Week 7: Chp 31: Hypertension Flashcards
(33 cards)
Normal BP
Systolic BP: less than 120
and Diastolic BP: less than 80
Normal: 120/80
Prehypertensive BP reading
Systolic: 120-129 mm Hg
and Diastolic: less than 80
Stage 1 Hypertension BP reading
Systolic: 130-139 mm Hg
or Diastolic: 80-89 mm Hg
Stage 2 Hypertension BP reading
Systolic: 140 mmHg or higher
or Diastolic: 90 mm Hg or higher
Hypertensive Crisis
Systolic: higher than 180 mm Hg and/or
Diastolic: higher than 120 mm Hg
-consult doctor immediately
Hypertensive Crisis: Hypertensive Urgency
Diastolic BP greater than or equal to 120 mm Hg with no obvious target organ damage (TOD)
Hypertensive Crisis: Hypertensive Emergency
Diastolic BP greater than or equal to 120 mm Hg with evidence of tissue organ damage (TOD)
TOD
tissue organ damage
-damage to the heart, eyes, or kidneys caused by hypertension
Hypertension
common and manageable chronic condition that is a risk factor for atherosclerotic cardiovascular disease, heart failure (HF), stroke, kidney failure, vision loss, dementia, and peripheral artery disease
-carries the risk for premature morbidity or mortality, which increases as systolic and diastolic pressure rise
Risk Factors
- age (tends to rise with age)
- gender
- race (African Americans)
- socioeconomic status (low socioeconomic status)
Essential Hypertension
has no identifiable medical cause
- appears to be a multifactorial, polygenic condition
- heredity is a predisposing factor
- familial
- the risk for this can increased when heredity is combined with unhealthy lifestyle choices such as smoking or a poor diet
- 4 times more common in African Americans
- accelerates more rapidly and more severe with higher mortality in African Americans
Notable Risk factors for Primary Hypertension
- obesity
- salt sensitivity
- renin elevation
- insulin resistance
- vitamin D deficiency
- cigarette smoking
Secondary Hypertension
characterized by elevations in blood pressure due to a specific cause
- most common cause is renal parenchymal disease affecting the renal medulla and renal cortex, where the “work” of the kidney is done
- excessive alcohol intake and use of oral contraceptives can be a cause, also NSAIDs, corticosteroids, cocaine or licorice
Mechanisms that result in hypertension
- increased sodium intake
- renin-angiotensin aldosterone system (RAAS)
- aldosterone
- sympathetic nervous system
Mechanisms that result in hypertension: Increased sodium intake
increased sodium causes fluid retention, increasing stroke volume and blood pressure
Mechanisms that result in hypertension: Renin-angiotensin aldosterone system (RAAS)
- excessive angiotensin II results in vasoconstriction and increased BP
- excess angiotensin also results in increased aldosterone release
Mechanisms that result in hypertension: Aldosterone
- excess aldosterone release results in sodium and water retention, which results in increased stroke volume and blood pressure
- enhanced potassium (K) excretion also occurs, resulting in low plasma K
- low plasms K increases vasoconstriction through closure of K channels
Mechanisms that result in hypertension: Sympathetic Nervous System
- increased sympathetic activity is a primary precursor to hypertension; it can cause vasoconstriction, resulting in increased peripheral vascular resistance and increased BP. may also increased HR
- overactivity of the SNS may result from either inappropriately elevated sympathetic drive from brain centers, an increase in synaptically released neurotransmitters in the periphery, or amplification of the neurotransmitter signal at the target tissue
Clinical Manifestations of Primary Hypertension
evident only after long-term increased BP has resulted in target organ damage (TOD)
-headaches, chest pain, vision changes, SOB, renal dysfunction, dizziness, fatigue, or nosebleeds
Diagnosis
is made on the basis of two or more properly measured BP readings on two or more office visits
-treatment is indicated at that time but may begin immediately if two consecutive readings during a single visit indicate an extreme elevation
What is done to detect tissue organ damage? (TOD)
a thorough history and physical examination
-allows better stratification of cardiovascular risk, encourages the achievement of lower BP target than usual, and helps with selection of most appropriate medication regimen
Treatment
to bring high BP down to a healthy level, treatment guidelines recommend healthy lifestyle changes, medication, or both
-lifestyle changes alone may be the first step in patients with mildly elevated (systolic between 120-129 and diastolic < 80) BP readings
Guidelines for Medications
only prescribing medication beginning at stage 1 if a patient has already had a cardiovascular event such as a heart attack or stroke or is at high risk of heart attack or stroke based on age, diabetes mellitus, chronic kidney disease, or calculation of atherosclerotic risk
-medication depends on ease of use, side effects, and coexisting medical conditions that may necessitate use of one agent versus another
Medications
- ACE
- ARB
- aldosterone antagonists
- direct renin inhibitors
- calcium channel blockers
- centrally acting alpha2 agonists
- sympatholytic: alpha adrenergic blockers and beta adrenergic blockers
