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M6 13-005

Exam 4: Cardiovascular System- Hypertension

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