Perfusion HTN Flashcards
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Describe symptomatic HTN
low perfusion - enough to cause “lightheadedness”, dizziness, pre-syncope, syncope, or abnormal weakness with normal activity, particularly getting up from a lying or sitting position. High risk for falls and trauma
Orthostatic Hypotension (Postural Hypotension) how can we determine if a patient has this?
Lying-to-standing or if very weak, lying-sitting-standing BP Drop in systolic BP of more than 20 mmHg
Orthostatic Hypotension Symptoms may occur with?
Symptoms may occur with volume depletion, overtreatment with BP medication, prolonged bed rest, older patients.
How do we get the baseline BP for patients with Orthostatic HTN.
Supine 2-3 min: baseline
How do we calculate MAP?
s + d +d/3
Why does prolonged best rest cause hypotension
the muscles are not contracting enough to get blood up the veins.
How can we determine a patient has HTN?
Two visits if ≥180/ ≥110 mmHg, Two visits if 140-179/90-109 with target organ damage, diabetes, or chronic kidney disease
Generally considered SBP≥_____ and / or DBP≥___ mm
Generally considered SBP≥140 and / or DBP≥90 mm
What nations of descent have a higher risk of being diagnosed with HTN and what gender?
Black Canadians and people of South Asian descent have a higher prevalence of hypertension than East Asians and Whites; it develops at a younger age, First nations canadians. HTN is more prevalent in older women than in older me
Isolated systolic HTN Describe
Common in older adults related to loss of elasticity in large arteries.
how do we calculate pulse pressure
systolic-diastolic
Primary hypertension describe
unclear (Idiopathic) or definite causes but we have associated causes eg smoking, lifestyle. 90–95% of patients
Secondary hypertension describe
5–10% in adults; >80% in children•Many causes; treatment aimed at the underlying cause
What are some of the risk factors of Primary Hypertension
low Vit D Excess dietary sodium Elevated serum lipids Diabetes mellitus Ethnicity
Secondary Hypertension: Etiology
Coarctation or congenital narrowing of the aorta
Renal disease such as renal artery stenosis (↓ flow to kidney → RAAS
Endocrine disorders such as Cushing’s syndrome and hyperaldosteronism
_________ in BP is more important than the absolute value.
rate of increase in BP is more important than the absolute value
patients with hypertensive Crisis are at risk of what
heart and kidney failure, bursting of blood vessels.
Who is at risking of hypertensive crisis?
May occur in patients with a history of HTN who have failed to comply with medications or who have been under-medicated
What is hypertensive crisis?
evere, abrupt increase in DBP (defined as >120–130 mm Hg) e.g. BP 220/120 mmHg
In emergency cases of hypertensive crisis what do we treat patients with?
Emergency treatment with vasodilator such as IV Nitroprusside
What is the first approach to HTN treatment
Lifestyle Modification prior to (or along with) medication therapy
What are the 7 first line Antihypertensive Drugs?
Thiazide/thiazide-like Diuretics (first choice if uncomplicated)
•ACE-I: Angiotensin converting enzyme inhibitors (non-black pt)
•ARB: Angiotensin II receptor blockers
•CCB: Calcium channel blockers
•Beta Blockers (Beta adrenergic receptor antagonists) (<60 y)
•Alpha Blockers (doxazoxin) (less common)
•Vasodilators (less common
An example of a Diuretics
Hydrochlorothiazide (HCTZ; HCT)
What is the MOA for the diuretics
Increases urine output, decrease plasma and extracellular fluid volumes Results •Decreased preload and cardiac output •Decreased arterial blood volume •Decreased total peripheral resistance
