n325 blood presure

blood pressure

• force exerted by blood against wall of vessels

• helps perfuse and move blood around

• systolic

  • pressure during ventricular contraction

• diastolic

  • pressure during ventricular relaxation

normal BP

• SBP:

  • <120

• DBP:

  • 60-80

elevated BP

• SBP:

  • 120-129

• DBP:

  • <80

stage 1 HTN

• SBP:

  • 130-139

• DBP:

  • 80-89

stage 2 HTN

• SBP:

  • greater than or equal to 140

• DBP:

  • greater than or equal to 90

types of hypertension

• primary hypertension (AKA essential HTN)

• secondary hypertension

• resistant hypertension

• white coat hypertension

• hypertensive crisis

primary hypertension (essential HTN)

• develops overtime with no single known or identifiable medical cause

• most common form of HTN

• driven by genetics, aging, and lifestyle factors like obesity, high salt intake, and inactivity

secondary hypertension

• caused by an identifiable underlying medical condition, medication, or substance - NOT from lifestyle factors

• affects 5-10% of patients

• appears suddenly

• more severe than primary hypertension

• can sometimes be cured by treating the foot cause

resistant hypertension

• BP resistant to changing despite lifestyle modifications and medications

white coat hypertension

• HTN during clinical readings

• may bc ppl nervous seeing doctors

• normal BPs at home

hypertensive crisis

• hypertensive emergency

• SBP over 200 or DBP over 120

preload

• blood volume going into heart

• amt of stretch or tension on the ventricular walls of the heart at the end of diastole, directly determined by the volume of blood in the ventricles just before contraction

cardiac output

• stroke volume x HR

• how much blood your heart is expelling

systemic vascular resistance

• resistance the left ventricle must overcome to circulate blood

risk factors for HTN

• non-modifiable

  • age

  • genetics

  • ethnicity

  • sex

• modifiable

  • smoking

  • obesity

  • sodium

  • caffeine

  • alcohol

  • stress/anxiety

  • lack of physical activities

chronic hypertension - part 1: the calm before the storm

• bloodstream flowing as usual

• healthy endothelium lining

• normal BP regulation

• systolic 120 mmHg

• diastolic 80 mmHg

chronic hypertension - part 2: the rising current

• slow and silent change - asymptomatic

• increased peripheral resistance results in decreased perfusion

• baroreceptors send signals for vasoconstriction and increased blood volume

• increased pressure causes damage to endothelial lining over time

chronic hypertension - part 3: the breaking of the banks

• damage and consequences

• endothelial injury

• inflammation

• platelet aggregation

• plaque buildup

• atherosclerosis

• decreased perfusion to kidneys, retina, heart, brain, distal extremities (PAD)

  • ischemia

  • organ damage

chronic hypertension - part 4: the flood

• the deadly finale

• plaque occlusion, arterial emboli, aortic dissection or rupture

• acute complications

  • stroke, heart attack, aneurysm rupture, limb ischemia

complications of HTN

• target organ damage (TOD)

  • brain

  • eyes

  • peripheral arteries

  • kidneys

  • heart

  • and more…

DASH diet

• dietary approaches to stop hypertension

• lowers SBP ~11mmHg

lifestyle modifications for HTN

• weight reduction

  • decr 5-20 mmHg per 10 kg wt loss

• DASH diet

  • 8-14 mmHg decr

• physical activity

  • 4-9 mmHg decr

• sodium reduction

  • 2-8 mmHg decr

• decrease ETOH

  • 2-4 mmHg decr

• avoid tobacco

• stress management

HTN assessment

• history

  • HA

  • change in LOC

  • vision changes

  • nose bleeds

  • chest pain

  • medications?

• CV

  • BP

  • heart sounds

  • pulses arterial bruits

  • edema

• labs

  • renal

  • electrolytes

  • H&H

  • FBG

  • lipids

• diagnostics

  • EKG

  • CXR

  • BUN/creatinine

  • arteriography

  • echo/ultrasound

  • ophthalmic exam

HTN interventions

• goal for BP = <130/80

• elevated (SBP 120-129)

  • lifestyle modifications

• stage 1 (SBP 130-139)

  • life style modifications

  • medications → thiazide first, then ACE, ARBs, BB, CCB, or combo

• stage 2 (SBP over 140)

  • lifestyle modifications

  • medications → two drug combo

• optimize doses/meds, lifestyle changes until goal is achieved

HTN medication classes

• diuretics

• beta-blockers

• ACEi

• ARBs

• CCBs

• alpha-blockers

• alpha-2 receptor agonists

• vasodilators

diuretics

• class: thiazide diuretics

• ex) hydrochlorothiazide (HCTZ)

• MOA: inhibits Na+ reabsorption in kidneys which promotes diuresis and reduces blood bolume

• cautions: orthostatic hypotension, electrolyte imbalances, can cause nephrotoxicity

beta-blockers

• ex) metoprolol

• MOA: blocks beta-adrenergic stimulation that increase BP (heart and peripheral vascular system)

• cautions: orthostatic hypotension, contraindicated with asthma, bradycardia

ACEis

• ex) lisinopril

• MOA: inhibits conversion of angiotensin I to angiotensin II → dilates arteries and veins

• cautions: orthostatic hypotension, dry cough, dizziness, hyperkalemia

ARBs

• angiotensin receptor blockers (ARBs)

• ex) losartan

• MOA: blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II

• cautions: orthostatic hypotension, angioedema, hyperkalemia

HTN education and followup

• routine assessment (Q3-6 months)

  • history

  • home BP logs

  • physical assessment

  • taking meds?

  • med SEs?

  • lifestyle modifications

• education

  • pt and family teaching → med compliance

  • home monitoring

  • when to call

  • when to come back in

hypertensive crisis

• urgency: BP > 180/120 no S/Sx TOD

• emergency: BP > 180/120 and S/Sx TOD

• clinical manifestations

  • S/Sx of TOD

  • retinal: papilledema. hemorrhage

  • neuro: HA, seizures, confusion, coma

  • CV: chest pain, SOB, dysrhythmias

• goal of treatment

  • lower BP: 2-4 hours later, BP reduction of 25%

  • stabilize to 160/100 mmHg over next 2-6 hours

• treatment

  • confirm reading

  • IV vasodilators

• complications

  • cerebral bleed, heart failure, renal failure

  • too-rapid reduction in BP can lead to ischemia

orthostatic hypotension

• supine to sitting to standing (AND/OR)

  • decrease of 20 mmHg or more in SBP

  • decrease in 10 mmHg or more in DBP

  • HR increase of 20 bpm

• risks/causes

  • >70 years old

  • BP meds

  • hypovolemia

  • fever

  • sepsis

  • reduced CO

  • bed rest

• assessment

  • vertigo

  • N/V

  • tachycardia

• interventions

  • elevate HOB

  • BP and HR supine, sitting, upright

  • compression stockings

  • fluids

  • support at side of bed

• patient teaching

  • change positions slowly

  • dangle before getting OOB

  • leg exercises

  • use call bell