Hypertension Flashcards
(73 cards)
1
Q
HTN risk factors
A
Age
Genetics
Diabetes and dyslipidemia
African American race
CKD
Excessive alcohol intake
2
Q
avg arterial blood pressure during normal flow
A
90mm hg
3
Q
systole hemodynamics
A
pressure in arteries increase
heart pumps blood into arterial system
wall of the arteries stretch
4
Q
diastole
A
recoil elasticity of vessel
forces blood out and into the capillaries
5
Q
minimum diastolic pressure
A
70-80 mmHg
6
Q
maximum systolic pressure
A
110-120
7
Q
BP regulation depends on
A
cardiac output and peripheral vascular resistance
8
Q
cardiac output impact on BP
A
affected by sodium intake, renal function, mineralocorticoids
9
Q
peripheral vascular resistance
A
dependent upon sympathetic nervous system, humoral factors, local vasculature autoregulation
10
Q
inotrope
A
strength of contraction
11
Q
chronotrope
A
beats per minute
12
Q
after load
A
force heart exerts to overcome peripheral resistance
13
Q
short term BP regulation (systems?)
A
neural
humoral
14
Q
neural short therm BP control
A
baroreceptors and chemoreceptors (O2, CO2, H+) in carotids and aorta to determine response
acts on vagus n. to DECREASE HR
acts on sympathetic n. to INCREASE HR and tone
15
Q
humoral BP control
A
RAAS promotes water retention and ADH vasoconstricts and decreases water loss
directly increases HR, contractility, vascular tone
16
Q
long term BP control
A
kidney
regulates pressure around an individual set point
17
Q
how is BP elevated?
A
hydrostatic pressure
widespread arteriolar vasoconstriction
18
Q
normal BP
A
systolic less than 120
diastolic less than 80
19
Q
prehypertension
A
120-139 systolic/ 80-89 diastolic
20
Q
hypertension stage 1
A
systolic 140-159 or diastolic 90-99
21
Q
hypertension stage 2
A
systolic > 160, diastolic > 100
22
Q
isolated systolic HTN
A
BP is >140/<90
23
Q
isolated diastolic HTN
A
<140/>90
24
Q
hypertensive urgency
A
BP at or above 180/120 with NO end organ damage
25
hypertensive emergency
evidence of impending or progressive target organ dysfunction
at or above 180/120
26
neurological HTN damage (4)
hypertensive encephalopathy
cerebrovascular accident (stroke)
subarachnoid hemorrhage
intracranial hemorrhage
27
cardiac end organ damage
HTN
myocardial ischemia/infarction
acute left ventricular dysfunction
acute pulmonary edema
aortic dissection
28
other hypertensive emergencies
acute renal failure/insufficiency
hypertensive retinopathy
pre-eclampsia/eclampsia
microangiopathic hemolytic anemia
29
diagnosis of HTN
must see provider 2x
initial (if 180- dx)
then come back for several random checks and then review with provider in 3 weeks
30
non-dippers
failure of BP to decrease nocturnally
confers a cardiovascular disease risk
31
younger patients and HTN risk
diastolic BP is most closely associated with CV risk
32
older adults and HTN risk
older adults typically have isolated systolic HTN
adults over 60- BP remains primary determiner of CV risk
33
African Americans and HTN
HTN that is more responsive to sodium intake, obesity, and diet
younger pts have more severe HTN than older
vulnerable to strokes and HTN kidney disease
3-5 times as likely ot have renal complications and end stage kidney disease
34
HTN classifications
primary or secondary
90-95% are primary
35
resistant HTN
typically secondary HTN
uncontrolled BP while on meds from 3+ drug classes (and one is a thiazide diuretic)
36
secondary HTN etiologies
1. CKD
2. polycystic kidney disease
3. renal artery stenosis
4. coarctation of aorta
5. thyroid dz
6. pheochromocytoma
7. primary hyperaldosteronism
8. medication
37
renal disease and secondary HTN
CKD- mc cause
PCKD - large size of kidneys
both have lo GFR and can't be reversed
38
renal artery stenosis
renovascular HTN
caused by arteriosclerosis in men and fibromuscular dysplasia in women
constant RAAS activation
39
when do you suspect renal artery stenosis
suspect if AKI with imitation of ACEI/ARD, refractory HTN, recurrent flash pulmonary edema, abdominal bruit
40
contraction of aorta
uncommon cause of secondary HTN
suspect if UE pulses and BP are higher than LE BP
41
medications that cause secondary HTN
ethanol
illicit drug use
estrogens
ephedra/pseudoephedrine
black licorice or licorice root
42
prehypertension history
asymptomatic increase in CO and intermittently elevated BP
43
early HTN history
persistently increased peripheral resistance
44
possible mechanisms causing HTN (6)
1. sympathetic N.s. hyperactivity
2. genetics
3. reduced adult nephron mass
4. sodium intake
5. immunologic
6. cardiac manifestations
45
sympathetic NS hyperactivity and HTN
over activity of sympathetic tone leads to increased vascular tone and HTN
46
sodium intake and HTN
increased salt intake triggers increase in BP that promotes increased natriuresis
brings BP up to basal levels
47
diseases that contribute to HTN (9)
1. obesity
2. sleep apnea
3. cigarette smoking
4. alcohol
5. lack of exercise
6. immune system activation
7. polycythemia
8. increased salt intake
9. NSAIDs
48
obesity HTN
associated with increase in intravascular volume, cardiac output, activation of RAAS, increased sympathetic outflow
lowers BP modestly
49
cigarette smoking and HTN
raises BP by increasing plasma norepinephrine and synergistic effect of smoking and high BP on CV risk
50
alcohol and HTN
raises BP
increasing plasma catecholamines
can be difficult to control in alcoholics
51
vascular remodeling and HTN
increased after load causes increased arterial wall stiffness, increased systolic BP, widened pulse pressures
decrease coronary perfusion pressures, increased myocardial O2 consumption, hypertrophy of left vent myocytes
52
steps in cardiac decline due to HTN (awk. phrasing but what happens first, second and third)
1. left ventricle hypertrophy
2. diastolic dysfunction
3. systolic dysfunction
53
left ventricle hypertrophy
left ventricle muscle gets thicker so that the heart can pump more strongly against the elevated pressure
increased risk of premature death and morbidity
54
diastolic dysfunction
incomplete passive relaxation of stiff hypertrophied left ventricle
less space to go in
55
cerebral auto regulation of BP
ability of vasculature to maintain constant cerebral blood flow across wide range of perfusion pressure
56
cerebral auto regulation and HTN
when chronic HTN present, CNS becomes accustomed to elevated perfusion pressures
therefore more prone to cerebral ischemia when BP/flow decreases
57
CNS auto regulation and HTN tx
pts with longstanding HTN
can be just as dangerous to lower their BP too precipitously as it is to let it stay elevated
can cause ischemia (too low) or edema (too high)
58
chronic HTN and the kidney
causes pathologic sclerotic changes in kidney
endothelial cell dysfunction and impaired vasodilation
alters auto regulation of blood flow to glomerulus and is instead affected by systemic arterial pressure
volume expansion is main cause
59
in patients with vascular disease, HTN is the result of (kidney)
activation of RAAS
secondary to tissue ischemia
volume expansion and activation of system is believed to be cause of HTN with chronic renal failure
60
RVHT
occurs when there is complete or partial vascular occlusion of a renal artery
RAAS Is activated by kidney with low blood flow
hyerreninemia promotes conversion of angiotensin I to angiotensin II = severe vasoconstriction and aldosterone release
61
CV risk factors
```
tobacco use
diabetes mellitus
obesity
lack of exercise
elevated LDL
>55 (men) or >65 (women)
GFR <60
microalbuminuria
family hx
```
62
prescription drugs causing drug induced HTN
```
NSAIDS
psych meds
migraine meds
high dose OCs
pseudoephedrine
```
63
situations w/prescriptions drug causing drug induced HTN
b- blockers without alpha blocker first when treating cocaine induced HTN or pheo
64
street drugs or other causing drug induced HTN
cocaine
cocaine withdrawal
narcotic withdrawal
st. john's wort
65
diagnostic HTN work up
```
urinalysis
fasting blood glucose
CBC
electrolytes
fasting lipids
baseline EKG
```
66
HTN target
general population
<140/90
- under 60 = <150/90
67
HTN target
80+
<150/90
68
HTN target
Diabetics Mellitus
<130/80
69
HTN target
CKD
<130/80 `
70
lifestyle modifications in HTN
```
weight loss
DASH diet
reduced salt intake
exercise
alcohol
```
71
tx goal of essential HTN
lifestyle and if insufficient, drug tx
reduction in CV and renal morbidity and mortality
72
HTN tx and drug chosen
mortality benefit for HTN related to AMOUNT lowering, not drug chosen
SO look at compelling indications and try to reduce # of pills
73
compelling indications (def + 6)
specific classes of drugs that should be initiated where evidence based survival benefit
1. heart failure
2. high CAD risk
3. CKD
4. Post Myocardial Infarction
5. Diabetes Mellitus
6. Recurrent Stroke Prevention
