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What is hypertension?
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Persistent elevation of systolic blood pressure greater than or equal to 140mm Hg or diastolic bp greater than or equal to 90 mm Hg
essential, primary or idiopathic HTN - 90%secondary HTN - 10% |
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Blood pressure =
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CO x SVRcardiac output x systemic vascular resistance
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Cardiac output is....?
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The amount of blood ejected from left ventricle with each contraction
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Systemic vascular resistance is....?
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Force from the left ventricle to overcome to eject blood
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What are the bp measurements of the four stages:Normal:Prehypertension:Stage 1 hypertension:Stage 2 hypertension:
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Normal: <120 SBP and <80 DBPPreHTN: 120-139 SBP or 80-89 DBPStage 1 HTN: 140-159 SBP or 90-99 DBPStage 2 HTN: ≥160 SBP or ≥100 DBP
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What is the primary etiology of HTN?
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-elevated BP without an identified casue--no one single cause -90-95% of all cases-3/4 of all diabetics are hypertensive
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What are risk factors for primary hypertension?
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Age, alcohol, cigarette smoking, diabetes mellitus, elevated serum lipids, excess dietary sodium, gender, family history, obesity, ethnicity, sedentary lifestyle, socioeconomic status, stress
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What does stress and increased sympathetic nervous system (SNS) activity do to the blood pressure?
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(primary pathophysiology of HTN)INCREASES!!! HTN-produces increased vasoconstriction-increased heart rate-increased Renin release
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How does insulin resistance and hyperinsulinemia effect the BP?
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(primary pathophysiology of HTN)INCREASES!!! HTNhigh insulin concentration stimulates SNS activity and impairs nitric oxide-mediated vasodilation
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What is secondary hypertension and what are contributing factors?
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-Elevated BP with a specific cause-5-10% of adult casesContributing factors:-Renal disease****-endocrine disorders-neurologic disorders-cirrhosis-sleep apnea
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What are clinical manifestations of HTN?
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Symptoms are often secondary to target organ disease and can include:-fatigue, reduced activity tolerance (don't have normal perfusion to have that activity tolerance like walking up a flight of stairs)-dizziness, palpitations, angina, dyspnea
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What are complications of hypertension?
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Target organ diseases occur most frequently in the :heartbrainperipheral vasculaturekidneyeyes
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Diagnostic studies for HTN
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History and physical examBP measurement in both arms-use arm with higher reading -bp highest in early morning and lowest at nightUrinalysis, creatinine clearanceserum electrolytes, glucoseBUN and serum creatinine (renal failure: Serum high Creatinine low)serum lipid profileECG Echocardiogram
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What are the overall goals for HTN?
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Control blood pressureReduce CVD risk factors
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How can the goals be accomplished?
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Make lifestyle changes-weight reduction Dietary approaches o stop hypertension (DASH) eating plan physical activity-avoidance of tobacco products-alcohol in moderation-stress management
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