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Test 2 FNP Primary Care 2 > HTN > Flashcards

Flashcards in HTN Deck (69)
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1

Arterial blood pressure is represented in two numbers in the form of a fraction. a. What is the name of the blood pressure represented in the upper number, and what does it represents?

1. Presión sistólica- presión del ❤️ cuando el corazón se contrae 2. Valor normal entre 90-110 mmHg

2

Pre hypertension:

entre 120-139 mmHg

3

HTN etapa 1 sistolica

HTN etapa 1 entre 140-159 mmHg (HTN benigna)

4

What is the name of the blood pressure represented in the lower number, and what does it represents?

Presión diastólica- Cuando corazón se relaja Valor normal entre 60-79mm Hg Pre hypertension: entre 80-89 mmHg HTN etapa 1 entre 90-99 mmHg (HTN benigna) HTN etapa 2 entre 100-109mmHg (HTN Benigna) HTN etapa 3 mayor o igual 110mmHg (HTN maligna)

5

HTN Etapa 2 sistolica

HTN etapa 2 entre 160-179mmHg(HTN benigna) 🙂👍🏻

6

HTN Etapa 3 sístole ☠️☠️☠️

HTN etapa 3 entre mayor igual a 180mmHg (HTN maligna) ☠️☠️☠️☠️☠️

7

What is the name of the blood pressure represented in the lower number, and what does it represents?

1. Presión diastólica- Presión que tiene el ❤️Cuando corazón se relaja 2. Valor normal entre 60-79mm Hg

8

Etapas HTN Diastolica

a. Etapa 1 está entre: 140 y 159 mmHg para la sistólica y entre 90 y 99 para la diastólica. b. Etapa 2 está entre: 160 y 179 mmHg para la sistólica y entre 100 y 109 para la diastólica. c. Etapa 3 está por encima de 180 mmHg para la sistólica 110 para la diastólica.

9

What is benign hypertension?

HTN Benigna cuando el paciente está en etapa 1 o 2: Suelen no causar síntomas inmediatos.

10

4-What is malignant hypertension?

1. La HTN severa en etapa 3. Esta constituye una emergencia porque puede causar aumento de la presión intracranial y daño a los órganos. 2. Etapa 3 está por encima de 180 mmHg para la sistólica y 110 para la diastólica.

11

Factores de riesgo NO modificables

1. Edad- aumenta con el avance de la edad 2. Sexo - mujeres y mujeres negras 3. Raza y etnicidad - blacks are at increase risk for HTN 4. Family History : HPB runs in family & Risk is increased when combined with unhealthy lifestyle

12

Modificable Risk factors

1. Diet - high sodium diet 2. weight - obesity and physical inactivity 3. Tabaco use - smoking damages blood vessels causing atherosclerosis 4.Alcohol use - Excessive alcohol use leads to the development of chronic illness including HTN 5.disease condition - statitics have shown that 60% of those with DM also have HTN

13

8-What is the JNC 7 BP classification.

a. La presión arterial sistólica normal debe estar entre 90 y 119 mmHg y b. la diastólica entre 60 y 79 mmHg.

14

La prehipertensión, o presión arterial un poco más alta de lo normal

Es la presión entre 120 y 139 mmHg para la sistólica y entre 80 y 89 mmHg para la diastólica.

15

Habitualmente cuando sube la sistólica la diastólica lo acompaña, de no ser así y una sola es la que aumenta recibe el nombre es:

Hipertensión sistólica aislada o hipertensión diastólica aislada.

16

First line of prevention and the recommendations (question 11)

1. Lifestyle changes, remain the first line of prevention and are continued throughout the treatment and management of HBP. 2. Recommendations: Lowering BP by lowering sodium intake combined with dietary approaches to stop hypertension (DASH) intake and increased consumption of fruit, vegetables, and whole grains. 3. Consuming no more than 2400 mg/d; however, further reduction to 1500 mg/d is desirable because this is associated with greater BP reduction. 4. In general, to lower BP, adults are advised to engage in an average of 40 min of moderate to vigorous intensity physical activity, 3 to 4 times per week.

17

DASH DIET

The DASH diet (Dietary Approaches to Stop Hypertension) is a dietary pattern promoted by the U.S.-based National Heart, Lung, and Blood Institute (part of the National Institutes of Health, an agency of the United States Department of Health and Human Services) to prevent and control hypertension. DASH stands for Dietary Approaches to Stop Hypertension. The diet is simple: Eat more fruits, vegetables, and low-fat dairy foods. Cut back on foods that are high in saturated fat, cholesterol, and trans fats.

18

sodium reduction to

The recommendations included consuming no more than 2400 mg/d; however, further reduction to 1500 mg/d is desirable because this is associated with greater BP reduction.

19

Excersise

In general, to lower BP, average of 40 min of moderate to vigorous intensity physical activity, 3 to 4 times per week. 150 min por week

20

Table 2. Proper In-office Procedure for BP Measurement

1. Person is seated quietly for at least 5 minutes on a chair and not on the exam table with the feet on the floor and the arm supported at heart level. 2. Caffeine, exercise, and smoking should be avoided at least 30 minutes before the measurement. 3. Appropriately sized cuff should be used. Cuff bladder should circle at least 80% of the arm. 4. At least 2 measurements should be made and the average recorded. 5. BP measurement while standing is indicated periodically, especially among individuals at risk for postural hypotension before adjusting their drug regimen and those who report symptoms consistent with reduced BP upon standing 6. Manual BP determination and palpated radial pulse should be used to estimate SBP. Cuff should be inflated 20-30 mm Hg above the palpated level for auscultatory determination. Cuff should be deflated at a rate of 2 mm Hg per second. SBP is when the first Korotkoff sound is heard, and DBP is when the Korotkoff sound disappears. 7. Clinicians should provide the patient his or her BP numbers and BP goal verbally and in writing.

21

JNC 7 BP Classification BP Classification SBP and DBP

Normal SBP < 120 and DBP < 80 Prehypertension SBP 120-139 or DBP 80-89 Stage 1 hypertension SBP 140-159 or DBP 90-99 Stage 2 hypertension SBP 160 or DBP 100

22

Recommendations in the New Guidelines There are 9 recommendations in the JNC 8 guidelines.

Recommendations 1 through 5 address BP threshold and goals, recommendations 6 through 8 deal with the choice of antihypertensive drugs, and recommendation 9 is a summary of strategies based on expert opinion in starting and adding antihypertensive drugs

23

Recommendation 1 General population JNC8 Grade A (strong recommendation)

Recommendation 1: In the general population, for those > or equal to 60 years old, a) pharmacologic therapy is initiated to lower SBP of 150 mm Hg or b) DBP of 90 mm Hg; and c) to treat to a goal of SBP 150 mm Hg or DBP 90 mm Hg A corollary recommendation: In the general population, for those > or equal to 60 years old, if drug therapy to treat high BP results in lower achieved SBP (eg, < 140 mm Hg) and treatment is well tolerated and without adverse effects on health or quality of life, treatment does not need to be adjusted.

24

Recommendation 1 General population JNC8 Grade A (strong recommendation)

Recommendation 1: In the general population, for those equal or more than 60 years old, a) pharmacologic therapy is initiated to lower SBP ≥ 150 mm Hg or b) DBP of ≥ 90 mm Hg; and c) to treat to a goal of SBP < or equal 150 mm Hg or DBP equal or < 90 mm Hg A corollary recommendation: In the general population, for those > or equal to 60 years old, if drug therapy to treat high BP results in lower achieved SBP (eg, < 140 mm Hg) and treatment is well tolerated and without adverse effects on health or quality of life, treatment does not need to be adjusted.

25

Recommendation 2 General population JNC8 Grade A (strong recommendation) for those 30-59 years old

Recommendation 2: In the general population, for those < less than 60 years old, initiate pharmacological therapy to lower DBP of > equal to 90 mm Hg and treat to a goal of DBP < 90 mm Hg.

26

JNC8 -Recommendation 3: Grade E (expert opinion)

Recommendation 3: In the general population, for those < 60 years old, initiate pharmacologic therapy to lower SBP ≥ 140 mm Hg and treat to a goal of SBP < 140 mm Hg

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JNC8 -Recommendation 4 Grade E (expert opinion)

Recommendation 4: In the population of those more or equal to 18 years old with CKD, initiate drug therapy to lower SBP ≥ to 140 mm Hg or DBP ≥ to 90 mm Hg and treat to a goal of SBP < 140 mm Hg or DBP < 90 mm Hg.

28

JNC8 -Recommendation 5 Grade E (expert opinion)

Recommendation 5: In the population of those > or equal of 18 years old with diabetes, initiate drug therapy to lower SBP ≥ to 140 mm Hg or DBP ≥90 mm Hg and to treat to a goal of SBP < 140 mm Hg or DBP < 90 mm Hg.

29

JNC8 -Recommendation 6 Grade B (moderate recommendation)

Recommendation 6: In the general non-black population, including those with diabetes, thiazide-type diuretic, CCBs, ACEIs, or ARBs are the initial drugs of choice.

30

JNC8 -Recommendation 7 Grade B (moderate recommendation) for general black population Grade C (weak recommendation) for black patients with DM

Recommendation 7: In the general black population, including those with diabetes, thiazide-type diuretic or CCBs should be the initial antihypertensive drug of choice