HTN: Exam 1

Question 1

The “idea” BP

Answer 1

119/79

Question 2

CPG NEW BP Guidelines

Answer 2

see pics

**CAN BE ONE OR THE OTHER

SBP OR DBP

doesn’t need to be both #s to be in that category!!!

Question 3

NORMAL BP

Answer 3

• SBP
  
  • ​<120
• DBP
  
  • ​<80
• Ideal== 119/79

Question 4

ELEVATED BP

used to be “Pre-HTN”

Answer 4

SBP== 120-129

OR

DBP== <80

Question 5

Hypertension

Stage 1

Answer 5

SBP== 130-139

OR

DBP== 80-89

Question 6

HTN

Stage 2

Answer 6

SBP== >/= 140

OR

DBP== >/= 90

Question 7

NOTE:

** indiv’s w/ SBP and DBP in 2 categories should be designated to _______

Answer 7

HIGHER BP category

Question 8

BP======

controlled by what 2 mechs?

Answer 8

BP= CO(HR*SV) * TPR

controlled by:

1. ANS

2. Hormonal system (Renin-angio system)

Question 9

Types of BP

Primary

essential or idiopathic

Answer 9

from Risk factors–90% of people

ex. sedentary, stress, genetics

Question 10

Types of BP

Secondary

Answer 10

caused by SOMETHING ELSE IN SYSTEM

ex. kidney dis.,

hard to treat

Question 11

Types of BP:

Labile

Answer 11

fluctuating BP

hormonal affects

Question 12

Types of BP

Anxiety induced HTN

“white coat HTN

Answer 12

exactly what it sounds like

Question 13

HTN:

The Sequela

explain

Answer 13

• Initially
  
  • ​INC SNS stim from risk factors cause:
    
    • periph vasoconstrict
    • inc blood plasma vol
    • sustained + inotrope and/or + chronotropic effect
  • High Na+ diet==> inc plasma volume
  • lack of ex, inact, sedent,
    
    • decondition heart==> non-optimal SV w/ reflexive + chrono effect
  • obesity ==> inc press in abd area/LE/UE
    
    • inc’s TPR
  • sleep deprivation
    
    • activates SNS
      
      • • chronotropic effect==INC HR/BP

**ALL of this produces overload in L. VENT, aorta, and periph arteries=====> EARLY HTN

Question 14

Sustained HTN

DECd compliance/distensibility of aa’s:

elastic tissue of aa’s and arterioles are replaced by fibrous collagen tissue =====

Answer 14

no recoil

prolonged or irreversible HTN

Question 15

sustained HTN

diminished SV is detected by KIDNEYS—->

activates RAS causing vasoconstriction and Na+/H2O retention=====

Answer 15

prolonged or irrev. HTN

Question 16

Sustained HTN

DEC compliance of CA’s leads to DEC O2 supply to myocardium ======

Answer 16

prolonged or irrev. HTN

Question 17

sustained HTN

L. vent working against elevated HTN for prolonged pds will become HYPERTROPHIED or rigid or less kinetic

this cannot be reduced =====

Answer 17

prolonged or irrev. HTN

Question 18

Sx’s HTN

early Tx the better!!!!

Answer 18

• asymptomatic
  
  • or just used to sx’s
• HA
• vertigo
• flushed face
• epistaxis
  
  • nausea, dry heave
• blurred vision
• nocturnal urinary freq
  
  • Nocturia
• dyspnea
• angina

Question 19

Basic med. tx HTN

Goal (3)

Answer 19

• normalize BP BOTH @ rest and BP resp during exertion
• PREVENT prolonged HTN patho
  
  • ​LVH, art stenosis, CVA
• IMPROVE CA O2 supply

*LIFE-STYLE CHANGES!!!

Question 20

MED TX HTN

meds

Answer 20

beta blocks

alpha blocks

ACE inhibitors

Ca+ channel blocks

Diuretics

Question 21

HTN Tx

Category + Tx

Answer 21

• Pre-HTN
  
  • ​lifestyle mod
• stage 1 HTN
  
  • ​diuretics
  • maybe ACE inhibitors
• Stage 2 HTN
  
  • ​combo of 2+ meds or cocktail
    
    • ​ALWAYS INCLUDES BETA BLOCKER
      
      • **blunted HR resp***
        
        • ​use borg!!!

Question 22

Systemic effects HTN

Brain

Answer 22

cerebral aneurysm

Hemorrhagic CVA

Question 23

Systemic effects HTN

Eyes

Answer 23

Retinopathy—-arterioloar damage

Question 24

Systemic effects HTN

Answer 24

Atherosclerosis

Question 25

Systemic effects HTN **Heart**

Answer 25

CHF atherosclerosis angina MI

Question 26

systemic effects HTN ## Footnote **Kidneys**

Answer 26

Nephrosclerosis (hardened tubules) CRF

Question 27

systemic effects HTN BP

Answer 27

persistent elevation

Question 28

Prognosis of HTN

Answer 28

HTN===sig. risk factor for dev. of **CAD, stroke, CHF and renal failure** ## Footnote **precedes heart failure in 90% of all cases and INCing in all other assoc'd cond's**

Question 29

Exercise is like a DRUG for HTN

Answer 29

reduces systolic AND diastolic BP @ rest ## Footnote **DOSE dependent (more==better)** **may be able to reverse early HTN** **may be able to AVOID, DISCONT, DEC dosage of med mgmt in prolonged HTN**

Question 30

High % of pts referred to PT will have \_\_\_\_\_\_

Answer 30

dx or undx'd HTN * **Monitor during tx sessions:** * **​**any pt over 45 * any pt w/ risk factors or **Dx** * **​CVA, DM, CAD, aortic aneurysm, PAD, obesity, CRF, alcoholism, chronic pain syndrome**

Question 31

3 categories to follow when to take vitals

Answer 31

* Healthy indiv's * during eval * pts w/ risk factors * EVERY session pre/post aerobic * Pts w/ Dx HTN * keep cuff on * **monitor constantly!!!**

Question 32

Exercise Capacity is pts w/ **prolonged HTN is REDUCED 15-30%** ## Footnote **why?**

Answer 32

* Sub-opt SV * SV inc's faster w/ ex * HIGHER RHR * LOWER peak HR * diminished CO **Prescribe accordingly!!!!**

Question 33

Indiv's medicated for HTN may have altered ___________ **if taking Beta blocker**

Answer 33

altered resp to EX **Do a warmup\*\*\*** **use RPE\*\*\***

Question 34

ASCM Guidelines: **Ex testing is CONTRAINDICATED IF:**

Answer 34

BP \>200/110

Question 35

ASCM GUIDELINES: ## Footnote **Discontinue Ex testing if:**

Answer 35

BP \>220/110 **in indivs w/ known CV dx** BP \>250/115 in **healthy indivs** **Anytime there is a DROP in SBP** **Anytime there is an ELEVATION or DROP in DBP \>/= 10**

Question 36

Pulm AA HTN== **MAP \> 25** 3 types

Answer 36

1. Idiopathic Pulm HTN 2. Secondary Pulm HTN 3. Chronic thromboembolic pulm HTN (**CTEPH) ---\> dev clots over time==HTN**