Exam 4: Cardiovascular System- Hypertension
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| Normal Systolic Blood Pressure | <120 mm Hg
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| Normal Diastolic Blood Pressure | <80 mm Hg
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| Prehypertension | 120-139/80-89
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| High Blood Pressure Systolic | arterial blood pressure 140 mmHg or higher
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| High Blood Pressure Diastolic | arterial blood pressure 90 mmHg or greater
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| Dx of HTN | 2 or more separate readings on 2 or more separate occasions
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| Systolic BP | Greatest force caused by CONTRACTION of the LEFT VENTRICLE
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| Diastolic Blood Pressure | Occurs during the RELAXATION phase between hearbeats
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| Arterial Blood Pressure | Pressure exerted by blood on the vessel walls
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| Vasoconstriciton & Vasodialtion | Controlled by sympathetic nervous system & Renin-angiotensin System
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| 3 Different Types of HTN | Primary (Essential), Secondary, Malignant
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| Primary (Essential) HTN | Cause Unknown, Constitutes 90% to 95% of all cases of HTN
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| Non-Modifiable Risk Factors (Essential) | Age, Race, Gender Family Hx
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| Modifiable Risk Factors (Essential) | Smoking, Obesity, High Na+ Diet, Elevated Serum Cholesterol, Oral Contraceptive /Estrogen Therapy, Alcohol, Emotional Stress, Sedentary Lifestyle
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| Untreated Primary HTN | Fibrous Tissue develop in the arterioles, Decreased Tissue perfusion
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| Play an important role in regulating BP | Blood Flow & Peripheral Vascular Resistance
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| Renin is released from the | Kidneys
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| Angiotensin-Converting Enzyme is released from | Lungs
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| Secondary HTN | Identifiable Medical Dx.
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| Conditions associated with Secondary HTN | Renal Vascular Disease, Adrenal Cortex Disease, Coarctation of the Aorta, Head Trauma, Cranial Tumor, Poregnancy-induced HTN
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| Adrenal Cortex Disease | Primary Aldosteronism, Cushing's Syndrome, Pheochromocytoma
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| Malignant HTN | Severe Rapid progressive elevation in BP. Diastolic >120 mmHg
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| Malignant HTN Causes | Damage in the small arterioles in major organs, heart, kidneys, brain eyes.
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| Renin-Angiotensin System | Hormone system that regulates blood pressure and water (fluid) balance.
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| Most distinguishable feature of Malignant HTN | Inflammation to arterioles of eyes (arteriolitis)
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| Malignant HTN most common in | Black males under 40 years old
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| Most common causes of death w/ Malignant HTN | MI, Heart failure, stroke, renal failure
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| Manifestation of HTN | Asymptomatic until VASCULAR CHANGES occur.
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| S/S Advanced HTN | Awaken w/ Headache, blurred vision, Spontaneous Epistaxis
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| Persistent untreated HTN May result in | Target organ (Heart, Kidney, Brain) damage.
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| Assessment of HTN | BP in both arms in SUPINE and SITTING positions.
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| HTN Dx Tests (What do they do) | Evaluate baseline of brain, heart & kidneys
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| HTN Lab Tests | CBC, Electolytes (Sodium, Potassium, Calcium), Lipid Profile, Fasting Blood Glucose, Creatinine, BUN and Urinalysis
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| HTN Dx Tests | Chest Radiograph, ECG and Possible Echo, Intravenous Pyelograph (IVP)
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| Why does HTN often go untreated? | Asymptomatic until target organ damage begins
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| Goal of HTN Management | Keep BP below 140/90 (older adults), 131/85 (younger adults w/ mild HTN)
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| Rx to decrease BP | Anti-hypertensives
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| RX to treat uncomplicated HTN | Diuretics, Beat Blockers, Abgiotensin-Converting Enzyme (ACE) Inhibitors, Angiotensin II Receptor Blockers, Calcium Channel Blockers, Alpha-Agonists
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| Special Rx Considerations for Diabetes Mellitus | ACE inhibitor helps protect the renal function
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| Special Rx Considerations for Heart Failure | ACE Inhibitors, diruetics
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| Special Rx Considerations for MI | Beta Blockers, ACE inhibitors
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| Special Rx Considerations for African-Americans | Calcium Channel Blockers, Diuretics
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| Non-Pharmacological Management | Weight Loss, Reduce Saturated Fats, Limit Alcohol Intake, Exercise, Reduce Sodium Intake, Exercise, Smoking Cessation, Relaxation Techniques
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| Anti-hypertensive Agents Use | Tx of HTN
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| Anti-hypertensive Agent Actions | Lower BP to a normal level (<90 mmHg Diastolic) or lowest level tolerated
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| Anti-hypertensive Therapeutic Goal | Prevention of end-organ damage
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| Anti-hypertensive Side Effects | CNS: Headache -- CV: hypotension, bradycardia, tachycardia -- GI: Nausea, Vomiting
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| Adrenergic Action | Potent vasodilator, improves myocardial contraction, reduces pulmonary congestion, works on the nervous system
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| ACE Inhibitor Action | Blocks the conversion of Angiotension 1 to Angiotension 2 (Prils)
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| Angiotensin II Recetptor Antagonist Action | Block the Angiotension II receptors (Sartans)
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| Beat Blockers Actions | Lols
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| Calcium Channel Blocker Actions | Inhibits the transport of calcium resulting in relaxation of the smooth muscle
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| Common side Effects | Hypotension, Bradycardia, Tachycardia, headache, nausea, vomiting, cough or SOB, Angioedema, ED
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