2+ BP readings with SBP 140-159 or DBP 90-99 or current use of antihypertensives

2+ BP readings with SBP over 160 or DBP over 100

HTN and CAD Flashcards by Will S

HTN stage 1

2+ BP readings with

SBP 140-159

DBP 90-99

current use of antihypertensives

How well did you know this?

Not at all

Perfectly

HTN Stage 2

2+ BP readings with

SBP over 160

DBP over 100

How well did you know this?

Not at all

Perfectly

Prehypertension range

SBP 120-139

DBP 80-89

How well did you know this?

Not at all

Perfectly

primary HTN

90-95% of all cases

No identified cause

Factors:
Alcohol/tobacco
Age
Inc. lipids
Younger men
Older women
DM
Obesity
Genetics
Stress

How well did you know this?

Not at all

Perfectly

Secondary HTN

Elevated BP w/specific cause

5-10% of cases in adults

80% of cases in kids

If under 20 or over 50 and BP spikes suspect secondary

Treatment: fix the cause- can be congenital narrowing of aorta, renal disease, sleep apnea, cirrhosis

How well did you know this?

Not at all

Perfectly

BP equation

BP=CO x Vascular Resistance

How well did you know this?

Not at all

Perfectly

renin-angiotensin function

Constricts vesels
Stimulate ADH release
Stimulate thirst
Stimulate aldosterone

How well did you know this?

Not at all

Perfectly

Aldosterone function

Cause kidneys to retain sodium and water

Increases blood volume and CO

How well did you know this?

Not at all

Perfectly

Atrial naturetic factor

Produced by Renin-Angiotensin, excretes sodium and water

How well did you know this?

Not at all

Perfectly

Humoral BP influencers

Vasoconstrictors

Angiotensin

Catecholamines

How well did you know this?

Not at all

Perfectly

HTN diagnosis

BP measured in both arms

Use arm with higher reading

BP highest early morning, lowest night

How well did you know this?

Not at all

Perfectly

Urinalysis labs

clear or cloudy

pH 4.5-8

Specific gravity 1.001-1.025

Bilirubin: may indicate liver damage

Protein: Should be trace to zero

How well did you know this?

Not at all

Perfectly

Cholesterol ranges

0-200: desirable

201-239: elevated

240+: high

How well did you know this?

Not at all

Perfectly

Drug choice without compelling indications for stage 1 HTN

SBP 140-159 or DBP 90-99

Thiazides

May consider ACE inhibitor, ARB, Beta blocker, calcium channel blockers

How well did you know this?

Not at all

Perfectly

Drug choice without compelling indications for stage 2 HTN

SBP 160+ or DBP 100+

Two drug combination for most

How well did you know this?

Not at all

Perfectly

Drug choice for HTN with compelling indications

More than two drugs as needed

Lifestyle modifications to reduce bp

22lb weight loss can reduce bp by 5-10 systolic

Decrease Na <2.4g/day

Priority problems for HTN

Tissues perfusion
Ineffective health maintenance
Compliance

Preload

Pressure from volume of blood in ventricles

End diastolic pressure

Increased in

Hypervolemia
Valve regurgitation
Heart failure

Afterload

Resistance L ventricle must overcome to circulate blood

Inc. in HTN and vasoconstriction

Review drug therapy on table 32-7

Diuretics
Adrenergic inhibitors
Direct vasodilators
Angiotensin inhibitors
Ca channel blockers

Diuretics

Reduce preload

inhibit sodium reabsorption
inc. excretion of sodium and water

HCTZ- Hydrochlorothiazide

Diuretic

Can result in low electrolyte values, hyperglycemia, dehydration, renal calcium

watch electrolytes

Adrenergic inhibitors

Reduce afterload

Alpha and beta blockers

Lower sympathetic (fight or flight) activity
lowers vasoconstriction

Monitor pulse- Needs to be ABOVE 60 BPM

May cause severe orthostatic hypotension,

Alpha blockers

vertigo, tachycardia, sexual dysfunction ex. doxasozin (Cardura), prazosin (Minipress)

Prazosin (Minipress)

Give initial dose at bedtime to avoid first dose effect (fainting after taking first dose) Side effects: Orthostatic Hypotension Reflex tachycardia Inhibition of ejaculation Nasal congestion

Beta blockers

Examples: Propranolol Atenolol Metoprolol Blocks beta receptors in heart: lowers HR, force of contraction, and rate of AV conduction Can cause Hypotension Bradycardia HF symptoms (coughing, SOB, edema, fatigue) Drowsiness, depression

Vasodilators

Decrease SVR (systemic vascular resistance) Reduce afterload reserved for hospitalized patients, need IV access

Nitroglycerin

Vasodilator Used to treat angina Rapid onset: 2-5 min Sublingual tabs, IV, translingual spray Slow onset: 20-60 min Transdermal patch Nitro ointments XR capsules SE: - Hypotension - Tachycardia - Dizziness - HA - Syncope

Angiotensin inhibitors

ACE inhibitors or ARB ACE inhibitors: prevent angiotensin vasoconstriction-->reduces afterload ARB: Vasodilation and inc. sodium/water excretion--> reduces preload

ARBs

Blocks action of Angiotensin 2 ex. Valsartan Losartan Olmesartan Can cause - Angioedema - Fetal harm - Renal damage doesn't cause hyperkalemia or cough

Which ARB is the only sartan approved for MI, stroke, CVD in patients not able to take ACE inhibitors?

Telmisartan

Which ARB is the only sartans approved for HF?

Valsartan, Cadesartan Inc. L ventricular ejection fraction

Which ARB is the only sartan approved for nephropathy in hypertensive patients with DM2?

Losartan | Irbesartan

Ace inhibitors (PRILS)

Captopril Lisinopril Enalapril Quinapril Lower peripheral vasc. resistance WITHOUT increasing: CO, HR, contractility Indicated for HTN, HF, post MI ``` can cause: Postural hypotension Angioedema nonproductive cough Hyperkalemia ```

Fosinopril (Monopril)

Decrease peripheral and arterial resistance and pulmonary capillary pressure. Increases exercise tolerance and CO May cause First dose effect Watch for Hyperkalemia, Hypotension, N/V, cough

Calcium channel blockers (Very Nice Drugs)

Blocks movement of calcium into cells ex. Verapamil Nifedipine Diltiazem Reduces afterload by inc. vasodilation-> which lowers SVR and BP. Lowers HR and contractility ``` Side effects: Hypotension Bradycardia AV block HA GI distress peripheral edema ```

Hypertensive crisis

Severe abrupt increase in DBP (over 140) Rate more important than actual value Often occurs in pt w/ hx of HTN that failed to comply w/ meds or have been underdosed ``` Hypertensive emergency: -evidence of acute target organ damage : Hypertensive encephalopathy, cerebral hemorrhage -Acute renal failure -MI HF w/ pulmonary edema ```

Hospitalization for hypertensive crisis

Critical care unit IV drug therapy titrated to MAP---slowly decrease MAP=(SBP + 2(DBP))/3 Monitor cardiac and renal function neuro checks determine cause education to avoid future crises