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lecture 22 raja

4 main organ systems that are damaged as a result of HTN heart, kidneys, brain and blood vessels
BP that warrants further investigation to r/o HTN 130/80 typically
BP at which pt is stage I hypertensive 140/90
typical BP at which starts showing dangerous PEx signs of hypertensive damage 160/100 or more --> pt may have papilledema, ischemia anywhere, renal damage, ST changes on EKG, etc.
hypertensive emergency acute severe elevation of BP to at least 160/100 that causes target organ damage such as coronary ischemia, cerebral dysfunction, stroke, renal failure or pulmonary edema. pt must be admitted
hypertensive urgency severe elevations in BP to at least 160/100 without any evidence of progressive target organ dysfunction . pt can be managed medically and sent home
3 goals of the initial evaluation for HTN accurately stage the BP, assess overall CV risk and seek clues for rarer secondary causes for HTN
describe requirements for correct technique of measuring BP pt must rest seated for @ least 5 min before, when taking BP: pt's back supported with feet on the floor, arm @ heart level, appropriate size cuff on bare arm. take 2 readings - one in each arm seated and standing
"white coat" HTN HTN likely due to adrenergic response to being in physician office and having BP measured. pt typically has mean daytime BP that is normal when measured outside of the office
"white coat aggravation" superimposition of adrenergic response while in physician's office onto an already elevated mean daytime BP = cause for alert
"masked" HTN BP is nl in the physician's office but if set up with ambulatory monitoring one will note nocturnal and ambulatory HTN. could be fatal as risk of stroke continues without dx and subsequent tx
BP changes with aging younger ppl can elevate their SBP easily/without consequence. high DBP in them is more concerning, but in ppl 50+ y/o, SBP tends to be more elevated. pulse pressure widens with age
persistent nocturnal HTN increases the aggregate BP burden on the CV system and greatly increases risk of target organ dz and CV death the morning surge (on top of nocturnal HTN) is strongly associated with peak incidence of stroke, MI and sudden cardiac death
residual lifetime risk in anyone greater than 65 even if in perfect health and normotensive is ______ 90% especially by age 85, usually due to increasing noncompliance of arteries and arterioles due to collagen replacing elastin in aorta. accelerated by atherosclerosis and HTN
isolated systemic HTN usually in pts who developed HTN after the age of 50 - their SBP is > 140 mmHg but DBP is usually nl or < 80-90 mmHg; this is due to decreased distensibility of large conduit arteries
the pt with isolated systolic HTN and wide pulse pressure is most at risk for fatal heart attack the pt with pulse pressure of 100 mmHg carries twice the risk of fatal CAD as compared with pt whose pulse pressure is 40 mmHg
CV risk factors men 55+ and women 65+, FMHx of premature CV dz, dyslipidemia, DM, chronic kidney dz, smoking, obesity, physical inactivity
high-risk hypertensives typically have (other dz): DM, chronic kidney dz, established coronary dz, atherosclerosis of other aa., high risk for CAD, heart failure
overall CV risk = high BP + other major risk factors + target organ damage
DM as risk factor very high risk factor, pts with DM that develop HTN usually need 3-4 meds to be maintained in normotension
PEx findings that might indicate HTN neuro dysfunction, papilledema, retinal hemorrhage, AV nicking, carotid bruits, thyroid enlargement, rhonchi and crackles, audible S4, bruits over renal artery or AA, dec peripheral pulses or edema
essential (primary) HTN describes up to 90% of cases of HTN - specific disease-causing mechanism is not identfiable
RAAS derangements that can serve as secondary causes of HTN chronic kidney dz (hypertensive nephrosclerosis), renal art.stenosis or fibromuscular dysplasia, aortic coarctation, primary aldosteronism (Conn syndrome with 20-30:1 aldo: renin levels), mineralocorticoid excess aka Cushing's syndrome, NSAIDs
sympathetic derangements that can serve secondary causes of HTN pheochromocytoma, sympathomimetics like cocaine, . obstructive sleep apnea?
Created by: sirprakes