Module 4B: Hypertension

Question 1

MAP

Answer 1

average arterial pressure in one cardiac cycle

Question 2

normal MAP

Answer 2

60-100 mmHg (<60mmHg → inadequate organ perfusion & >105mmHg → increased cranial pressure

Question 3

pulse pressure

Answer 3

PP = SBP - DBP (normal 30-40 mmHg)

Question 4

PP <30mmHg

Answer 4

serious ↓ CO, causes ↓ stroke volume, systolic obstruction of blood flow (shock, hypovolemia, stenosis)

Question 5

PP >40mmHg

Answer 5

↑ stroke volume, systemic vascular resistance, ↓ distensibility of arteries

Question 6

primary hypertension

Answer 6

no identifiable cause, 95% of cases

Question 7

secondary hypertension

Answer 7

identifiable cause (secondary to a disease), risk factors: kidney disease, adrenal disease, pregnancy, aortic stenosis)

Question 8

white coat hypertension

Answer 8

irregular blood pressure when visiting the doctor (unexpected anxiety)

Question 9

isolated systolic hypertension

Answer 9

normal diastolic with an increased systolic measurement

Question 10

malignant hypertension

Answer 10

high BP undetected in clinical settings, unobservable in clinical settings and BP at home is elevated (d/t lifestyle factors)

Question 11

hypertension diagnosis

Answer 11

people w/o diabetes → AOBP of 135/85 or higher and non-AOBP of 140/90 or higher
people w/ diabetes → AOBP (or non-AOBP) of 130/80 or higher

Question 12

hypertension s/s

Answer 12

usually asymptomatic, breathlessness, headache, bleeding from nose, blurred vision, fatigue, tinnitus, profuse sweating, nocturia

Question 13

hypertension concerns

Answer 13

target organ damage, ↑ stress on heart causes left ventricular hypertrophy, ↑ stress on blood vessels causing atherosclerosis, CVA, and MI, renal disease and retinopathy

Question 14

hypertension modifiable risk factors & prevention

Answer 14

stress, abdo obesity, smoking nicotine products, heavy ETOH consumption, stress/anger response, poor dietary habits, low dietary intake of K+, Ca, Mg, sedentary lifestyle, oral contraceptives

Question 15

hypertension non-modifiable risk factors

Answer 15

risk increases with age, male ↑ incidence before 55, female ↑ incidence after 55, family history/genetics, glucose intolerance, immigration-related changes in socioeconomic status

Question 16

hypertension diagnostics

Answer 16

urinalysis, electrolytes + fasting blood glucose, renal fxn, lipid profile (chol, HDL, LDL, triglyceride), CRP, 12-lead ECG, echocardiogram, angiogram

Question 17

3 steps to prevent hypertension

Answer 17

1. lifestyle
   smoking cessation, ↓ ETOH use (1-2 drinks/day), diet/weight loss (DASH), exercise (light weights/aerobic), blood glucose control for people w/ diabetes, pt education
2. medication
   start with one drug at a low dose and increase if necessary
3. combination of medications
   addition of a second anti-hypertensive medication until results are achieved

Question 18

hypertension patient teaching & learning

Answer 18

learning assessments (HTN & target organ damage) → heart, brain, kidney, PVD, retinopathy
assessment of barriers to medication compliance → simplify regimen, collaboration, family, support groups
teaching regarding medications and self-monitoring BP and side effects

Question 19

diuretics

Answer 19

lower BP → reducing blood volume through excretion of water and sodium through urine

assessments → BP, lab values, weights, I/O, K+ levels

side effects → hypotension, electrolyte imbalances, dehydration

e.g., furosemide

Question 20

beta blockers

Answer 20

lower BP → selective (b1 only) and non-selective (b1+2) and blockage of b1 receptors causes ↓ HR, reduced force of contraction, reduced impulse conduction through AV node

assessments → pt specific parameters for holding med, BP + HR if SBP is less than 90 and/or HR <50 bpm

side effects → hypotension, dizziness, bradycardia

e.g., atenolol, metoprolol, propranolol

Question 21

angiotensin-converting enzyme inhibitors (ACE inhibitors)

Answer 21

MOA → inhibit ACE by stopping conversion of angiotensin I to angiotensin II causing vasodilation and ↓ blood volume

assessments → BP, labs

side effects → hypotension, ↑K+, cough, angioedema

e.g., enalapril, captopril, ramipril, quinapril

Question 22

angiotensin II receptor blockers (ARB)

Answer 22

MOA → block action of angiotensin II at receptor site

assessments → BP, labs

side effects → hypotension, do not often cause significant ↑ K+, lower incidence of dry cough

e.g., atacand, coxar, micardis, candersartan

Question 23

calcium channel blockers

Answer 23

MOA → relaxation of vessel walls through blocking of calcium ion channels

assessments → BP, HR

side effects → hypotension, worsen HF

e.g., diltiazem, verapamil, amlodipine, felodipine

Question 24

direct vasodilators

Answer 24

MOA → direct peripheral arterial dilation and used in hypertensive crisis

assessments → BP q5 min if given IV, watch for reflex tachycardia

side effects → rapid hypotension, reflex tachycardia, headache, dizziness

e.g., hydralazine, nipride

Question 25

orthostatic hypotension

Answer 25

change in BP from lying to standing (wait 2-3 mins between taking BP), ↓ SBP /= 10 mmHg

Question 26

orthostatic hypotension causative factors

Answer 26

prolonged best rest, aging, tall thin people (adolescents w/ low BP), some medications (diuretics), hypovolemia

Question 27

orthostatic hypotension & learning

Answer 27

instruct pt to sit, stand, then start, walk slowly if orthostatic drop, use a walker or cane as needed for balance, teach expected symptoms → dizziness, lightheaded and possible syncope

Question 28

hypertensive emergency

Answer 28

blood pressure is elevated with evidence of actual or probable target organ damage

Question 29

hypertensive urgency

Answer 29

blood pressure is elevated but there is no evidence of target organ damage

Question 30

hypertensive disorders during pregnancy

Answer 30

chronic hypertension (pre-pregnancy HTN), gestational hypertension, pre-eclampsia

Question 31

hypertension in pregnancy complications

Answer 31

acute renal failure, death or pregnancy pt, pulmonary edema, HELLP syndrome, cerebral edema w/ seizures, higher rates of infant mortality, placental abruption, pre-term abruption, intrauterine growth restriction, acute hypoxia in fetus

Question 32

non-severe BP in pregnancy

Answer 32

BP >/= 140/90, abnormal fetal HR, ↓ placental perfusion, possible oligohydramnios (low amniotic fluid)

Question 33

severe BP in pregnancy

Answer 33

BP >/= 160/110, ↓ placental perfusion (intrauterine growth restriction), late decelerations in fetal HR in labour, obstetrical emergency

Question 34

gestation hypertension

Answer 34

BP = 140/90, no proteinuria or edema, BP returns to normal after birth, not usually associated w/ fetal growth restriction

Question 35

pre-eclampsia w/o severe features

Answer 35

BP 1400-150/90-109, proteinuria, mild edema, can be asymptomatic

Question 36

pre-eclampsia w/ severe features

Answer 36

BP >160/>110, severe headache + visual disturbances, confusion, hyperreflexia, RUQ abdo pain, nausea. vomiting, dyspnea, ↑ proteinuria, oliguria, altered renal fxn. extensive peripheral edema

Question 37

eclampsia

Answer 37

cerebral edema is so acute causing grand-mal seizures or coma & fetal prognosis is poor d/t hypoxia + consequent fetal acidosis

Question 38

hypertension in pregnancy management

Answer 38

monitor BP, assess deep tendon reflexes, monitor fetal health status (fetal HR, fetal growth), monitor placental abruption (in pre-eclampsia), activity restriction for pts w/ pre-eclampsia, diet (no sodium restrictions but avoid excessively salty foods)

Question 39

hypertension in pregnancy pharmacological management

Answer 39

magnesium IV (prevent/control seizure), anti-hypertensives, corticosteroids to accelerate fetal lung maturity (if risk of giving birth 5wks before due date)