1. What is considered prehypertension
    120-139/  80-89
  2. Decrease BP in LUE and femoral artery
    Coarctation of the aorta
  3. Whats the difference between primary and secondary hypertension
    • Primary 95%-unknown etiology
    • Secondary 5%-known etiology
  4. Name the types of secondary hypertension
    renovascular, coarctation of aorta, phenochromocytoma, OSA, exogenous substance.
  5. GEnder difference

    –-males in all age group
    –In the third and fourth decades, it is more than twice as common among men as in women.
    –Men have a substantially higher complication rate than women
    AGE RISK factors

    • •Age
    • –BP rises steadily into the fifth and sixth decades of life
    • –By then the prevalence of HTN approaches 50% > 50 yrs
    • –The complication risk also rises steadily with age
  6. Ethicity

    –African American marked increase prevalence–Compared to Caucasians, the prevalence is
    –Severe HTN is 5 times more common in African Americans–CVA of AA due stoke > mortality
    • •Obesity
    • –Clients with BMI > 30 have a 3-5 times risk of developing HTN than people of normal weight.

    –Positive family history
    –Psychological stress (difficulty to identify and quantify)
    WHEN to Screen

    • –First screening at age 3
    • –-all adult
    • - BP at lease 2 times.  Any time take BP is screening
  8. Where to screen

    –Screen everyone at clinic
    –Malls, grocery stores, schools, etc.
    –Must be able to refer if in a booth in mall
    .–Must have a plan

    • –Reliable equipment
    • –Correct cuff size 80% of arm
    • –Correct position (feet on floor, arm relaxed, sitting position)
    • –Correct technique
    •        •Systolic measured when first sound  heard
    •        •Diastolic measured when sound disappears
    •         •Arm positioned at heart level
    •         •BP should be taken in both arms with client seated
    •          •Averages of two successive measurements in each arm are recorded
  9. Other Causes > BP

    •-full bladder
    •Recently exercised (last 4-6 hrs)
    •-caffeine (last 6 hrs)
    •Decongestants (peusdomenphine)
    • •Diagnosis
    • –The diagnosis of HTN must never be made on the basis of a single reading. (on 2 occasion)
    • –If elevated during routine screening, recommend client have a recheck within one week. Must have 2 reading.  
    •     Can recheck at home if believe relable methhod
  10. Definition HTN
    –Greater than 140/90 on two or more readings taken at two or more visits
    –Diabetics:130/80 goal on ace (<130/80)/ need low BP to reduce risk
    –Renal 125/70
    • Diagnosis HTN
    • –First step is to look for it.
    • –Make sure it is measured correctly.
    • –May be falsely elevated with:
    •      •-anxiety
    •      •Previous activity
    •      •-tobacco if smoke heavyly ( treat for BP
    •      •-caffenie
    •      •Decongestants
    –A single reading of >210 sys &/or >115 diastolic is adequate to make the diagnosis and treat.
    –Geriatric Considerations:
       •Isolated systolic HTN is common (diastiloc is normal)  
    ICD 9 Codes
       •-elevated bp (796.2) not labeled for life
       •-HTN (401.1) for life and on medical records
    -White syndrome
        will have >BP at other time in life. 
        Follow closely with frequent check
    • Differential Diagnosis
    • –Eliminate secondary causes
    •     •-HTN for first time in individual <25 (rarely have do full work up)
    •      •Acute onset of severe ( >210 DBP >110)HTN at any age
    •      •Adherent individuals whose BPs do not lower with antihypertensive medications ( not able to control so consider complete work up)
  12. DifferentialDiagnoses:
    Patients with certain clinical manifestations
     –Central obesity, ecchymosis Cushing
     –-acute anterior chest and mid back pain (Anuersym)
    Weight loss, nervousness, exophthalmos (hyperthyriodism)
    –Paroxysmal complaints of headache, perspiration, palpitations (Phenochromcytoma) PPP comes and go
    •Renal Disease
    •-arteriscortic vascular disease
    • •Sedentary life-style
    • •Obesity
    • •-type A
    • •ETOH
    • •Family history
    • •-Stress
    • •Previous history of HTN
    • •Make sure they understand why they were on it
    • •Patient ED is important
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