Pathophysiology and Pharmacotherapy of Hypertension Flashcards
What is the most common and modifiable cardiovascular disease (CD) risk factor
Hypertension
What percentage of adult americans have hypertension
33%
CVD risk doubles when Systolic Blood Pressure and Diastolic Blood Pressure is raised by what increments and at what blood pressure
SBP: 20 mmHg, DBP: 10 mmHg, 115/75
What are common CVD risk factors for hypertensionthat are modifiable
Smoking, unhealthy diet, physical inactivity, DM2, Dyslipidemia
What are fixed CVD risk factors for hypertension
increased age, family history, CKD, being male, emotion, race
What is primary hypertension, what is the goal for a patient with primary hypertension
high blood pressure that doesn’t have a known cause, control the blood pressure
What is secondary hypertension, what is the goal for patient with secondary hypertension
Comorbid condition or medication contributes to the hypertension, remove causative agent or treat underlying condition
What medications that may cause secondary hypertension
Ampethamines, steroids, calcineurin inhibitors, decongestants, NSIADS, estrogen
What food may cause secondary hypertension
Sodium, Alcohol, Black Licorice
What disease complications can hypertension lead to
Stroke, Retinopathies, Heart attack, CKD, Hardened arteries
What is the equation that determines blood pressure
Blood Pressure = Cardiac Output (CO) X Peripheral Resistance (PR)
What is the equation that determines Cardiac Output
Cardiac Output = Stroke Volume (SV) X Heart Rate (HR)
What determines the peripheral resistance
Vascular structure and Vascular Function
What is systolic Blood pressure
Peak value during contraction
What is diastolic Blood pressure
Peak value during rest/cardiac chamber filling
What is the main neurotransmitter of the parasympathetic nervous system, how does it influence Heart Rate
Acetylcholine, decrease Heart Rate
What is the main neurotransmitter of the sympathetic nervous system, how does it affect the heart
Norepinephrine/Epinephrine, increase heart rate and stroke volume and peripheral resistance
What causes increased cardiac output
increased sodium intake/retention, increased renin-angiotensin-aldosterone system (RAAS) stimulation, increased sympathetic nervous system
What causes increased peripheral resistance
Vascular contrstiction and/or vascular hypertrophy, genetics
What are the steps of the RAAS
Renin converts the angiotensinogen into angiotensin 1 -> angiotensin 1 is converted to angiotensin 2 by angiotensin-converting enzyme (ACE) -> angiotensin two stimulates the release of aldosterone
What does angiotensin 2 do that contributes to high blood pressure, what medication class is used to inhibit this
Sodium and Chloride reabsoprtion = H20 retnetion, aldosterone secretion, ateriolar vasoconstriction/ ACE inhibitors
What is normal and elevated blood pressure
Normal less than 120 mmHg/less than 80 mmHg, Elevated: 121-129 mmHg/less than80 mmHg
What are blood pressure levels for stage 1 Hypertension
130-139 mmHg/80-89 mmHg
What are blood pressure levels for Stage 2 Hypertension
Greater than 140 mmHg/greater than 90 mmHg
When a person has no clinical CVD and a 10 year ASCVD risk less than 10% what blood pressure would cause a need for intervention, what is the goal blood pressure
Greater than 140/90, less than 130/80
T/F: Patients with Clinical CVD, 10 year ASCVD risk greater than 10%, or are older than 65 have a BP threshold of greater than 130 and a BP goal of less than 130
True
What specific comorbidities would lead a patient to need intervention at a BP of greater than130/80 and a BP goal of less 130/80
DM, CKD, CHF
