What is the goal of treating HTN?
to reduce associated morbidity and mortality from CV events
What does ACC/AHA recommend reguarding blood pressure guidelines?
high BP should be treated earlier with lifestyle changes and in some patients with medication – at 130/80 mm Hg rather than 140/90
What are ACC/AHA guidelines for HTN classification (nml vs elevated vs stage 1/2)
Normal= SBP <120 AND DBP <80
Elevated= 120-129 AND <80
HTN stage 1= 130-139 OR 80-89
HTN stage 2= >140 OR >90
What is ACC/AHA recommendation for treatment/follow up of “elevated BP”
(elevated= SBP 120-129 and DBP <80)
Recommend healthy lifestyle changes and reassess in 3-6 months
What is ACC/AHA recommendation for treatment/follow up of “normal BP”
(normal BP= SBP <120 and DBP <80)
Recommend:
- evaluating yearly
- encourage healthy lifestyle changes to maintain nml BP
What is ACC/AHA recommendation for treatment/follow up of “HTN stage 1”
(Stage 1= SBP 130-139 OR DBP 80-89)
Recommend:
- assess 10-yr risk for heart dz and stroke using ASCVD risk calc
- <10%: TLC, reasses in 3-6 months
- >10% or pt has known CVD, DM or CKD:
- TLC + antihypertensive (1 med)
- reassess in 1 month
According to ACC/AHA, what treatment/followup is recommended for a patient that has stage 1 HTN (SBP 130-139 or DBP 80-89) AND has an ASCVD risk of >10% or has known CVD/DM/CKD?
Recommend:
- Start with lifestyle changes and BP-lowering med (1 med)
- reassess in 1 month for med effectiveness
- if goal met after 1 month- reassess in 3-6 months
- if goal NOT met after 1 month- consider dif. med or titration
- Continue monthly follow up until control is achieved
According to ACC/AHA, what treatment/followup is recommended for a patient that has the following blood pressure: SBP >140 or DBP >90.
This is STAGE 2 HTN
Recommend
- healthy lifestyle changes and BP lowering med (2 meds or different classes)
- Reassess in 1 month for effectiveness:
- If goal met after 1 month: Reassess in 3-6 months
- If goal NOT met after 1 month: consider different meds or titration
- Continue monthly follow up until control is achieved
What is isolated systolic HTN defined as?
BP >130/<80
What BP is considered diastolic HTN
<130/>80
What is considered mixed systolic/diastolic HTN?
>130/>80
Flow chart for ACC/AHA recommendations for BP treatment/follow up
2017 ACC/AHA: What are new BP goals for patients with comorbidities?
updated guideline generally recommends prescribing BP-lowering medications in patients with clinical CVD and new stage 1 or stage 2 hypertension to target a BP of less than 130/80 mm Hg (this was previously less than 140/90 mm Hg).
During a cardiac cycle, _____ of the time is spent in diastole and _____in systole.
2/3 in diastole, 1/3 in systole
________ is calculated using the following equation:
(SBPx1/3) + (DBPx2/3)
Mean Arterial Pressure (MAP)
ex: the MAP of a BP that is 90/45= 30+30= 60
What is the major determinent of SBP?
Cardiac Output
What largely determines DBP?
Total peripheral resistance
_____ is a function of SV, HR and venous capacitance
Cardiac output
so…
BP= HR x SV x TPR
Elevated BP can result from increased ____ and/or increased _____
Cardiac output and/or increased total peripheral resistance
What can cause increased Cardiac output and ultimately result in HTN?
- Increased cardiac preload
- from increased fluid vol. from excess sodium intake or renal sodium retention (from reduced # of nephrons or decreased glomerular filtration)
- Venous Constriction:
- Excess stimulation of the RAAS system
- SNS over activity
The following are causes of increased _________, which can ultimately result in HTN
- Functional Vascular constriciton
- Excess stim. of RAAS
- SNS over activity
- Genetic alterations of cell membranes
- Endothelial derived factors
- Structural vascular hypertrophy
- Excess stim. of RAAS
- SNS over activity
- Genetic alterations of cell membranes
- Endothelial derived factors
- Hyperinsulinemia resulting from the metabolic syndrome
Increased Peripheral resistance
What is important to remember to include in your Ddx for HTN?
Current medications
