How do both SBP and DBP change with age? Mechanism for age-related changes?
Effect on Pulse Pressure?
SBP - Increases with age up until death bc blood vessels get stiffer
DBP - rises until age 50 and then starts to decline bc blood vessels lose elasticity and canno longer maintain pressures
Pulse Pressure Widens!
Name the 4 predictors of mortality in HTN and which one is most significant?
1) Elevated systolic pressure
2) elevated diastolic
3) Wide Pulse Pressure* most significant
4) Loss of Nocturnal Dip (normally BP goes down at night but if it doesn't anymore then bad HTN)
What is the numerical definition of Isolated Systolic HTN?
SBP >140 and DBP <90
occurs predominantly in older people and indicates underlying stiffness of vessels
How does AG2 contribute to primary HTN?
AG2 acts on receptors in vessels and leads to 1) Vasoconstriction and 2) Fibrosis and 3) Thrombosis
What are the target organ sequelae of HTN in the eyes?
Retinal vein and artery thrombosis
*Papilledema - PATHOPNEUMONIC!!!
Other Findings on fundoscopic exam evidence of Eye damage:
AV Nicking - arteries in retina thickened and intent onto veins there they cross
Copper Wiring - arteries look thick and prominent
Flame Hemorrhage, Hard exudates, Cotton wool spot, Papilledema
How does HTN lead to target organ damage in the heart and cardiac failure...Then walk through an example of the progression
Coronary Artery Disease decreases luminal caliber leading to Hypertrophy of LV
LV Hypertrophy becomes so thick that heart has hard time relaxing so has to contract more frequently to maintain CO (bc less filling)
LV Hypertrophy also leads to stretching of myocytes and changes electricity in heart - Arrhythmias
WALK THROUGH EXAMPLE
Early - ventricle thickened and Diastolic heart failure so blood backs up into periphery and lungs
Later - ventricle gives out bc cant pump against increased pressure and get dilated Systolic Heart Failure
What is a Clinical Presentation clue to Peripheral Vascular Disease?
Claudification of feet and legs - get sore with exertion
What are the CNS organ damage effects from HTN?
Hemorrhagic - shear force of high BP on tiny vessels that burst
Ischemic - Atheroma and plaque dislodges distally to get ischemic area - LACUNAR CAVITY FORMS = Pathopneumonic for HTN
What are the 4 classes of drugs to treat primary HTN and how do they work?
diuretics - Lower CO by reducing salt and water load
Sympatholytics - act centrally or peripherally
Vasodilators - Dilate vessels for less TPR
RAS Antagonists - block effects of Renin and AG2
Which anti-HTN durgs should NOT be used in pregnancy?
ACE-Inhibitors and ARB
What is the rule of tens? to what does it apply?
Rule of Tens for SYSTOLIC pressure only
add 1 additional drug to treat HTN for every additional 10 mmHG reduction that needs to be made