Define the Following Blood Pressure and Hypertension in Adults Flashcards

Classification SBP DBPNormal <120 <80Prehypertension 120-139 80-89Stage 1 Hypertension 140-159 90-99Stage 2 Hypertension >/= 140 >/= 100

Essential hypertension. It is idiopathic, and called essential because they used to think that it was a natural occurrence for BP to increase with age.

At the age of puberty, men's systolic and diastolic are higher than women's, but women eventually catch up. There is an acceleration at the rate of BP increase after menopause.

Cardiac hypertrophy (heart works too hard)Increased incidence of atherosclerosisAnginaMyocardial infarctionHeart failureThrombosis and hemorrhage of cerebral vesselsDementiaRenal FailurePeripheral arteral diseaseRetinopathy

Metabolic syndrome -hypertension, DM, elevated LDL or low HDL, obesityOther -Age (>55 female, >65 male) -Estimated GFR <60 ml/min -Family history of premature cardiovascular disease -Microalbuminuria -Physical inactivity -Tobacco usage (particularly cigarettes)

Fundamental faultGenetic (30%)Disordered of regulation (impaired homeostasis)NeurogenicPsychogenic (stress, anxiety)Disease of adaptation (blood to some organ/tissue)Disruption of normal renal-body fluid relationship -Excess dietary Na^{+ -Impaired renal functionMultifactorial Thesis}

Weight reduction - normal BMI (18.5 - 24.5)Adopt DASH eating plan - Reduced saturated and total fatDietary sodium reduction - no more than 100 mmol/day - 2.4g sodium or 6g sodium chloridePhysical activity - 30 min/day most daysModeration of alcohol consumption - 2 for men, 1 for women per day

Diuretics - Thiazides, loop diuretics, K⁺ sparingBeta Blockers - Arterial or arterial and venousCalcium Channel BlockersSympatholytic Drugs Renin-angiotensin system blockers

1. Lifestyle2. Lifestyle + initial drug -w/o compelling indications -Stage 1 = thiazides, maybe ACEI, ARB, BB, CCB -Stage 2 = 2 drug combo: thiazide + one of other

-Controls of fluid balance-Vascular smooth muscle-Both central and peripheral components of the sympathetic nervous system-The renin-angiotensin systems

MOA: Inhibits NaCl reabsorption in the early segments of the distal tubule to facilitate sodium and chlorine loss
Toxicity: hypokalemia, hyponatremia, contraction alkalosis, uric acid retention, allergic reactions, metabolic, weakness, impotence, headache

MOA: Relatively short-acting agents that inhibit NaCl reabsorption in the thick ascending loop of henle.
Not for uncomplicated hypertension - reserved for patients with renal or cardiac failure or on minoxidil.
Toxicity: hypokalemic metabolic alkalosis, ototoxicity, magnesium wasting, hyperuricemia, allergic reactions, nausea, cramps, dizziness, diarrhea

MOA of spironolactone: antagonizes efects of aldosterone at the cortical collecting tubule.MOA of others: directly inhibits Na⁺ transport in the collecting tubule.
Used to offset K⁺ loss due to thiazides and loop agents
Toxicity: Hyperkalemia, nausea, headche, allergies, gynecomastia and imptence

Autoregulation: blood flow is maintained nearly constant in many vascular beds despite highly varying arterial pressure

Myogenic theory: a contractile response to stretch is an inherent property of vascular smooth muscle.
Metabolic theory: vasodilator substances accumulate in active tissues. When blood flow is low, their concentration is high. When blood flow is high, they are washed away.