Hypertension

Question 1

What are we really measuring when we taking someone’s BP?

Answer 1

Force of the blood on the arterial wall and vice versa

Question 2

Why does BP go up when we are in pain?

Answer 2

Increased O2 demand

Question 3

What’s happening to our bodies when our BP is too high?

Answer 3

Stroke is most common or MI

Question 4

How do we define HTN?

Answer 4

• Systolic BP over 140

- Diastolic BP over 90

Question 5

Pre-HTN

Answer 5

120-139 and/or 80-89

Question 6

Stage 1 HTN

Answer 6

140-159 and/or 90-99

Question 7

Stage 2 HTN

Answer 7

over 160 and/or over 100

Question 8

HTN aka …

Answer 8

The Silent Killer

Question 9

WHO identifies HTN as…

Answer 9

being responsible for 62% of cerebrovascular dz and 49% of ischemic heart disease

Question 10

CDC estimates…

Answer 10

that appox. 1 in 4 adults are hypertensive. Many do not realize

Question 11

What is BP?

Answer 11

Force exerted against the walls of the arteries and veins by the blood as its being pumped from the heart

-Remember your physics: also the pressure exerted by the walls of the arteries and veins against the blood

Question 12

Systolic pressure

Answer 12

highest amount of pressure exerted on the arterial wall at the peak of ventricular contraction

Question 13

Diastolic pressure

Answer 13

lowest pressure exerted during ventricular relaxation

Question 14

MAP

Answer 14

Mean Arterial Pressure

-avg amount of pressure exerted throughout cardiac cycle

Question 15

MAP is measured..

Answer 15

as the cardiac output, multiplied by the peripheral vascular resistance

COxPVR=MAP

Question 16

Pulse Pressure

Answer 16

SBP-DBP=PP

Question 17

Why is MAP important?

Answer 17

• gives us a picture of the entire cardiac cycle
• monitors the perfusion of organs
• MAP 70-110 is normal, over 60 is enough to perfuse all organs, less is potentially bad

Question 18

Sympathetic Nervous System BP control

Answer 18

baroreceptors in the carotid arteries can activate SNS

Question 19

Vascular endothelium

Answer 19

produces several vasoactive substances

Question 20

Renal System BP control

Answer 20

• controls extracellular fluid
• renin, angiotensin, aldosterone
• prostaglandins - vasodilators

Question 21

Primary HTN

Answer 21

elevated BP without a single identified cause

Question 22

Secondary HTN

Answer 22

elevated BP with specific cause which can be identified and corrected

Question 23

Preclampsia

Answer 23

elevated BP during pregnancy, usually after 20 weeks

-possible organ damage esp kidneys. Very dangerous.

Question 24

Contributing factors of Primary HTN

Answer 24

• Elevated SNS activity
• Elevated sodium retaining/vasoconstricting hormones
• Increased body weight
• Diabetes
• Tobacco/alcohol consumption

Question 25

Risk factors for HTN

Answer 25

- Age - Body weight - Diet - Exercise - Genetics - Sex - Ethnicity - Alcohol/Tobacco - Stress

Question 26

Manifestations of HTN

Answer 26

- Early on, asymtomatic, only high BP - HA - Nocturia - Mental status changes later on - N/V - Visual changes, papilledema (swelling of optic nerve)

Question 27

altered kidney function

Answer 27

leads to excess fluid volume and retention

Question 28

CHF and HTN

Answer 28

Increased workload, ventricles stretch, hypertrophy, muscle thickens, fluid backs up, increased BP even more

Question 29

Diabetes and HTN

Answer 29

Increased blood visocity, increased fluid volume

Question 30

Secondary HTN

Answer 30

- coarctation or congential narrowing of aorta - S/E of drugs or hormones - Traumatic brain injury, tumors - Glomerulonephritis, kidney dz - cirrhosis

Question 31

HTN Crisis/ Emergency

Answer 31

- develops over several hours, days, or even weeks - situation when BP rises to severe levels - rate of rise is more important than the end value however pts with chronic HTN typically tolerate higher BPS normally

Question 32

HTN Crisis Manifestations

Answer 32

- Encephalopathy - Renal insufficiency - Angina, MI, chest pain, SOB

Question 33

Encephalopathy

Answer 33

increased cerebral capillary permeability * HA * N/V * seizures, confusion, edema

Question 34

HTN Crisis Tx

Answer 34

- Aimed at lowering BP immediately - nitroprusside sodium - labetalol

Question 35

Nitroprusside sodium

Answer 35

vasodilator given IV in HTN crisis, must be closely monitored and tightly titrated

Question 36

Labetalol

Answer 36

mixed alpha and beta adrenergic blocker given IV

Question 37

Prevention/Tx of HTN Crisis

Answer 37

- Modify diet - Increase activity, exercise, decrease weight - stress reduction - dash diet - drugs - will depend on individual and the cause of their HTN

Question 38

DASH Diet

Answer 38

- Dietary approaches to Stop HTN - Lots of fruits, veges, whole grains, low fat dairy, fish, poultry, nuts - very few sugary foods, sugary beverages, red meats, added fats

Question 39

Beta Adrenergic Receptor Blockers

Answer 39

- Atenolol - Metoprolol Make the heart beat slower and with less force

Question 40

Angiotensin Coverting Enzyme Inhibitors

Answer 40

- Enalapril - Lisinopril Stops veins from vasocontricting

Question 41

Diuretics

Answer 41

- Furosemide - Hydrochlorothiazide Makes you pee K+ sparing, Spironolactone

Question 42

Your patient has been prescribed Toprol XL (Metoprolol) for the treatment of Hypertension. Which change do you expect to occur in your patient as a result of this new prescription?

Answer 42

Decrease in HR

Question 43

HTN often goes undetected until symptoms of major organ system failure begin to appear. Which of the following would be the most likely to occur in the patient with HTN?

Answer 43

Cerebrovascularaccident

Question 44

Your patient has been prescribed a vasodilator (Hydralazine) for the treatment of HTN. Which side effect do you want to monitor your patient for?

Answer 44

Tachycardia

Question 45

Whats happening to our bodies when our BP is too high?

Answer 45

Blood vessels are under stress and loses elasticity