For CVD risk, is systolic or diastolic BP more important?
For persons over age 50, SBP is more important than DBP as a CVD risk factor. For under 50, it's unclear.
It is unclear what causes primary "essential" hypertension. What are 2 hypothesis?
Primary defect in renal sodium excretion causes an increase in plasma volume and an increase in cardiac output which causes an initial over-perfusion of organs. An autoregulatory increase in systemic vascular resistance brings the perfusion back to normal but causes an increase in blood pressure.
In vascular smooth muscle cells, there is a Na/K-ATPase that brings potassium into the cell and sodium outside the cell. There is also a Na/Ca exchanger that brings sodium into the cell and Ca out of the cell. This hypothesis states that there is a Na/K-ATPase inhibitor that binds to VSMCells and this causes an increase in intracellular Na. An increase in intracellular Na causes a decrease in Na/Ca exchanger activity. This causes an increase of intracellular Ca. An increase in cell Ca causes vascular contriction and an increase in systemic vascular resistance.
Explain JNC 7 blood pressure classification
Normal - Systolic less than 120 and diastolic less than 80
Prehypertension - systolic 120-139 or diastolic 80-89
Stage 1 hypertension - systolic 140-159 or diastolic 90-99
Stage 2 hypertension - systolic greater than 160 or diastolic greater than 100
Why worry about pre-hypertension?
Patients with pre-hypertension have a high risk of developing hypertension.
Also, people with pre-hypertension have higher incidence of CV events. Pre-hypertension is not a normal BP!
True or False: Microalbuminuria or estimate GFR less than 60 ml/min are independent risk factors for CVD
True or False: lowering BP saves lives. In stage 1 HTN (SBP 140-160mmHg) and addiitional CVD risk factors, achieving a sustained 12 mmHg reduction in SBP over 10 years will prevent 1 death for every 11 patients treated
True or False: Smoking cessation is the single most important way to help for managing BP for adults
How do you treat pre-hypertension, stage 1, and stage 2 hypertension?
Encourage lifestyle modification for all.
Pre-hypertension doesn't need antihypertensive drugs
Stage 1 HTN is treated by thiazide-type diuretics for most. May consider ACEI, ARB, BB, CCB, or combination.
Stage 2 HTN is treated with two-drug combination (usually thiazide-type diuretic and ACEI or ARB or BB or CCB)
What BP target do you have for patients with diabetes or CKD?
It's important to achieve this goal especially in persons greater than 50 years of age.
True or False: dietary sodium reduction alone doesn't help that much with BP control.
The biggest things you can do are weight reduction and the DASH eating plan. However, every bit counts so you want to encourage it all.
Smoking is not on this list but it is by far the most helpful lifestyle modification.
What is different about JNC 8 compared to 7? Are these guidelines used in the renal community?
JNC8 says that patients over the age of 60 should be treated to 150/90 and under the age of 60 should be treated to 140/90. JNC8 does not have any exceptions for CKD or diabetes while JNC 7 treats CKD or diabetes as "compelling indications" to add an additional antihypertensive drug.
JNC8 is not followed in the renal and geriatric communities.
True or False: Essential hypertension is not very common
FALSE. It is very common
Is systolic or diastolic blood pressure a more important indicator for risk?
According to JNC7, what is the target BP to shoot for? How about if the patient has CKD or diabetes?
True or False: physicians should be treating HTN much more aggressively with lifestyle modification suggestions and drugs