-
hypertention defined
- ≥140/≥90
- or
- use of antihypertensive meds
-
values for
normal
prehypertension
stage 1 hypertension
stage 2 hypertension
- 120/80
- 120-139/ 80-89
- 140-159/ 90-99
- ≥160/≥100
-
isolated systolic hypertension defined as
≥140/< 90
-
isolated systolic hypertension factors
- -top number is elevated
- -more common in elderly people
-
pseudohypertension
-hardened arteries wont squeeze down so BP is not actually high
-
HTN is a risk factor for
- CAD
- CHF
- Stroke
- Renal failure
-
what two ethnicities have lower rates of BP control
Mexican americans and native americans
-
what ethnicity has the highest prevalence of HTN
African americans
-
causes of isolated HTN
cause unknown
-
modifiable rrisk factors
- A: alcohol
- B: body weight
- C: Cig smoking
- D: diet
- E: excersise
-
what is MAP
- avg of the BP
- 60 is the cut off
-
cardiac factors that influence BP
- HR
- INotropic state
- neural
- humoral
- WE CAN CONTROL THESE
- they effect CO
-
renal factors that effect fluid volume that effect BP
- renin angiotensin
- aldosterone
- atrial natriuretic factors
WE CAN CONTROL THESE
-
-
-
what do these effect
renin angiotensin
aldosterone
atrial natriuretic factors
HR
INotropic state
neural
humoral
cardiac output
-
SNS factors that influence BP
- a adrenergenic receptors(contrict)
- b adrenergenic receptor(dialate)
-
humoral factors that influence BP
vasoconstrictors angiotensisn and catecholameines
-
local regulation that effects BP
- -vasodialators prostaglandins and EDRF
- -vasoconstrictors endothelin
-
what do these effect in regards to BP
-a adrenergenic receptors(contrict)
-b adrenergenic receptor(dialate)
-vasoconstrictors angiotensisn and catecholameines
-vasodialators prostaglandins and EDRF
-vasoconstrictors endothelin
systemic vascular resistance (SVR)
-
trick to remember bblock I vs II
-
primary or idiopathic HTN is
- -elevated BP without a cause
- -most common
-
secondary htn is
-elevated BP with a specific cause
-
examples of secondary HTN
- renal disease
- cirrhosis
- apnea
- neuro
- narroeing of aortas
- endocrine
-
primary HTN or idiopathic HTN contributing factors
- increase SNS
- increase RAAS
- endothelial cell dysfunction
- DMbody weight
- increase sodium
- alcohol
-
once over 50, is SBP or DBP more important and why
- SBP
- it is a CVD risk factor
-
risk factors for salt sensitivity
- obese
- elderly
- African American
- diabetic
- renal disease
-
how does stress and increased SNS activity effect primary HTN
- increased vascoconstriction
- increased HR
- increased renin release
-
how does insulin resistance and hyperinsulinemia effect primary HTN
- -high insulin stimulates SNS and impairs nitric oxide mediated vasodialation
- -altered renin-angiotensin(high plasma renin activity)
- -endothelial cell dysfunction
-
how is HTN discoverd
random testing
-
what are the symptoms of HTN
normally asymptomatic
-
secondary symptoms of HTN
- fatigue
- dizzy
- palpatations
- angina
- dyspena
-
target organ disease most often occurs in
- heart
- brain
- periph vascular
- kidney
- eyes
-
examples of hypertensive heart disease
- CAD
- left ventricular hypertrophy
- heart failure
-
HTN diagnostics tests
- -urine, creatine, bun and serum creatine= renal involvement
- -serum electrolytes like potassium= detect hyperaldosteronism
- -lipid profile= risk factors r/t atherosclerosis and cvd
- -ECG= baseline of heart status
- -echocardiogram= if LVF is suspected
-
if white coat phenomenom is suspected
use ambulatory blood pressure monitoring, which non invasively monitors bp over a 24 hour period
-
benefits of lowering bp
- reduce:
-
- stroke
- myocardial infarction
- HF
-
weight loss of __ kg may decrease ___ bp by __ to __ Hg
-
recommended sodium reduction
less than 2.3 g of sodium/day
-
recomended salt intake
2300 mg
-
recomended alcohol consumption
- men 2 drinks/day
- women 1 drink/day
-
what is the primary action of the drugs that are used to treat HTN
- reduce SVR
- reduce volume of circulating blood
-
diuretics are used to treat
- mild to moderate HTN
- HF or kidney disease
-
which drug is often the first choice to treat htn
diuretics
-
diuretics promote____ and reduce _____
- sodium and water excretion
- plasma volume, and vascular response to catecholamines
-
loop or high celling dieuretics
- -reduce edema ass. w/ CHF
- -increase UO even if flow to kidney is diminished
- -MOST EFFECIENT
-
loop or high celling dieuretics meds
-
dieuretic thiazidides
- -most widely prescribed
- -not first choice for diabetics
- -mild to moderate htn
-
biggest dieuretic side effect
- hypokalemia
- cardiac arythmya
-
potassium sparing dieuretics
- -prevent hypokalemia
- -mild htn
- -no supplement needed
- -watch for hyperkalemia
-
if on pot sparing diuretic, use with caution on pt that take
ace inhibitors or angio II blockers
-
nursing considerations for pt on dieuretics
- -ortho hypotension
- -dry mouth, irritation
- -electrolyte imbalance=hypokalemia=potassium less than 3.5
- -disorientation
-
best time to administer dieuretics
AM
-
calcium channel blockers
increase sodium excretion and cause arteriolar vasodialation by preventing the movement of extracellular calcium into cells
-
what is the result of calcium chanell blockers
decrease demand for o2 and decrease PVR which relaxes the arteriols
-
group of meds ending in ipine, amil or azem
calcium chan blockers
-
acronym for calcium chan blockers
- A= amlodipine
- Very= verapamil
- Nice= nifedipine
- Drug= diltiazem
-
"dipine"
"azem"
- -tend to not dip hr
- -dips hr
-
what drug would calcium channel blockers be used as an alternative to and why
b blockers if pt has hx of asthma
-
calcium chan blockers can also be used for
arrythmias
-
calcium chan blocker side effect
- decrease bp
- bradycardia
- a-v block
- headache
- abdom discomfort
- periph edema
-
angiotensin converting enzyme inhibitors
"ACE"
prevent the conversion of angio I to angio II and reduce angio II mediated vasoconstriction and sodium and water retention
-
ACE inhibitors end in
pril
-
ace inhibitors decrease___ without _____
- -peripheral vascular resistance
- -increasing CO, cardiac rate and cardiac contractillity
-
use___ for pt with hx of diabetes
ACE
-
advantages of ACE
- less orthostatic hypotension
- lack of aggravation on pulmonary and DM
- increase renal blood flow
- less effect on HR
-
-
diuretics end in
thiazidide, done, one
-
what enhances the effects of ACE
- dieuretics
- alcohol
- beta blockers
-
adrenergenic receptors
alpha 1
alpha 2
beta 1
beta 2
- constrict
- dialate
- increase HR
- bronchodialate
-
angiotensin receptor blockers end in
sartan
-
angio II receptor blockers
prevent action of aII and produce vasodialation and increased sodium and water excretion
-
which 2 should not be used together and why
- ACE and ARB
- adverse renal effects
-
beta blockers
inhibit cardiac response to sympathetic nerve stimulation by blocking beta receptors
-
beta blockers end result
decrease HR, CO and BP
-
beta blockers end in
olol
-
beta blocker
selective
non selective
- beta 1 atenolol
- beta 1 and 2 propanolol
-
beta blocker selective vs non selective
- selective: cardioselective and only block beta 1
- nonselective; block beta 1 and 2
-
nursing intervention unique to beta blockers
- can not be stoped abruptly
- check baseline bp
- check hx of respitory bronchoconstriction
-
beta blocker side effect
- brady
- bronchospasm and wheezing
- DIABETIC HYPOGLYCEMIA
- heart failure related s/s like edema, dyspnea, rhales, fatigue, drowsy
-
alpha 1 adrenergenic blockers
block postsynaptic alpha 1 adrenergenic receptors to produce arteriolar and venous vasodialation
-
alpha 1 adrenergenic blockers result
reduce peripheral vascular resistance
-
alpha 1 blockers end in
osin
-
which drug is low on the list because of its strength
alpha 1 blockers
-
alpha 1 blockers side effects
- drowsy
- headache, vertigo
- tachy
- weak
- sexual dysfunction
- other antihypertensives enhance effects
-
which drugs side effects are more prevalent with the first dose
alpha 1 blockers
-
most common alpha 1 blockers
- doxizosin***
- prazosin
- terazosin
-
centrally acting alpha 2 agonists
stimulate a2 receptors in brainstem and reduce sympathetic outflow from cns
-
centrally acting alpha 2 agonists result
decreases HR, SBP and DBP
-
centrally acting alpha 2 agonists meds
- clonidine-catapres
- methyldopa-aldomet
-
direct acting vasodialators
direct arteriolar smooth muscle relaxation, decreasing PVR
-
direct acting vasodialators uses
- htn
- renal dx
- more of a PRN drug
-
direct acting vasodialators meds
apresoline, minoxidil, hydralazine
-
direct acting vasodialators side effects
- tachy
- ORTHO HYPO
- dizzy
- nausea
- fluid retention
-
ABCD rule
- AB pairs and CD pairs
- AB often first choice for younger pt
- CD often first choice for African americans
Ace and Arbs go with Beta blockers
Calcium chan block go with diuretics
-
ACE and ARB considerations
-
beta blocker considerations
MI
-
CHF considerations
do not use calcim channel blockers
-
ethinicity considerations
C and D
-
first line of drug therapy
thiazadines "dieuretics"
-
auscultatory gap
wide gap between the first korotkoff sound and subsequent beat
older patients have this
-
what is the cause for orthostatic hypotension in older adults
varying degrees of impaired bareoreceptor reflex mechanism
-
hypertensive crisis is a
severe abrubt increase in DBP >140
-
hypertensive crisis often occurs when
pt with a hx of HTN who have failed to comply with meds or have been under medicated
-
hypertensive urgency vs emergency
- urgency=no target organ damage
- emergency= target organ damage
-
examples of hypertensive emergency
- HTN encephalopy
- cerebral hemorage
- acute renal failure
- MI
- HF w/ pulm edema
-
lipids should be checked____
ECG should be done___
-
resistant HTN
failure to reach target BP after on a 3 drug treatment that includes a diuretic
-
which fills and which one pushes out
- systolic pushes out
- diastolic fills
-
right side HF
- -things back up
- edema
- jvd
- fatigue
- large liver and spleen
- gi stress
-
left sided HF
- where most HF starts
- lungs
- edema
- cough
- sob
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