Systemic Hypertension Flashcards by Julianna Small

Describe the categories of HTN and their pressures?

Normal = <120 / <80
Pre = 120-139 / 80-89
Stage 1 = 140-159 / 90-99
Stage 2 = >160 / 100
Isolated Systolic = ≥140 / <90 (only the systolic number is high)

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What is considered a hypertensive blood pressure?

2 readings of >140/90

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Essential hypertension is also known as what?

Primary hypertension

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Primary hypertension is caused by what?

Idiopathic but related to hereditary and metabolic causes

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Secondary hypertension is caused by what? (6)

HTN is secondary to a known disease:

Renal disease
Endocrine/hormonal
CNS: Increased sympathetic tone (fight/flight)
Pituitary/Hypothalamic (Cushing Disease)
Hyperthyroidism
Aortic coarctation

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What is mean pressure?

Average pressure over the cardiac cycle

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What is the formula for MAP?

(2 x DBP + SBP) ÷ 3

2. CO x SVR

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How is pulse pressure calculated?

PP = SBP - DBP

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Any factor which increases CO will increase what?

Average blood pressure

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Any factor which increases systemic vascular resistance will increase what?

Mean arterial blood pressure

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What is the main mechanism of HPnEF (HFpEF)?

Diastolic dysfunction

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What is the number one symptom of diastolic dysfunction?

Dyspnea

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Resistance increases with an increase of what factors?

Length of vessel, viscosity, and decreased radius

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A compliant vessel has what kind of pulse pressure?

Lower pulse pressure

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A stiffer vessel has what kind of pulse pressure?

Wider pulse pressure

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What happens to right heart filling with inspiration?

Increased right heart filling

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What happens to right heart filling with expiration?

Decreased right heart filling

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What is volemia?

Total blood volume

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What two factors increase volemia?

Water retention and total body mass

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What mechanism causes CHF?

Increased work load (afterload) on an overloaded muscle and diastolic dysfunction

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What mechanism causes CAD?

Endothelial damage in coronary artery accelerates plaque formation

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What mechanism causes PVD?

Endothelial damage accelerates plaque formation

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What mechanism causes renal failure?

Pressure too high for kidneys to function well which leads to endothelial damage

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What mechanism causes angina?

Increased workload of the muscle and decreased coronary perfusion

What is EDRF?

Endothelium relaxation factor

Nitric oxide is a product of what?

Metabolism

What does nitric oxide do?

Makes the endothelium release EDRF which leads to vasodilation

What does EDRF allow the smooth muscle cells of the tunica intima and media to do?

Relax

What is endothelial function analysis based on?

Nitric oxide measurement

What needs to be modified first for hypertension management?

Lifestyle

Name three diuretics and their main effect:

1. Dyazide 2. Hydrochlorothiazide 3. Metazone Lowers volemia by promoting urination (excreting salt with water) which reduces afterload and preload

Name three beta blockers and their main effect:

1. Acebutolol 2. Metoprolol 3. Propranolol Blocks the sympathetic stimulation to reduce HR by 25% and allow better contraction and profusion (reduces BP)

Name three calcium channel blockers and their main effect:

1. Dil-zem 2. Ni-pine 3. Vera-mil Block calcium from entering the muscle cells which reduces contraction/inotropy lowering afterload

Name three ACE inhibitors and their main effect:

1. Captopril 2. Lisinopril 3. Ramapril Prevent angiotensin from causing arterial constricting which lowers afterload

EF measures what type of function?

Systolic

E/A ratio measures what type of function?

Diastolic

E/e prime ratio measures what type of function?

Diastolic

Pulmonary v profile measures what type of function?

Diastolic

Tissue doppler measures what type of function?

Diastolic

Explain concentric remodeling:

Normal LV mass with increased relative wall thickness

Explain concentric hypertrophy:

Increased LV mass and increased relative wall thickness

Explain eccentric hypertrophy:

Increased LV mass with normal or decreased relative wall thickness (Why? Starting to 'bag out')

LV mass linear technique can be done with what?

M-mode or 2D

LV Mass index formula?

Total LV mass/BSA

What is RWT and state the formula for?

Relative Wall Thickness relates wall thickness to chamber size in diastole 2PWTd/LVIDd

What is a normal relative wall thickness?

<0.42

What are risk factors for HTN? (12)

- Age - African - Male - Smoking - Obesity - Inactivity - Diabetes - Stress - Dyslipidemia - Sodium - Alcohol - Inadequate calcium or potassium

How do higher heart rates affect mean pressure?

Higher heart rates equal higher pressure because there is more time spent in systole

What happens to the pulse pressure during AR?

The PP gets larger because the systolic component goes up (contracting harder - starlings law) and the diastolic component goes down (inability to fill) creating a bigger diff between SBP and DBP PP = SBP - DBP

What does SVR sand for?

Systemic Vascular Resistance

Describe BP regulation?

The peripheral resistance, SV(inotropy) and HR determine CO which is regulated by the baroreceptors in the carotid bulb/aorta that either tell the heart to pump more to profuse the brain or less. (As we age baroreceptors need help from medication to regulate)

How does volemia affect BP?

Increased blood volume increases blood pressure

Explain the relationship of salt and BP?

Increased sodium chloride (Na+Cl-) = increased water retention (to dilute) = increased volemia = increased BP

What diseases are caused by HTN?

1. CHF 2. CAD 3. PVD (peripheral vascular disease) 4. Renal failure 5. Angina

What 3 things need to be regulated to manage HTN?

1. Blood Volume regulation 2. CO regulation (SV and HR) 3. Peripheral Resistance regulation

Describe the effect of exercise on HTN management?

1. Muscle contraction 2. Vasodilation of vessels supplying the muscles 3. Increased O2 supply and CO2 removal 4. Lower SVR 5. Lowers BP

Describe the effect of smoking on HTN and how quitting helps? (2)

1. Smoking decreases O2 to the brain and releases catecholamine which increases HR and BP 2. 50% reduction for MI and CVA in the 1st year after quitting, another 50% after 5 years

How does ASE recommend indexing LV mass with obese patients and why?

Indexing with height only instead of BSA because their huge BSA will make an enlarged LV mass appear normal when indexed