Diagnosis of Hypertension is based on

Blood pressure is defined as

Hypertension is defined as....

Blood pressure is known as the.....

and is.......

Silent killer

higher in African americans

Blood pressure is the product of?

Medications used to treat Hypertension function to

Primary hypertension

cause can not be identified

90-95 % of patients have primary HTN

Secondary HTN

Identifiable cause

renal artery stenosis

hyperaldosteronism, medications

Pregnancy

contraction of the aorta

Major risk factors For HTN

obesity

menopause

family history

male

activity

>60

DM

Smoking

What is blood flow?

Peripheral Vascular Resistance

opposing forces or impedance to blood flow

determined by viscosity, length of vessel, diameter of the vessel.

Mean Arterial Pressure

equals

Cardiac output x SVR

DBP + PP

>60 mm hg

orthostatic hypotension

Decrease in systolic > 10-15 mm hg

Decrease in diastolic

On standing

Sympathetic nervous system affects BP by...

casusing vasoconstriction of arterioles increasing

blood pressure

Parasympathetic nervous system affect BP

causes vasodilation of arterioles

lowering Blood pressure

Pathophysiology of Primary HTN

Systemic responses of primary HTN

sympathetic nervous system overactivity

renin-angiotensin-aldosterone system overactive

chemical mediator of vasomotor tone (atrial natriuretic peptide)

interactions between insulin resistance and endothelial function of vessels

Affects of sustained HTN

accelerated rate of atherosclerosis

increased workload on left ventricle leading to left ventricular hypertrophy

leads to nephrosclerosis and renal insufficiency

Environmental conditions as related to HTN

cold causes vasoconstriction

Heat causes vasodialation

Chemicals hormones and drugs affect CO and or peripheral vascular resistance

Dietary factors affecting HTN

Personal factors affection HTN

Manifestations of HTN

Early, no S/S

later- vague h/a back of head and neck occurs when wakened subsides during day

may develop S/S if other organs involved including confusion, n/v. visual disturbances

Eye exam: narrowed arterioles, hemorrhage and papilledema

Goals of hypertension therapy

Reduction of CV and renal morbidity and mortality rates.

Treating SBD and DBP to targets < 140/90 is associated with a decrease in CVD

Pts with diabetes or renal disease the goal is <130/80

Life style modifications

weight reduction

physical activity

moderaton of ETOH consumption

Diet rich in potassium and calcuim and low in Na

(DASH)

Pharmacologic treatment of HTN

Ace inhibitors

Angiotenisin REceptor Blockers

Beta Blockers

Calcium channel blockers

Thiazide-type diuretics

Function of Diuretics

unsurpassed in preventing the CV complications of HTN

Enhance antihypertensives effica cy of multidrug regimens

Use in combinations (thiazide, loop, K sparing, ARB's)

Diuretic indications

avoid gout and diabetic patients, hyperuricemia and hyperglycemia

monitor K

I and O's, weights

K rich diet

Monitor for hypokalemia

give early in the day

know difference between K sparing and depleting

ACE inhibitors

"pril"

inhibit angiotensin 1 form converting to angiotensisn 2 resulting in peripheral vasodilation

-used commonly in pts with ischemic HD, HF, *Diabetic HTN

-Protect kidney

-avoid women of child bearing age

History of angioedema

Angiotensin II antagonists

blocks the binding of angiotensisn 2 on its receptors resulting in decreased aldosterone

-reduces left ventricular hypertrophy

-common side effect is cough

"Sartan"

Calcium channel blockers

dilating peripheral arterioles and reducing peripheral resistance

used for CV disease

Avoid use in heart failure patients and post MI

Good results with AA population

"pine" verapamil, diltiazem

Beta andrenergic blockers

reduce cardiac output

commonly used with diuretics

avoid with pulmonary and diabetic patients

used with ischemic HD

slows heart rate

Beta 1 and 2 receptors

"lol"

Common side effects of HTN

elevated b/p from ientifiable underlying condition

kidney disease-disrupt renin-angiotensin0aldosterone system

coarctation of aortoa

Differences in pressure in upper and lower extremities, weak lower distal pulses.

Other conditions r/t Secondary HTN

endocrine - cushings syndrome

neurologic- increased ICP

drug use - estrogen, oral contraceptive, stimulants

pregnancy

Diagnostic test for HTN

renal function studies -  urinalysis

blood chemistries - endocrine and CV disease

IV pyelography, renal ultrasound, CT or MRI

Malignant HTN

Indications during Hypertensive emergencies

BP must be lowered immediately to prevent target organ damage

Vasodilators (nitropress, vasotec, nitro-bid)

Hypertensive urgency

Hypertension

Meds to know

diuretics hydrochlorothiazide, lasix, aldactone

BB - tenormin, lopressor, inderal

CCB - norvasc, calan

ACE inhibitors - capoten, vasotec

ARBS - atacand, Cozaar