Hypertension 1 Flashcards
(130 cards)
1
Q
What are the major forms of cardiovascular disease?
A
- hypertension
- atherosclerosis
- ischemic heart disease
- peripheral vascular disease
- heart failure
- cerebrovascular disease
2
Q
Cardiovascular disease =
A
disease of heart and/or vessels
3
Q
What are the top leading causes of death in Canada?
A
- Cancer
- Diseases of the heart
- Cerebrovascular disease
4
Q
What used to be the leading cause of death?
A
Diseases of the heart (but new drugs and understanding)
5
Q
Between males & females, what is the prevalence of hypertension?
Why is there a difference?
A
- increasing chance for males versus females
- because of higher obesity and overweight rates among males
6
Q
Which age category has the highest prevalence of hypertension?
A
75+
bigger prevalence among females (because they live longer)
7
Q
What is the number 1 reason for visits to physicians in Canada?
A
Hypertension
it is the number 1 reason for taking medication
8
Q
How many in Canada are affected by hypertension?
A
more than 1/5 = 20% aged +20
9
Q
What is the % of people unaware they have HTN?
A
18%
10
Q
What is the % risk of developing HTN between 55-65yo with normal BP?
A
90%
11
Q
What is the HTN prevalence among adults in the USA?
A
1/3 have hypertension
1/3 have pre-hypertension
12
Q
HTN increases with/for:
A
- age
- males>females
- African-Americans> whites > hispanic
13
Q
What are the 2 phases of the cardiac cycle?
A
- contraction = systolic
- resting = diastolic
14
Q
MAP =
A
Mean Arterial Pressure
= Cardiac output x peripheral resistance
= the average of systolic and diastolic pressure
15
Q
MAP is regulated by :
A
- sympathetic nervous system (autonomous)
- renin-angiotensin-aldosterone system
- renal function
- hormones: epinephrin, vasopressin, angiotensin II
16
Q
Cardiac output formula
A
CO (L/min)= stroke volume (L/beat) x heart rate (beats/min)
17
Q
Resistance formula
A
R= (length vessel x viscosity of blood) / (radius^4)
18
Q
Which has the biggest impact on resistance?
- viscosity of blood
- radius of vessel
- length of vessel
A
- radius of vessel : a small change has a big impact on the resistance
19
Q
Vasoconstriction: resistance high/low
A
high
20
Q
Vasodilation: resistance high/low
A
low
21
Q
Heart rate is controlled by:
A
- Parasympathetic NS (decreases HR)
- Sympathetic NS + epinephrine (increases HR)
22
Q
What controls blood volume on:
- the short term
- the long term
A
- ST: fluid shifts
- LT: salt and water balance in the kidneys
23
Q
What increases blood viscosity?
A
- high number of RBCs
24
Q
Liver releases ->
Kidney releases ->
Lunges release ->
Adrenal cortex releases
A
Liver -> angiotensinogen
Kidney -> renin
Lungs -> angiotensin-converting enzyme
AC -> aldosterone
25
__ stimulates vasopressin release + thirst + arterial vasoconstriction + aldosterone production
Angiotensin II
26
Vasopressin role
increases water reabsorption by kidney tubules
27
What are the different organs damaged by hypertension?
- heart
- kidney
- peripheral vascular system
- eye
- brain
28
What damages does HTN have on heart?
- LVH : left ventricular hypertrophy
- CHD : coronary heart disease
- CHF : congestive heart failure
29
What damages does HTN have on kidneys?
- renal failure
| - proteinuria (albumin)
30
What damages does HTN have on eyes?
- retinopathy
31
What damages does HTN have on brain?
- hemorrhage
- stroke
- vascular dementia
32
What instruments measure BP?
sphygmomanometer
33
What is the unit of BP?
in mmHG (mercury)
34
Primary/essential/idiopathic causes of HTN?
- interaction from environmental and genetics factors
| - dietary and behavioural factors
35
Secondary causes of HTN?
0ccurs secondary to another condition such as renal, endocrine or neurological disorders
36
Why is HTN the "silent killer"?
It is typically asymptomatic
37
Non-modifiable risk factors of HTN
- age > 60y
- men, postmeno women, ethnicity (African-American, Russians, Finns)
- family history of CVD : women <65y or men <55yo
38
Modifiable risk factors of HTN
- smoking
- sedentary lifestyle
- abdominal obesity, insulin resistance
- excess sodium intake
- poor diet quality
- stress
39
Which other mechanisms can contribute to HTN?
- excessive sécession of vasopressin + ANG2
- renal disease
- adrenal disorders
- hyperinsulinemia
- neurological diseases
40
Reason why smoking contributes to HTN
Interferes with nitric oxide (dilates vessels) --> impairs epithelial vasodilation
41
Reason why renal disease contributes to HTN
reduced blood flow -> high ANG2 -> vasoconstriction + sodium, chloride, water retention -> blood volume
42
Reason why adrenal disorders contribute to HTN
increase secretion of epinephrine and norepinephrine -> vasoconstriction / increased cardiac output
43
Reason why excessive secretion of ANG2 and vasopressin contributes to HTN
increase vasoconstriction and fluid retention
44
Values of NORMAL systolic and diastolic BP
SBP: 90-119 mmHG
DBP: 60-79 mmHG
45
Values of PRE-HTN systolic and diastolic BP
SBP: 120-139 mmHg
DBP: 80-89 mmHg
46
Values of STAGE 1 HTN systolic and diastolic BP
SBP: 140-159 mmHg
DBP: 90-99 mmHg
47
Values of STAGE 2 HTN systolic and diastolic BP
SBP: 160-179 mmHg
DBP: 100-109 mmHg
48
Values of STAGE 3 HTN systolic and diastolic BP
SBP: >= 180mmHg
DBP: >=110 mmHg
49
According to HTN Canada:
| LOW risk patients =
don't have target organ damage or cvd risk factors
50
According to HTN Canada:
| MODERATE-HIGH risk patients =
multiple cvd risk factors and 10-year global risk <15%
51
According to HTN Canada:
| HIGH risk patients =
With 1 or + :
* clinical or sub-clinical cvd disease
* chronic kidney disease (non-diabetic nephropathy, proteinuria <1g/d)
* estimates 10year global cvd risk >=15%
* Age >= 75yo
52
Patients with Diabetes Mellitus are at which risk?
High risk
53
Different BP measurement methods
- Office
- Office Automated (unattended, AOBP)
- Out of office (ABPM)
54
Office BP measurements (2)
- Automated office BP (AOBP) - oscillometric (electronic)
| - Non-automated (manual) office BP -> auscultatory (mercury)
55
Which office measurement is preferred?
AOBP
56
Office automated BP measurements
- automated unattended (AOBP) -> oscillometric (electronic)
57
Out of office BM measurements
Ambulatory (ABPM) : measures over 24h
58
Which value measured in office is considered HTN
BP>= 180/110
59
White coat hypertension =
increase BP because of stress and intimidation of pt
60
Comprehensive plans to treat HTN include
- - physical activity
- - wt reduction
- - nutrition therapy
- - moderation in alcohol, relaxation therapy, smoking cessation
- - pharmacological interventions
61
Pharmacological interventions
loop diuretics
thiazides
carbonic anhydrase inhibitors
potassium sparing diuretics
62
Dietary factors involved in HT
```
!! sodium + potassium
calcium
magnesium
alcohol
high calories, excess wt, obesity
```
63
Link between obesity + HTN in adults <55y
60% of those in excess weight + normal BP will develop HTN in the next 4 years
64
Obesity associated with increased cvd
abdominal obesity
65
Causes of HTN associated with obesity (4)
insulin resistance/hyperinsulinemia
alterations in RAAS
overactivity of SYMPA NS
leptin increases sympa activity
66
Most effective approach to treat and HTN
Weight loss
67
Anthropometric measures aimed for weight loss
BMI <= 25 kg/m2
| waist circumference <102 cm (men) ; <88 cm (women)
68
Leptin is produced by
Adipocytes
69
Per 10 kg weight lost, BP reduction of
5-20 mmHg per 10kg lost
70
Overweight patients should achieve a wt loss of __ kg
| (a decrease in SPG by __ and DPB by __ mmHg) to reduce Bp and risks for organ damage
5 kg
decrease SPB by 4.4
decrease DPB by 3.6
71
If patient uses __ weight loss can be more difficult
beta-blockers
72
beta-blockers tend to
decrease HR and metabolic rate of the person
73
Weight loss approaches
diet education and instruction
increase PA
behavior modification
74
Range of sodium maintained by body
135-150mE/L
75
Relation between sodium intake and excretion is _
direct
76
True / False
| sodium intake is directly related to blood pressure
true
77
For every increase of 100 mmol Na/day there is an increase in __ SPB/DBP
3-6/0-3 mmHg
78
Lower sodium intake __ systolic BP
reduced
79
Impact of decreasing sodium intake on BP is bigger on __ individuals
hypertensive (than normotensive)
80
Is the decrease in BP higher in DASH diet or US diet when decreasing sodium form high to medium sodium diet
in US diet (unhealthy diet -> less potassium)
81
Individual responses to reduction of sodium intake
- varies among individuals
- responders: respond to decrease sodium intake by having lower BP
- non-responders
82
Responders:
- African-american
- Middle age
- HTN, diabetes, renal
83
Sodium sensitivity is largely influenced by
potassium : high potassium -> low sodium sensitivity
84
Dietary sodium DRI (AI) =
1500 mg/day (14-5yo)
1300 mg/day (51-70y)
1200 mg/day (71+y)
85
Upper limit sodium
2300 mg Na/day for all adults
86
True / false
| Majoriy of Canadians exceed UL
True
Males > females (sodium intake)
87
Average total intake of sodium (Canada)
3400 mg/d
88
CHEP sodium intake recommendations to decrease BP
2000mg per day
89
5g salt = __ mmol sodium
87 mmol
90
1/2 tsp salt =
1150 mg sodium
91
80% of average sodium intake is where?
in processed foods
| only 10% added at table or cooking
92
Major food contributors to sodium intake
1. bread
2. processed meat
2. vegetable-based dishes, tomato
3. soups
93
Why is bread in the highest food contributor?
Is lower in sodium but eaten in high amounts as opposed to gravies and sauces high in sodium but eaten in low amounts
94
Reading nutrition label advise
- Choose foods with les than 120 mg sodium per serving
| - choose foods with sodium <5% DV
95
Reading food packages advise
- by unsalted and lower sodium foods
| - look for "sodium-free", "low sodium", "reduced sodium", "no added salt"
96
3 Na controlled diets
3000 mg
2000 mg
1000 mg
97
3000 mg Na controlled diet
- eliminate high Na processed foods and beverages
| - up to 0.25 tsp salt permitted during cooking or added at table
98
2000 mg Na controlled diet
- eliminate processed and prepared foods + beverages high in Na
- limit milk + milk products to 2 cups/d
- no salt in preparation of foods or at table
99
1000 mg Na controlled diet
- like 2000 mg NA but omit canned, frozen, deli goods, cheeses, margarines.
- limit bread to 2 servings/d
100
Is the 1000 mg Na diet recommended to someone with HTN
NO
| It could have the opposite effect and lead to massive increase in Na in blood
101
If a patient with hypertension consumes 3500 mg sodium per day what would you advise?
The 3000 mg Na diet and then the 2000 mg
102
Reducing sodium intake:
reduces BP
prevents HTN
additive effect to antihypertensive medications
103
Relationship between potassium and BP is __
inverse
104
With a higher potassium intake, there is a decreased
prevalence of HTN
105
Mechanisms of potassium
- natriuresis
106
Mechanisms of potassium
- natriuresis (increase Na excretion)
- suppressed renin
- vasodilation
- reduces sympathetic activity + ANG2
107
Why is the effect of potassium inter-dependent with sodium
the greater the increase in BP with Na, the greater the decrease with supplemental K
108
True / false
| Having high potassium reduces BP
False:
Is for salt-sensitive
Potassium protects against familial susceptibility
109
Deficit in K in body causes
Retention of Na by kidneys
110
Average totale potassium intake in Canadian adults
2800 mg/d (women)
| 3300 mg/d (men)
111
Potassium DRI
4700 mg/d
112
Daily dietary K recommendations associated with decreased risk of stroke mortality
>= 60 mol (2300 mg)
113
K supplementation recommendation
- above daily dietary intake of 60 mol/d ≠ recommended to treat HTN
- may be useful if diuretic-induced hypokalaemia
114
K supplementation recommendation
- >60 mol/d NOT recommended to treat HTN
| - may be useful if diuretic-induced hypokalaemia
115
CFG recommendation for K
emphasising fruits + veg for sufficient K intake
116
Patients at risk for hyperkalemia
- using RAAS inhibitors
- receiving other drugs causing hyperkalemia
- chronic kidney disease filtration rate
- baseline serum potassium > 4.5 mol/L
117
Blood pressure and calcium relationship : _
inversely associated
118
Increased calcium leads to :
increase sodium excretion
increase sensitivity to nitric oxide -> vasodilation
reduced production of superoxide and prostanoids (vasoconstriction)
119
CFG recommendation for calcium
2-3 servings of milk products daily
120
Calcium supplementations or HTN
NOT recommended if consume + daily recommendations
Does not prevent high BP for normosensitive
121
Blood pressure and magnesium relationship:
Inverse relationship
122
Magnesium regulates
vascular structure and function : regulates vascular reactivity and contractility
123
Magnesium DRI
420 mg/d (men)
| 320 mg/d (women)
124
Magnesium recommendation for hypertensive patients
To increase DIETARY Mg to reach DRI
125
Relationship between alcohol and blood pressure
dose-response relationship : over 2 drinks/d increases BP
126
Alcohol effect
immediate: decrease BP
following: elevated BP in next 10-15h
127
Mechanisms of alcohol
- stimulates cortisol
- stimulates SYMPA NS
- increased Ca uptake by cell membranes
128
Moderate consumption of alcohol effects on BP
cardio protective effects, does not raise BP
129
Alcohol recommendations
2 drinks per day - men
| 1 drink per day - women
130
standard drinks :
beer =
wine =
spirits =
```
beer = 360 mL (5%)
wine = 150 mL (12%)
spirits = 45 mL (40%)
```
