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AH-Lewis Ch. 33
Hypertension
| Question | Answer |
|---|---|
| Hypertension is defined as? | a persistant systolic blood pressure 140 and diastolic pressure 90 |
| What does hypertension mean? | that the heart is working harder than normal, putting both the heart and the blood vessels under strain |
| What is prehypertension? | 120-139 and 80-89 |
| CVD is the? | #1 death of women |
| What is blood pressure? | the force exerted by the blood against the walls of blood vessels |
| What is cardiac output? | the total blood flow through the systemic or pulmonary circulation per minute |
| What is systemic vascular resistance? | the force opposing the movement of blood within the blood vessels |
| What is the principal factor determining vascular resistance? | small arteries |
| BP is regulated by both? | short term and long term mechanisms |
| Short term mechanisms are activated? | within a few seconds |
| Long term mechanisms include? | renal and hormonal processes that regulate arteriolar resistance and blood volume |
| The nervous system increases BP primarily by? | activation of the SNS |
| Changes in BP are sensed by? | baroreceptors |
| Where are baroreceptors? | in the carotid artery and the arch of the aorta |
| What does norepinephrine activiate? | receptors location in the SA node, myocardium and vascular smooth muscle |
| What increases CO and SVR? | SNS |
| What increase HR and cardiac contractility? | SNS |
| What promotes release of renin from kidneys? | SNS |
| What are baroreceptors? | nerve cells located in the carotid arteries and arch of the aorta |
| Inhibition of sympathetic activity results in? | decreased heart rate, decreased force of contraction, and vasodilation of periperal arterioles |
| Increased Parasympathetic activity reduces? | HR |
| What is vascular endothelium? | single layer that lines the blood vessels |
| What is endothelin? | an etremely potent vasoconstrictor |
| What are the three subclasses of endothelines? | ET1 ET2 and ET3 |
| what does ET1 do? | vasocontriction, adhesion and aggregation of neutrophiles and stimulates smooth muscle growth |
| How do the kidneys regulate BP? | controlling Na excretion and ECF volume |
| What also helps BP regulation? | renin angiotensin aldosterone system |
| What is renin (ACE)? | an exzymes that converts angiotension 1 to angiotension 2 |
| What is Angiotension 2? | a potent vasoconstrictor and increases vascular resistance, increase in BP |
| What do prostaglandins do? | decrease SVR and lower BP |
| What is the classification of BP based on? | the average of age of two or more properly measured, seated BP readings on each of two or more office visits |
| What is isolated systolic hypertension? | an average SBP of 140 coupled with an average DBP 90 |
| What is pseudohypertension? | false hypertension |
| What is osler's sign? | a palpable radial or brachial artery after the blood pressure cuff is fully inflated |
| What is the only way to measure BP in pseudohypertension? | intraarterial catheter |
| What is primary hypertension? | elevated BP without an identified caused |
| What is secondary hypertension? | elevated BP with a specific cause that often can be identified and corrected |
| What is the treatment for secondary hypertension? | getting rid the the underlying cause |
| What is the hallmark of hypertension? | persistently increase SVR |
| Excessive Na intake is considered responsible? | for initiation of prehypertension |
| What is commonly associated with BP salt sensitivity? | obesity, increasing age, african american, diabetes, and chronic kidney disease |
| High plasma renin activity results in? | the increased conversion of angiotensinogen to angiotensin 1 |
| Atertial pressure is influenced by factors such as? | anger, fear, and pain |
| Abnormalities of glucose, insulin and lipoprotein are common is? | primary hypertension |
| Hypertension is often called? | the silent killer |
| What are secondary symptoms of hypertension? | fagigue, dizziness, palpitation, angina, and dyspnea |
| What are the most common complication of hypertension? | target organ diseases |
| Hypertension is a major risk factor for? | CAD |
| Sustained high BP increases the? | cardiac workload and produces left ventricular hypertrophy |
| When does heart failure occur? | when the heart's conmensatory adaptation are overwhelmed and the heart can no longer pump enough blood to meet the metabolic needs of the body |
| What is the most common cause of cerebrovascular disease? | atherosclerosis |
| Hypertensice encephalopahty may occur after a marked rise? | in BP if the cerebral blood flow is not decreased by autoregulation |
| Hypertension speeds up the process of? | atherosclerosis |
| What is intermittent claudication? | ischemic muscle pain precipitated by activity and relieved with rest |
| The appearance of the retina provides important info about the severity and duration of the? | hypertensive process |
| The retina is the only place in the body where the blood vessels can be? | directly visualized |
| Basic lab studies are performed to? | rule out causes of secondary hypertension, eveluate target organ disease, determine overall heart risk, establish baseline leveles |
| What is white coat hypertension? | when someone only has an elevated BP in a hospital setting |
| what is ABPM? | noninvasive, fully automated system that measures BP at preset intervals over a 24 hr period |
| What are lifestyle modifications for a hypertensive person? | weight loss, DASH, Na reduction, Moderation of alcohol consumption, regular aerobic physical activity, no tobacco |
| What does the DASH eating plan include? | eating several fish each week, drinking lots of water |
| If you have hypertension you should not consume more than how many alcohol drinks? | 2 |
| Drug therapy is not recommended for people with? | prehypertension |
| What are the two main actions of drugs that treat hypertension? | they decrease the volume of circulating blood and the reduce SVR |
| What are the two types of angiotensin inhibitors? | angiotension converting enzyme inhibitors and A II receptor blockers |
| What are theazide type diurects used for? | initial therapy for most pt's with hypertension |
| Many pt's that are hypertensive require how many meds? | 2 |
| What is a common AE of hypertensive drugs? | orthostatic hypotension |
| BP is lowest at? | night |
| BP is high? | shortly after waking up |
| What is resistant hypertension? | the failure to reach goal BP in pt's who are adhering to full doses of an appropriate three drug therapy regiman that includes a diurects |
| What are the overall goals for a pt with hypertension? | achive and maintain the goal BP, understand, accept and implement the therapeutic plan, experience minimal or no unpleasant side effect of therapy, be confident of ability to manage and cope with condition |
| What is orthostatic hypotension? | increase of 20 beats/min or more in pulse from supine to standing |
| Family and pt teaching includes? | nutrional therapy, drug therapy, physical activity, home monitoring of BP and tobacco sensation |
| What is a major problem in long term management of the pt? | noncompliance |
| What is ausculatory gap? | the gap between the first korotokoff sound and the next beat |
| What is hypertensive crisis? | severe and abrupt elevation in BP |
| Hypertensive crisis is classified by? | |
| What is hypertensive emergency? | develops over hours or days |
| What is hypertensive urgency? | which develops over days or weeks, BP is severely elevated but there is no clinical evidence or target organ damage |
| What is hypertensice encephalopathy? | a syndrome in which a sudden rise in BP is associaed with headache, nausea, vomiting, seizures, confusion, stupor and coma |
| Hypertensive emergencies require? | hospitalization, IV administraction, and intensive care monitoring |
| When treating hypertensive emergencies what is used to guide and avaluate therapy? | Mean atertial pressure |
| Hypertensive urgencies can be managed with? | oral agents |
Created by:
alicia.rennaker
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