Module 4B: Hypertension Flashcards
MAP
average arterial pressure in one cardiac cycle
normal MAP
60-100 mmHg (<60mmHg → inadequate organ perfusion & >105mmHg → increased cranial pressure
pulse pressure
PP = SBP - DBP (normal 30-40 mmHg)
PP <30mmHg
serious ↓ CO, causes ↓ stroke volume, systolic obstruction of blood flow (shock, hypovolemia, stenosis)
PP >40mmHg
↑ stroke volume, systemic vascular resistance, ↓ distensibility of arteries
primary hypertension
no identifiable cause, 95% of cases
secondary hypertension
identifiable cause (secondary to a disease), risk factors: kidney disease, adrenal disease, pregnancy, aortic stenosis)
white coat hypertension
irregular blood pressure when visiting the doctor (unexpected anxiety)
isolated systolic hypertension
normal diastolic with an increased systolic measurement
malignant hypertension
high BP undetected in clinical settings, unobservable in clinical settings and BP at home is elevated (d/t lifestyle factors)
hypertension diagnosis
people w/o diabetes → AOBP of 135/85 or higher and non-AOBP of 140/90 or higher
people w/ diabetes → AOBP (or non-AOBP) of 130/80 or higher
hypertension s/s
usually asymptomatic, breathlessness, headache, bleeding from nose, blurred vision, fatigue, tinnitus, profuse sweating, nocturia
hypertension concerns
target organ damage, ↑ stress on heart causes left ventricular hypertrophy, ↑ stress on blood vessels causing atherosclerosis, CVA, and MI, renal disease and retinopathy
hypertension modifiable risk factors & prevention
stress, abdo obesity, smoking nicotine products, heavy ETOH consumption, stress/anger response, poor dietary habits, low dietary intake of K+, Ca, Mg, sedentary lifestyle, oral contraceptives
hypertension non-modifiable risk factors
risk increases with age, male ↑ incidence before 55, female ↑ incidence after 55, family history/genetics, glucose intolerance, immigration-related changes in socioeconomic status
hypertension diagnostics
urinalysis, electrolytes + fasting blood glucose, renal fxn, lipid profile (chol, HDL, LDL, triglyceride), CRP, 12-lead ECG, echocardiogram, angiogram
3 steps to prevent hypertension
- lifestyle
smoking cessation, ↓ ETOH use (1-2 drinks/day), diet/weight loss (DASH), exercise (light weights/aerobic), blood glucose control for people w/ diabetes, pt education - medication
start with one drug at a low dose and increase if necessary - combination of medications
addition of a second anti-hypertensive medication until results are achieved
hypertension patient teaching & learning
learning assessments (HTN & target organ damage) → heart, brain, kidney, PVD, retinopathy
assessment of barriers to medication compliance → simplify regimen, collaboration, family, support groups
teaching regarding medications and self-monitoring BP and side effects
diuretics
lower BP → reducing blood volume through excretion of water and sodium through urine
assessments → BP, lab values, weights, I/O, K+ levels
side effects → hypotension, electrolyte imbalances, dehydration
e.g., furosemide
beta blockers
lower BP → selective (b1 only) and non-selective (b1+2) and blockage of b1 receptors causes ↓ HR, reduced force of contraction, reduced impulse conduction through AV node
assessments → pt specific parameters for holding med, BP + HR if SBP is less than 90 and/or HR <50 bpm
side effects → hypotension, dizziness, bradycardia
e.g., atenolol, metoprolol, propranolol
angiotensin-converting enzyme inhibitors (ACE inhibitors)
MOA → inhibit ACE by stopping conversion of angiotensin I to angiotensin II causing vasodilation and ↓ blood volume
assessments → BP, labs
side effects → hypotension, ↑K+, cough, angioedema
e.g., enalapril, captopril, ramipril, quinapril
angiotensin II receptor blockers (ARB)
MOA → block action of angiotensin II at receptor site
assessments → BP, labs
side effects → hypotension, do not often cause significant ↑ K+, lower incidence of dry cough
e.g., atacand, coxar, micardis, candersartan
calcium channel blockers
MOA → relaxation of vessel walls through blocking of calcium ion channels
assessments → BP, HR
side effects → hypotension, worsen HF
e.g., diltiazem, verapamil, amlodipine, felodipine
direct vasodilators
MOA → direct peripheral arterial dilation and used in hypertensive crisis
assessments → BP q5 min if given IV, watch for reflex tachycardia
side effects → rapid hypotension, reflex tachycardia, headache, dizziness
e.g., hydralazine, nipride
orthostatic hypotension
change in BP from lying to standing (wait 2-3 mins between taking BP), ↓ SBP </= 20 mmHg ↓ DBP >/= 10 mmHg
orthostatic hypotension causative factors
prolonged best rest, aging, tall thin people (adolescents w/ low BP), some medications (diuretics), hypovolemia
orthostatic hypotension & learning
instruct pt to sit, stand, then start, walk slowly if orthostatic drop, use a walker or cane as needed for balance, teach expected symptoms → dizziness, lightheaded and possible syncope
hypertensive emergency
blood pressure is elevated with evidence of actual or probable target organ damage
hypertensive urgency
blood pressure is elevated but there is no evidence of target organ damage
hypertensive disorders during pregnancy
chronic hypertension (pre-pregnancy HTN), gestational hypertension, pre-eclampsia
hypertension in pregnancy complications
acute renal failure, death or pregnancy pt, pulmonary edema, HELLP syndrome, cerebral edema w/ seizures, higher rates of infant mortality, placental abruption, pre-term abruption, intrauterine growth restriction, acute hypoxia in fetus
non-severe BP in pregnancy
BP >/= 140/90, abnormal fetal HR, ↓ placental perfusion, possible oligohydramnios (low amniotic fluid)
severe BP in pregnancy
BP >/= 160/110, ↓ placental perfusion (intrauterine growth restriction), late decelerations in fetal HR in labour, obstetrical emergency
gestation hypertension
BP = 140/90, no proteinuria or edema, BP returns to normal after birth, not usually associated w/ fetal growth restriction
pre-eclampsia w/o severe features
BP 1400-150/90-109, proteinuria, mild edema, can be asymptomatic
pre-eclampsia w/ severe features
BP >160/>110, severe headache + visual disturbances, confusion, hyperreflexia, RUQ abdo pain, nausea. vomiting, dyspnea, ↑ proteinuria, oliguria, altered renal fxn. extensive peripheral edema
eclampsia
cerebral edema is so acute causing grand-mal seizures or coma & fetal prognosis is poor d/t hypoxia + consequent fetal acidosis
hypertension in pregnancy management
monitor BP, assess deep tendon reflexes, monitor fetal health status (fetal HR, fetal growth), monitor placental abruption (in pre-eclampsia), activity restriction for pts w/ pre-eclampsia, diet (no sodium restrictions but avoid excessively salty foods)
hypertension in pregnancy pharmacological management
magnesium IV (prevent/control seizure), anti-hypertensives, corticosteroids to accelerate fetal lung maturity (if risk of giving birth 5wks before due date)
