Risk Factors for Postural Hypotension Risk Factors for Postural Hypotension

- Age - Postprandial hypotension - Dehydration - Medications - Pregnancy - Certain disease - Bed rest - Alcohol

Classification of Hypertension Sys/Dia - Normal - Stage 1 - Stage 2

- Normal = 120/80 - Stage 1 = >130-139 / 90 - Stage 2 = >140/90

Lecture 3 - Hypertension & Dyslipidemia Guidelines Flashcards by Danielle Hixon

Cardiovascular Mortality Risk Doubles with each ______ increase in BP

20/10 mm Hg

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Hypertension can be diagnosed using one of the

following three acceptable measurement strategies:

Ambulatory blood pressure monitoring (ABPM)
Home blood pressure monitoring (HBPM)
Office-based blood pressure measurements

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Diagnosis of Hypertension: Home Measurement
Why do we like it?
What are some drawbacks?

Why do we like it?
• Available
• Inexpensive
• No white coat syndrome
• Can improve BP control and compliance

What are some drawbacks?
• Training/BP technique
• Access to appropriate/accurate device

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Diagnosis of Hypertension: ABPM
Why do we like it?
What are some drawbacks?

Why do we like it?
• Detects morning bp surge • Quick results
• Dippers v. non-dippers
• If treatment is working at the best time

What are some drawbacks? • Availability
• Expense

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Dippers v. non-dippers

Dipper blood pressure dips at night where as non-dippers

Non-dippers are more at risk as BP should dip when you sleep…natural surges in the am

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Non-dippers or dippers need ambulatory BP monitoring

Non-dippers

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The proper measurement of office-based BP requires attention to all of
the following:
(6)

Time of measurement
Type of measurement
Cuff placement
Patient condition
Technique of measurement
Number of measurment

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Oscillometric method

Analyzes pulse waves collected
from the cuff during constricted
blood flow

(Automated one at most doctors offices)

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Auscultatory method

Listening to the internal sounds of the body, usually using a stethoscope

(Most efficient way uses ear)

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Correct Office Based Measurement:

Cuff Placement

• Bladder midline over brachial artery • Two finger lengths above “elbow bend”

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Correct Office Based Measurement:

Type of Measurement Device

Oscillometric method

Auscultatory method

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Correct Office Based Measurement:

Patient Condition

Patient position (sitting, feet on floor etc)

* Extraneous variables (caffeine, smoking etc)

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Correct Office Based Measurement:

Technique of Measurement

Depends on skill of operator

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Correct Office Based Measurement:

Alternative Sites for Measurement

Radial artery
Brachial artery
Dorsalis pedis artery 
Popliteal artery 
Posterior tibial artery

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Postural Hypotension

AKA?
What is it?
Add what to diet?

Aka orthostatic hypotension
Low BP when you stand up from sitting/laying down
Add sea salt to diet to increase BP

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Pathophysiology of Postural Hypotension

Normal

Stand up
Gravity moves blood to legs
** Baroreceptors in neck and heart arteries sence low BP
Send signals to brain
** Signals heart to breat faster and vessels to constrict to increase BP

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**_____ in neck and heart arteries sense low BP

Signals heart to beat ____ & vessels to ____

Baroreceptor

faster & constrict

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**Pathophysiology of Postural Hypotension

Abnormal

Stand up
Gravity moves blood to legs
**Interruption of natural process
Less blood circulating to heart
Decreased BP

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Risk Factors for Postural Hypotension

Age
Postprandial hypotension
Dehydration
Medications
Pregnancy
Certain disease
Bed rest
Alcohol

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Postprandial hypotension

A condition in which a person’s blood pressure drops after they eat

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Classification of Hypertension
Sys/Dia

Normal
Stage 1
Stage 2

Normal = 120/80
Stage 1 = >130-139 / 90
Stage 2 = >140/90

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Non-Pharmacologic Treatment for hypertension

Weight reduction
Adopt DASH eating plan
Dietary sodium reduction
Physical activity
Moderation of aalcohol consumption
Stop smoking

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Recommended sodium intake

less than 1500 mg/day

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Hypertension BP goals for general population with no diabetes or CKD:

Older than 60
Younger than 60

<150/90

<140/90

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Hypertension BP goals for population with diabetes or CKD: - All Ages Diabetes present and no CKD - All Ages and races with CKD present with or without diabetes

140/90

Treatment for nonblack

- Thiazide - ACEI - ARB - CCB (alone or in combo)

Treatment for black

- Thiazide | - CCB

Blood pressure reduction is less with ______ or _____ compared with other drug classes in African Americans What's the exception

ACE inhibitors or ARBs Exception: If they have chronic kidney disease (start on ACE and ARB)

If ACEI, ARB, CCB and Thiazide are not working what is the next step?

- Reinforce lifestyle and adherence | - Add medication class (beta-blocker, aldosterone antagonist)

What are the four | main classes of drugs that are recommended for use as initial monotherapy:

- ACE Inhibitor (ACEI) - Angiotensin receptor blocker (ARB) - Thiazide diuretic - Calcium channel blocker (CCB)

ACE Inhibitors work to prevent ________ being converted to __________

Angiotensin I to Angiotensin II | This prevents the retention of fluid + vasoconstriction that would raise the BP

Volume Regulating Hormones drugs

ARBs = targets vasoconstriction Aldosterone antagonist = aldosterone Thiazide diuretic = targets Na+ and water retention

ARBs

Vasoconstriction

HTN Drug Classes: | -pril

ACE Inhibitor

HTN Drug Classes: | -pine

CCBs

HTN Drug Classes: | sartans

ARBs

HTN Drug Classes: | ACE Inhibitors

Inhibits ACE, preventing conversion of ang I to ang II (see RAAS pathway)

HTN Drug Classes: | ARBs

Blocks ang II from binding to receptor on vascular smooth muscle

HTN Drug Classes:

Inhibits Ca movement through Ca channels --> vasodilation and decreased BP

How do you calculate estimated VLDL?

TG/5

What cholesterols are measurable?

- T-C (total cholesterol) - HDL (HDL cholesterol) - LDL (LDL cholesterol)

How do you calculate estimated LDL?

LDL = TC - HDL - VLDL | Not to be used when TG > 400mg/dl

LDL Cholesterol desirable range

< 100

HDL Cholesterol desirable range

< 40 males | < 50 women

Non-HDL Cholesterol (TC-HDL) desirable range

< 130

Four Major Statin Benefit Groups

1. Individuals with clinical ASCVD (Atherosclerotic vascular disease) 2. Primary elevation of LDL > 190mg/dL 3. Diabetes & 40-75 years of age with LDL between 70-189mg/dl 4. Patient 40-75 with LDL between 70-189 with estimated 10 years ASCVD risk of 7.5

We want 10 year ASCVD rate to be ______

> 7.5% | less

10 year ASCV Risk Calculator

Provides an estimate of an individual’s risk of having a cardiovascular event during the next 10 yrs

What is the BMI range one should aim for?

18.5 - 24.9 kg/m2

Saturated fats

• Molecules “saturated” with hydrogen molecules • Typically solids at room temperature (High LDL..example coconut oil)

Trans fat

``` • Industrial process that adds hydrogen to liquid vegetable oils to make them more solid ``` • **AKA: ____ partially hydrogenated oils

Unsaturated fats

* Monounsaturated * Polyunsaturated * Usually liquid at room temp (Healthy body can't make these)

Cholesterol

* Waxy substance | * Most of what we require is produced by our bodies

____________ aka “statins” | are the primary pharmacologic agent used

HMG- CoA Reductase Inhibitors

Statins

Inhibit the enzyme HMG-CoA reductase, which prevents the conversion of HMG-CoA to mevalonate..the rate limiting step in cholesterol synthesis (decrease LDL + TG; increase HDL)

Bile Acid Sequestrants/Bile Acid Binding Resins

Binds bile acids in intestine forming a complex that is excreted in the feces ↓LDL ↑HDL No change or ↑TG

Fibrates

↓LDL, but can ↑LDL if TG are high ↓ TG ↑HDL

Fish oils

↓TGs ↑HDL, can ↑LDL

Statins target what?

Inhibit HMG- CoA reductase which limits cholesterol

Pharmacologic agents used to decrease TG include: (4)

* Fibric Acids * Fish Oils * Nicotinic acid * Statins

Only add a pharmacologic agent to treat TG once LDL goal is reached and if TG remain ______-

≥ 200mg/dL

Epidemiologic data suggest that ___% to ___% of the population believed to have hypertension may have lower blood pressure outside of the office setting

15% to 30%

The average nocturnal blood pressure is approximately ___% lower than daytime values in both normotensive and hypertensive patients

15%

Adverse fish oil effect

Increase LDL

Adverse bile acid effect

No change in TG

Adverse Fibrate effect

Increase LDL (if TG is high)

Lecture 3 - Hypertension & Dyslipidemia Guidelines Flashcards

(66 cards)