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Hypertension&CVDisorders

Hypertension&CVDisorders

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Published by: dlneisha61 on Mar 19, 2009
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05/10/2014

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HYPERTENSIONHYPERTENSION
DISEASE OF CIVILIZATIONDISEASE OF CIVILIZATIONWHAT IS HIGH BLOOD PRESSUREWHAT IS HIGH BLOOD PRESSURE
Hypertension (HTN)Hypertension (HTN)
Systolic blood pressureSystolic blood pressure
Diastolic blood pressureDiastolic blood pressure
Systolic blood pressure (SBP) equal to or greater than 140 mmHg or a diastolicSystolic blood pressure (SBP) equal to or greater than 140 mmHg or a diastolic pressure (DBP) equal to or greater than 90 mm Hg (extended period of time), orpressure (DBP) equal to or greater than 90 mm Hg (extended period of time), or taking antihypertensive medicationstaking antihypertensive medications
Based on average of two or more blood pressure measurements taken in two orBased on average of two or more blood pressure measurements taken in two or more contacts with health care provider after an initial screening. (JNC 7)more contacts with health care provider after an initial screening. (JNC 7)
TWO MAJOR TYPESTWO MAJOR TYPES
Primary (esPrimary (essential or idiopathic)sential or idiopathic)
Secondary hypertensionSecondary hypertension
“the silent killer”“the silent killer”
JNC 7 CLASSIFICATIONJNC 7 CLASSIFICATION
NormalNormal
Pre HypertensionPre Hypertension
HypertensionHypertension
Stage 1Stage 1
Stage 2Stage 2
PATHOPHYSIOLOGYPATHOPHYSIOLOGY
Blood pressure = total peripheral resistance + cardiac outputBlood pressure = total peripheral resistance + cardiac output
Changes in arteriolar bed – increased peripheral vascular resistanceChanges in arteriolar bed – increased peripheral vascular resistance
Abnormally increased tone in sympathetic nervous system originates inAbnormally increased tone in sympathetic nervous system originates in vasomotor system centersvasomotor system centers
Increase in arteriolar thickening from genetic factors which leads to increasedIncrease in arteriolar thickening from genetic factors which leads to increased peripheral resistanceperipheral resistance
Abnormal renin release – angiotensin II which constricts arteriole and increasesAbnormal renin release – angiotensin II which constricts arteriole and increases volumevolume
Prolonged hypertension increases heart’s workload as resistance in leftProlonged hypertension increases heart’s workload as resistance in left ventricular ejection increasesventricular ejection increases
11
 
To increase force of contraction the left ventricle gets larger (hypertrophy) –To increase force of contraction the left ventricle gets larger (hypertrophy) – raising heart’s oxygen demand and workloadraising heart’s oxygen demand and workload
Promotes coronary atherosclerosisPromotes coronary atherosclerosis
Vascular changesVascular changes
Secondary hypertension – patho related to underlying diseaseSecondary hypertension – patho related to underlying disease
TARGET ORGAN DAMAGE (COMPLICATIONS)TARGET ORGAN DAMAGE (COMPLICATIONS)
Hearteart
Left Ventricular hypertrophyLeft Ventricular hypertrophy
Angina /prior MIAngina /prior MI
Heat failureHeat failure
Hypertensive Heart DiseaseHypertensive Heart Disease
Brainrain
Stroke or TIAStroke or TIA
KidneyKidneyChronic kidney diseaseChronic kidney diseaseNephrosclerosisNephrosclerosis
VascularVascular
PVDPVD
Eyesyes
Retinopathy (retinal damage)Retinopathy (retinal damage)
RISK FACTORSRISK FACTORS
Cigarette SmokingCigarette Smoking
HyperlipidemiaHyperlipidemia
DMDM
AgeAge
GenderGender
Family historyFamily history
ObesityObesity
Refer to table 32-3, pg 781Refer to table 32-3, pg 781
Age Related ChangesAge Related Changes
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Accumulation of atherosclerotic plaqueAccumulation of atherosclerotic plaque
Elastin replaced causing arterial stiffness & decreased vascular complianceElastin replaced causing arterial stiffness & decreased vascular compliance
Increased collagen depositsIncreased collagen deposits
Impaired vasodilatationImpaired vasodilatation
Aorta and large arteries are less able to accommodate the volume of bloodAorta and large arteries are less able to accommodate the volume of blood pumped out by heart and energy used to stretch the vessels used to elevate thepumped out by heart and energy used to stretch the vessels used to elevate the systolic BPsystolic BP
Wide auscultatory gapWide auscultatory gap
SIGNS & SYMPTOMSSIGNS & SYMPTOMS
Physical exam – high blood pressure – 2 consecutive readingsPhysical exam – high blood pressure – 2 consecutive readings
“Silent Killer” – asymptomatic until vascular changes“Silent Killer” – asymptomatic until vascular changes
Retinal changesRetinal changes
Severe HPTSevere HPT
Other SSxOther SSx
MEDICAL HISTORYMEDICAL HISTORY
Patient history or symptoms of CHDPatient history or symptoms of CHD
Family HxFamily Hx
History of recent changes in weight, leisure time, physical activity, smokingHistory of recent changes in weight, leisure time, physical activity, smoking
Dietary assessmentDietary assessment
Rx and OTC meds & HerbalRx and OTC meds & Herbal
Psychosocial and environmental factorsPsychosocial and environmental factors
Physical ExamPhysical Exam
Initial physical examInitial physical exam
Person seated quietly for at least 5 minutes in a chair (rather than on examPerson seated quietly for at least 5 minutes in a chair (rather than on exam table) with feet on the floor and arm supported at heart level.table) with feet on the floor and arm supported at heart level.
2 measurements taken2 measurements taken
Verification in opposite arm (if values are different,Verification in opposite arm (if values are different,
higher value shouldigher value should be usede used
))
Ht, Wt, Body mass index (BMI), waist circumferenceHt, Wt, Body mass index (BMI), waist circumference
Funduscopic examinationFunduscopic examination
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