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Flashcards in Hypertension Deck (42)
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1

What is hypertension?

  • abnormal elevation of arterial pressure: ≥120/80
  • aka silent killer 
    • bc it has no warning signs or symptoms
  • preventable in most cases

2

Hypertension: Risk Factors

  • Controllable-lower risk by changing these
    • lifestyle
    • diet
    • exercise
  • Uncontrollable
    • Family hx
    • age

3

Hypertension: Epidemiology

  • 77 million Americans
    • 19% unaware
    • 25% not under current treatment
    • 48% treated, but not controlled
  • Prevalence increases with age
    • 50% of people >65 y.o. have HBP
  • Systolic rises throughout life
    • diastolic levels off after 50 y.o.
  • >90% of adults will develop HTN
  • dental practice: ~500 people per 2,000 pts

4

Physiology of Blood Pressure

  • pressure against interior walls of arteries
  • Korotkoff sounds
    • sound produced by turbulent blood flow
  • 1st sound=systolic pressure
  • disappearance of sound=diastolic pressure

5

Causes of Hypertension:

  • 90-95% unknown
    • called essential/primary hypertension
  • 5-10%
    • Obesity; Chronic Kidney disease; Coarctation of aorta
    • Cushing syndrome; chronic steroid therapy; obstructive  uropathy; Pheochromocytoma; Primary Aldosteronism
    • Renovascular disease
    • thyroid or parathyroid disease
    • SLEEP APNEA
    • Meds
      • BC 
      • cold remedies
      • de congestants
      • OTC pain relievers
      • some prescription drugs
      • illegal drugs
        • cocaine
        • amphetamines
    • Alcohol abuse or chronic alcohol use

6

BP Categories

  • Normal
    • <120/80
  • Elevated:
    • Systolic: 120-129 & Diastolic: <80
  • Stage 1:
    • Systolic: 130-139 or diastolic: 80-89
  • Stage 2:
    • Systolic: 140+ and/or 90+
  • Hypertensive crisis
    • Systolic: 180+ and/or Diastolic >120
    • change meds if no other indications of problems or immediate hospitalization if signs of organ damage

7

New Guidelines Take aways

  • prehypertension category- no longer exists
    • replaced by elevated BP
    • different numbers 
      • systolic and diastolic lower
    • HBP=Systolic 130 or diastolic 80
      • old 140/90
  • HTN stage 1
    • if systolic >130/80
      • old=prehypertensive
  • HTN stage 2:
    • >140/90
      • old=HTN stage 1

8

When to prescribe medication for stage 1 hypertension

  • Stage 1 HTN
    • only if pt has :
      • already had a cardio event 
        • heart attack or stroke
      • high risk of heart attack or stroke based on age
      • diabetes mellitus
      • chronic kidney disease
      • calculate atherosclerotic risk

9

What are the CVD risk factors in adults for HTN that we need to screen for and manage?

  • Smoking
  • Diabetes
  • dyslipidemia
  • excessive weight 
  • low fitness
  • unhealthy diet
  • psychosocial stress
  • sleep apnea

10

What are some basic tests for primary hypertension

  • fasting blood glucose
  • complete blood cell count (CBC count)
  • basic metabolic panel
  • thyroid stimulating hormone (TSH)
  • urinalysis
  • electrocardiogram w/optional echocardiogram
  • uric acid
  • urinary albumin to creatinine ratio

11

What are the new recommendations for taking blood pressure?

  • first visit
    • record BP in both arms
    • if >130/80, f/y w/PCP
    • use higher reading arm for readings down the road
  • Wait 1-2 min before repeating
  • Give patient the BP reading written and verbally
  • allow patient to rest for 5 mins prior to measuring BP
    • average at least 2 readings over 2 visits
    • should not determine if patient is hypertensive based on 1 BP measurement

12

How do new guidelines impact dental professionals?

  • Dental appointment
    • more patients diagnosed w/HTN 
    • will see HTN drugs more frequently
      • need to understand side effects of most common
      • ex: Calcium Channel blockers
        • amlodipine=Gingival hyperplasia
    • educate pt about new guidelines
    • more important role in screening for HTN bc patients see dentist more often

13

What are the complications of undiagnosed or uncontrolled high BP?

  • Aneurysms
  • Chronic kidney disease
  • Eye damage
  • heart attack
  • heart failure
  • peripheral artery disease
  • stroke
  • vascular dementia
  • Artherosclerosis

14

Artherosclerosis

  • thick and hard arteries
  • leads to MI and/or stroke

15

Aneurysm

  • Weakened blood vessels that bulge
  • Types:
    • Saccular
    • Fusiform
    • Pseudoaneurysm
  • Brain Aneurysm
    • Cerebral Aneurysm
      • ruptured=Hemorrhagic stroke

16

Chronic Kidney Disease

  • Kidneys=filter XS fluid and waste from blood
  • weak and narrow blood vessels in kidney

17

Damage to kidney: Types

  • Kidney failure
  • Kidney Scarring (Glomerulosclerosis)
  • Kidney Artery Aneurysm

18

Kidney Disease

  • HTN one of the most common causes
  • damages larger arteries leading to your kidney and tiny blood vessels (glomeruli) in the kidney
  • can't filter waste from blood→accumulates
  • require dialysis or kidney transplant

19

Kidney Scarring

  • aka Glomerulosclerosis
  • glomeruli scarred
    • tiny blood vessels in kidney
  • can't filter waste
  • leads to kidney failure

20

Damage to brain: types

  • Transient Ischemic Attack (TIA)
  • Stroke
  • Dementia
  • Mild Cognitive impairment

21

Transient Ischemic Attack

  • caused by atherosclerosis or blood clot
  • warning that you're at risk of a stroke

22

Stroke

  • occurs when part of brain is deprived of oxygen and nutrients
  • causes brain cells to die
  • uncontrolled HBP damages and weakens brains blood vessel-→stroke

23

Dementia

  • Brain disease
  • problems with:
    • thinking
    • speaking
    • reasoning
    • movement

24

HTN: Treatment goals

  • <60 y.o., Diabetes, Chronic Kidney Disease
    • BP <120/80
  • >60 y.o.
    • <150/90
    • recommend home monitoring

25

Non-Medicine Treatment options for HTN:

  • Life style changes
  • age & condition based criteria
  • Weight loss if overweight:
    • adopt DASH eating plan
      • Dietary Approaches to Stop Hypertension
        • fruits
        • veggies
        • low fat dairy
        • reduced cholesterol, saturated and total fat
        • adequate potassium and calcium
    • Reduce sodium intake (<2.4 g/day) ****
    • Regular aerobic physical activity
    • limit alcohol intake (<1-2 drinks/day
    • stop smoking

26

HTN: Pharmacologic management-different types of drugs used

Common

  • Diuretics (thiazides)
  • Beta adrenergic blockers 
  • Alpha Adrenergic blockers
  • Alpha-Beta Adrenergic blockers
  • ACE inhibitors (angiotensin converting enzyme)
  • Calcium Channel Blockers
  • ARBs (angiotensin II receptor blockers)

Less frequently Used

  • Vasodilators
  • central alpha agonists

27

HTN Tx: Medication related concerns

  • NSAIDs and Antihyptensive
  • Antibiotics & Calcium Channel Blocker=Fatal combo
    • increased risk of hospitalization for
      • acute kidney injury
      • hypotension
      • death

28

HTN: Common side effects of ACE inhibitors

  • persistent dry cough
    • most common
  • dizziness
  • taste disturbance
  • rashes

29

HTN: Common side effects of ARBs

  • Dizziness
  • Headache

30

HTN: Common side effects of Calcium Channel Blockers

  • Flushed face
  • headaches
  • swollen ankles
  • dizziness
  • tired