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341 Exam 1 > Hypertension > Flashcards

Hypertension Flashcards

1
Q

As BP increases so does the risk of: 5 things

A

i. MI
ii. Heart failure
iii. Stroke
iv. Renal disease
v. Retinopathy

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2
Q

All ethnicities: Three factors for decreased prevalence

A

Born outside US
Doesn’t speak English
Limited time living in US

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3
Q

African Americans has (3 things)

A

Highest prevalence
More resistant HTN
More nocturnal non dipping BP

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4
Q

African Americans are less responsive to

A

renin inhibiting meds

Better control with: calcium channel blockers & diuretics

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5
Q

African Americans are at an increased risk of

A

Angioedema (allergy deep in skin) with ACE inhibitors

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6
Q

Men & HTN

A

more common before middle age

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7
Q

Women & HTN

A

increased 2-3x with oral contraceptives
Preeclampsia
More common after menopause
Harder to control for women

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8
Q

Normal BP

A

Systolic <120

Dystolic <80

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9
Q

Elevated (pre-hypertension) BP

A

SBP 120-129

DBP <80

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10
Q

Hypertension stage 1

A

SBP 130-139

DBP 80-89

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11
Q

Hypertension Stage 2

A

SBP 140 or higher

DBP 90 or higher

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12
Q

Hypertension Crisis

A

SBP higher than 180

DBP higher than 120

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13
Q

Two types of hypertension

A

Primary & secondary hypertension

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14
Q

Primary hypertension

A

also called essential/idiopathic HTN
Elevated BP of unknown cause
90-95%

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15
Q

Contributing factors to primary hypertension (8 things)

A 
Altered endothelial function increased SNS activity
increased Na+ intake
overproduction of Na+ retaining hormones
overweight
diabetes
tobacco
excess alcohol
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16
Q

Secondary hypertension

A

elevated BP with specific cause; sudden development

5-10%

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17
Q

Clinical findings relate to underlying cause (secondary hypertension)

A

Cirrhosis;
aortic problems;
drug-related;
endocrine, neurologic, or renal problems; pregnancy-induced, or sleep apnea

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18
Q

Secondary hypertension treatment is

A

aimed at removing or treating cause

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19
Q

Increased BP=

A

Increased CO or SVR

Persistently increased SVR

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20
Q

Risk Factors for Primary Hypertension

A

a. Age
b. Alcohol use
c. Tobacco use
d. Diabetes
e. Elevated serum lipids
f. Excess dietary sodium
g. Gender
h. Family history
i. Obesity
j. Ethnicity
k. Sedentary lifestyle
l. Socioeconomic status
m. Stress

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21
Q

Different sets of genes regulate

A

BP at different times

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22
Q

Research of primary hypertension genetic link

A

endothelial dysfunction

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23
Q

Hypertension Clinical Manifestations (S&S)

A

“Silent Killer” asymptomatic until severe & target organ disease occurs

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24
Q

Symptoms of severe hypertension (6 things)

A 
Fatigue
Dizziness
Palpitations
Angina
Dyspnea
Nocturia
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25
Q

Target organ diseases occur most frequently in:

A

♡ , brain, peripheral vascular disease, kidney, eyes

26
Q

What occurs in the ♡ from HTN?

A
  1. Coronary artery disease; atherosclerosis
  2. Left ventricular hypertrophy
    a. Large & thickening
  3. Heart failure
27
Q

What occurs in the brain from HTN?

A

Cerebrovascular disease
TIA/Stroke; atherosclerosis
Hypertensive encephalopathy

28
Q

What occurs in peripheral vascular disease?

A

i. Atherosclerosis leads to PVD, aortic aneurysm, aortic dissection
ii. Intermittent claudication

29
Q

Kidney

A

Nephrosclerosis leads to chronic kidney disease (CKD)

30
Q

Eyes-retinal damage

A

Blurry or loss of vision; retinal hemorrhage

31
Q

Damaged retinal vessels indicate concurrent damage to

A

in heart, brain, and kidneys

32
Q

Labs are done for hypertension too:

A
  1. Identify or rule out secondary HTN
  2. Evaluate target organ disease
  3. Determine CV risk
  4. Establish baselines before starting therapy
33
Q

Hypertension lab names:

A

Renal function, U/A, BMP, CBC, serum lipid profile, uric acid, ECG, ophthalmic exam

34
Q

Ambulatory blood pressure monitoring (ABPM); avoids

A

“white coat” HTN

35
Q

Noninvasive, fully automated system that measures BP at preset intervals over 12 to 24-hour period

A

Ambulatory BP monitoring

36
Q

Teaching for ABPM

A

Teach patient to hold arm still while device reads BP and keep diary of activities

37
Q

Other applications for use of ABPM

A
  1. Antihypertensive drug resistance
  2. Hypotensive symptoms with antihypertensive therapy
  3. SNS dysfunction
  4. Episodic HTN (spiking during different times of the day)
  5. Diurnal variability; nondippers; reverse dippers
38
Q

Lifestyle modifications, AHA life’s simple 7

A
  1. Manage BP
  2. Control cholesterol
  3. Reduce blood sugar
  4. Get active
  5. Eat better
  6. Lose weight
  7. Stop smoking
39
Q

Overall goals of HTN care

A

i. Achieve and maintain goal BP

ii. Reduce CV risk factors and target organ disease

40
Q

Lifestyle modifications

A

Weight reduction

i. Weight loss of 1 kg (2.2lbs) will decrease SBP by 1 mm Hg
ii. Calorie restriction and physical activity

41
Q

DASH eating plan

A

i. Fruits, vegetables, fat-free or low-fat milk/milk products, whole grains, fish, poultry, beans, seeds, and nuts
ii. Calcium & Magnesium

42
Q

Sodium for healthy adults

A

less than 2300 mg/day

43
Q

Sodium for blacks, middle-aged and older, those with hypertension, diabetes, or chronic kidney disease

A

less than 1500 mg/day

44
Q

Salty Six (AHA)

A

bread/rolls, lunch and cured meats, sandwiches, pizza, soup, poultry

45
Q

Moderation of Alcohol Intake

A

Men: 2 drinks/day; women: 1 drink/day

46
Q

Physical Activity

A

Moderate-intensity aerobic activity, at least 30 minutes, most (at least 5) days of the week for goal of 150 minutes/week

47
Q

Nicotine causes

A

vasoconstriction and elevated BP

48
Q

Smoking cessation reduces risk factors

A

within 1 year

49
Q

Two primary actions of hypertension

A

i. Decrease circulating blood volume

ii. Reduce SVR

50
Q

Patient teaching

A

i. If a drug is not tolerated, then another classification will be used
ii. Monthly follow-up visits until at goal BP; then 3 to 6 months

51
Q

Patients should:

A

report all side effects & different meds may be tried if severe

52
Q

Common side effects of drug therapy

A

Orthostatic hypotension
sexual problems
dry mouth
frequent voiding

53
Q

Failure to reach goal BP with appropriate therapy and drug

A

Resistant Hypertension

54
Q

Resistant hypertension increases the risk for

A

stroke of MI

55
Q

Causes of resistant hypertension

A
  1. Improper BP measurement
  2. Volume overload
  3. Drug-induced or other causes
  4. Associated conditions
  5. Secondary HTN
56
Q

Primary prevention of HTN

A
  1. Lifestyle modification—DASH, decreased Na+

2. Education regarding dangers of HTN

57
Q

Individual patient evaluation and education (4 things)

A

i. Screening programs
ii. Identify risk factors for HTN and CAD
iii. BP measurement; health assessment
iv. Drugs and/or previous treatment

58
Q

Assess for orthostatic hypotension

A

i. BP and HR after supine for 5 minutes
ii. Assist to standing
iii. Measure BP and HR at 1 minute and 3 minutes of position change

59
Q

Normal orthostatic hypotension

A 
SBP decreased (less than 10 mm Hg)
DBP and HR increased slightly
60
Q

Abnormal orthostatic hypotension

A

SBP decreased 20 mm Hg or more

  1. DBP decreased 10 mm Hg or more
  2. HR increased 20 beats/min or more
61
Q

Most patients start with

A

diuretic

341 Exam 1 (8 decks)

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