as target organ damage), treatment becomes more urgent and intensive. The goal is to lower the blood pressure to prevent further damage) *IV Drugs, Slow titration; MAP (mean arterial pressure, average pressure in person's arteries during one heartbeat cycle) 110-115 mm HG -MAP = (SBP + 2 DBP) / 3 *this number is for sufficient blood flow to organs without causing further damage Drugs: vasodilators (sodium nitroprusside, help widen vessels), adrenergic inhibitors (reduce affects of adrenaline and similar hormones to lower BP and HR), Ca channel blockers (prevent Ca from entering cells of heart and blood vessel walls, which lowers BP) -have rapid onset, monitor HR and BP q 2-3 min Special considerations: aortic dissection (This is a serious condition where the inner layer of the aorta, the large blood vessel branching off the heart, tears. Blood pressure must be carefully and quickly controlled to prevent further tearing) acute ischemic stroke (In the case of a stroke caused by a blood clot, blood pressure management is complex. While high blood pressure needs to be lowered, it's also crucial to maintain enough blood flow to the brain) post stroke patients (After a stroke, blood pressure management is essential to prevent another stroke and to minimize further brain damage. However, overly aggressive lowering of blood pressure can potentially reduce blood flow to the brain, which is already vulnerable)