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Flashcards in Lust 3 Deck (14)
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1

HTN in the US

  • HTN
    • major risk factor for
      • heart disease  (3x to die from)
        • #1 cause of death 
      • stroke (4x to die from)
        • #4 cause of death
    • 1 in 3 adults have high BP
    • 1,000 deaths per day
    • w/ 1st heart attack-69%
    • w/ 1st stroke-77%
    • w/ Chronic Heart Failure-74%

2

BP Categories

3

2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults

  • Newer guidelines, no prehypertensiveness
  • increased responsiveness of providers
  • Get BP several times, including out of office

4

Where does HTN develop?

  • CNS
    • increase sympathetics or decrease parasympathetics 
    • reduce sensitivity of receptors
  • Vessels
    • increase endothelin: Contributes to better contractility
    • hypertrophy associated w/Type 2 diabetes

5

If BP is increased, at least one must be present:

  • increased Cardiac Output
  • Increased Vascular Resistance
  • Increased Fluid Volume

6

What impacts BP

  • HR = heart rate
  • SV = stroke volume
  • CC = cardiac contractility
  • VR = venous return/ preload
  • PSNS = parasympathetic nervous system
  • SNS = sympathetic nervous system

7

how can we manage BP

  • drugs decrease BP

8

Why do we worry about HTN as a disease

  • Wearing out the heart higher O2 requirement
    • heart failure
    • ischemia and infarction
    • injury and repair leads to athlersclerosis
  • elevated pressure weaknes walls
  • most individuals dont have regular health check-ups

9

What are the characteristics of primary essential Hypertension:

  • 80-95% cases of elevated BP
  • complex interaction- multiple genetic and enviromental factors
    • race
    • gender
    • Dietary Salt
    • Weight
    • Diabetes
    • EtOH
    • Smoking
    • Activity Level

10

Characteristics of Secondary Hypertension:

  • 5-20% cases of elevated BP
  • Specific underlying disorder
    • renal artery stenosis
    • renal parenchymal disease
      • Glomerulonephritis
      • polycistic kidney disease
    • Endocrine
      • increased aldosterone
    • Steroids
    • Contraceptives
    • NSAIDs

11

What are the first line drugs for Hypertension?

  • For CAD, MI, heart failure=ACE Inhibitors
    • But in renal artery stenosis, ACE inhibitors
      • new onset renal failure
      • Increase in plasma creatinine after drug is started
        • Why? prevents efferent constriction=GFR decreases

12

How does Angiotensin help with Renal artery stenosis? 

  • Efferent Arteriole constricts

13

Stroke: Epidemiology

  • #3 cause of death in US
  • 600,000+ new or recurrent strokes/year
  • over half significant disability
  • risks:
    • Age:
      • >70% of strokes in 65+
    • atherosclerotic risk factors 
    • 70% of strokes associated with HYPERTENSION
    • Sex and Race
      • < 60: Female>Male
      • >60: Male> Female
      • AA>>Caucasian
        • both genders
        • incidence and mortality

14

Strokes: Risk Score Card

  • High Risk >3
    • make appointment today
    • talk to healthcare provider immediately 
    • ask about stroke prevention plan
  • Caution: 4-6
  • Low risk 6-9