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29 Cards in this Set
- Front
- Back
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What is mean arterial pressure? How is it calculated?
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MAP= CO x SVR
MAP = [(2 x diastolic)+systolic] / 3 Diastole counts twice as much as systole because 2/3 of the cardiac cycle is spent in diastole. A MAP of about 60 is necessary to perfuse coronary arteries, brain, kidneys. (Usual range: 70-110) |
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What factors will increase MAP?
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Anything that increases cardiac output or vascular resistance
1. increased venous return-->increased stroke volume 2. ECF volume expansion 3. renal Na and H2O retention 4. impaired natriuresis |
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How do you diagnose HTN?
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Average of 2 or more seated blood pressure readings; During each of 2 or more outpatient visits; Verify in the contralateral arm
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How can you ensure to get the most accurate BP reading?
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Seated for at least 5 minutes
Cuff at heart level Cuff size fits body size Cuff and stethoscope in correct location |
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What is white coat HTN? What can you do about it?
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HTN brought on by stress of doctor's visit
consider ambulatory BP monitor-takes BP every 15-30 minutes (eventually the patient's stress levels should come down) |
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What lifestyle modifications can the patient employ to help reduce HTN?
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weight reduction
DASH diet-fruits and veggies, low fat diet physical activity reduce Na intake reduce EtOH consumption |
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What are the BP classification stages?
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Normal: <120/80
Pre-HTN: 120-140 or 80-90 Stage 1: 140-160 or 90-100 Stage 2: >160 or >100 Isolated systolic HTN: >140/<90 |
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What impact can HTN have on organs?
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1. Heart-Left ventricular hypertrophy; Angina or myocardial infarction; coronary revascularization; Heart failure
2. Brain-Stroke or transient ischemic attack 3. Chronic kidney disease 4. Peripheral arterial disease 5. Retinopathy |
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What is the CVD risk of HTN?
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The BP relationship to risk of CVD is continuous, consistent, and independent of other risk factors.
Each increment of 20/10 mmHg doubles the risk of CVD across the entire BP range starting from 115/75 mmHg. |
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What are some statistics about HTN?
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Prevalence of HTN increases with advancing age. Prior to age 55, HTN is more prevalent in men. After age 55, it's more prevalent in women.
Blacks have highest prevelance of HTN HTN is increasing in recent years |
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What are the benefits of lowering BP?
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reduced risk of:
stroke MI heart failure |
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How do diuretics work?
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they act to increase the relationship between urine output and mean arterial pressure (steepen the curve back toward normal)
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How do Angiotensin receptor blockers work?
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Angiotensin II is a potent vasoconstrictor that stimulates norepinephrine release and sympathetic stimulation. Angiotensin receptor blockers act directly on the AT I receptor. This permits Angiotensin II to bind to the AT II receptor, leading to favorable effects of vasodilatation and possible slowing of atherosclerosis.
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How do Beta blockers work?
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Beta-blockers bind to beta-adrenergic receptors in the vasculature, cardiac myocytes, conduction system, and cardiac nodal tissue. These receptors primarily bind norepinephrine. Beta-blockers inhibit inotropy, chronotropy and dromotropy (conduction velocity) in the heart. Nonselective beta-blockers also block vasoconstriction (through alpha1 blockade) and vasodilation (through beta2 blockade) in the periphery.
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How do Ca channel blockers work?
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block L-type Ca channels to inhibit Ca from going through the phospholipid bilayer
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What are the goal BP for patients w/ HTN?
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primary HTN-<140/90
HTN w/ diabetes or chronic kidney disease-<130/80 HTN w/ renal disease and proteinuria-<125/75 |
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What is the J curve phenomenon?
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studies have shown that optimal blood pressure is low but not too low (really low BP is shown to have some increased CAD)
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What does the self measurement of BP do?
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Provides information on:
1. Response to antihypertensive therapy 2. Improving adherence with therapy 3. Evaluating white-coat HTN Home measurement devices should be checked regularly; Patients should be given goals |
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What are the treatment options for renal HTN (secondary HTN)?
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Medical therapy
revascularization surgery (bypass?) |
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When is medical therapy indicated in the treatment of renal HTN?
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patients with unilateral renal artery stenosis
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When is Angioplasty + stenting indicated in patients with renal HTN?
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1. Hemodynamically significant lesion
2. Resistant hypertension or malignant hypertension 3. Inability to tolerate antihypertensive medications 4. Recurrent episodes of flash pulmonary edema |
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When is surgery indicated for renal HTN?
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correction of complex lesions
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When should you think about checking for secondary HTN?
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Age <30 or > 55
Caucasian males Refractory Hypertension-More than 3 anti-hypertensives Abrupt onset or Abrupt escalation Laboratory values or examination consistent with secondary hypertension-Hypertension + Hypokalemia; Rise in creatinine after ACEi or ARB initiation |
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What are some ways to evaluate for secondary HTN?
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Aldo/Renin > 30 + Serum aldosterone greater than 15 ng/dL.
MRA vs. US with doppler 24 hr urine fractionated metanephrines + chatecholamines Sleep study |
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What factors can increase cardiac output?
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Hypervolemia:
1.Renal artery Stenosis 2. Renal Disease 3. Hyperaldosterone 4. Hypersecretion of ADH 5. Aortic Dissection 6. Pre-eclampsia Stress Pheochromocytoma |
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What factors can increase peripheral resistance?
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Idiopathic-Essential HTN
Stress-Sympathetic activation Atherosclerosis Renal Artery Disease-Increased angiotensin Thyroid dysfunction Diabetes |
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What is the treatment algorithm for resistant HTN?
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1. Confirm treatment resistance: above hypertensive goals with 3 antihypertensives or needing 4 antihypertensives to reach goal
2. Exclude pseudo-resistance: patient adherence; obtain home readings to exclude white coat effect 3. Identify contributing lifestyle factors: obesity; physical inactivity; excessive EtOH consumption; high Na, low fiber diet 4. Discontinue interfering substances: NSAIDS; sympathomimetics (diet pills, decongestants); stimulants; oral contraceptives; licorice; ephedra 5. screen for secondary causes of HTN |
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What is hypertensive urgency? How do you treat it?
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Subacute rise in blood pressure >180/110
No evidence of end organ damage Can be managed in 24-48 hour time frame Oral Medication can be used : Captopril Nicardipine or Nifedipine Labetalol |
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What is hypertensive emergency? How do you treat it?
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Acute rise in BP >180/120 mmHg
Symptoms/Findings: Retinal hemorrhages, exudates, and papilledema Acute pulmonary edema, left ventricular failure (CHF) Headache, nausea, vomitting, CNS dysfunction Acute Kidney Injury Should be managed in the ICU |
