HTN

BASICS

100

This common chronic disease is known as the “Silent Killer”

HTN

200

What is known as the leading cause for readmission to hospitals?

HTN

300

Explain the patho for HTN

A change in one of for of the factors affecting PVR or CO

        OR

A problem with the body’s control systems that regulate Blood Pressure (ex. ANS or RAAS)

400

A patient has a BP of 135/80

HTN STAGE 1 (130-139) or (80-89)

500

A patient has a BP of 160/90

HTN STAGE 2 (140 or >140) OR (90 or >90)

BP

100

A patient has a BP of 190/122

HYPERTENSIVE CRISIS (>180) or (>120)

200

How can cuff sizes affect a patient’s BP reading?

TOO LARGE = LOWER BP

TOO SMALL = HIGHER BP of about 10-40 mmHg difference

300

What information should you provide your patient regarding how to take a blood pressure reading?

1. DO NOT exercise, drink coffee or smoke 30 minutes before taking BP

2. DO NOT talk while taking BP

3. Feet should remain flat on the floor with legs uncrossed

4. Arm should remain at heart level

400

HTN risk factors

• Advanced Age

• African American

• Genetics/Family history

• Stress

• Poor diet - too much salt

• Diabetes - damage blood vessels

• Hypercholesterolemia - damage blood vessels

• Increased alcohol use

• Smoking or exposure to secondhand smoke

• Overweight/obesity

500

Secondary HTN is different from Primary HTN due to

SECONDARY HTN HAS AN UNDERLYING CAUSE:

• Renal disease - affects blood volume

• Endocrine disorders - cortisol or aldosterone ↑ affects RAAS system; tumor in the adrenal gland ↑ epinephrine and norepinephrine → dysregulation of the ANS

• Pregnancy - ↑ or worsen BP especially after giving birth

DX

100

If a patient has a SBP of >140 mmHg, but has a NORMAL DBP of <80 mmHg (145/70). What would the patient have?

ISOLATED SYSTOLIC HTN

200

How do we treat ISOLATED SYSTOLIC HTN?

• reduce risk for cardiovascular events (ex. Stroke, MI, and death)

300

What tests do we conduct to RULE OUT UNDERLYING CAUSES AND COMPLICATIONS OF HTN?

• Electrocardiogram (ECG/EKG)

• Echocardiogram (ultrasound)—visualize size of heart

• Urinalysis - look at kidney function

• Labs:

  • BUN & Creatinine

  • Electrolytes

  • Lipid Panel

  • Fundoscopy (eye exam)

400

What are some clinical manifestations of HTN?

NONE: 

• Asymptomatic (“Silent Killer”)

• May be difficult for patients to stay on medications because they feel fine

500

If left UNTREATED, what are some LATE S/S (based on which organ is compromised) that a patient might have?

• 1st symptom: changes in visual acuity (blurry vision)

• Headache

• Fatigue

• Dyspnea

• Edema in lower extremities

• Nocturia - attempt to decreased BP by increase urine output at night

• Chest pain - sign of MI or severe heart failure

MANAGEMENT

100

What is the main goal for HTN management?

• GOAL: Maintain BP < 130/80 mm Hg - goal isn't to make their BP perfect but to prevent organ damage!

200

What should ALL PATIENTS do when managing their hTN?

LIFESTYLE CHANGES FIRST (over pharmacological treatment):

• Increase exercise

• Stress management

• Avoid or decrease alcohol intake

• Smoking cessation

• Promote nutrition (ex. Dash Diet - address both fat and sodium intake)

300

What diet should HTN patients implement?

DASH DIET: 

• Sodium:  ≤ 2.3 g/day
  

  • Recommend taking away salt shaker or use lemons or other spices (keep in mind any other interactions with medications)

400

What is the MAIN GOAL for pharmacological treatment for HTN patients?

GOAL: 

- DECREASE peripheral resistance

- DECREASE blood volume

- DECREASE strength and rate of myocardial contraction

500

What are FIRST-LINE ANTI-HTN MEDS? and which ones are recommended for BLACK PEOPLE?

1. THIAZIDE DIURETICS (recommended for blacks)

2. ACE-Is

3. ARBs

4. CCBs (recommended for blacks)

- CCB's are NOT recommended as first-line unless they have a a Hx of HF or CAD.

(sometimes beta-blockers like metoprolol)

HTN CRISES

100

A patient has a BP reading of 190/122 and has recently STOPPED their medications. What could this patient have?

HTN CRISIS! but which one???

- depends on if the patient has any symptoms.

1. HTN URGENCY (asymptomatic)

2. HTN EMERGENCY (symptomatic)

(SBP >180mmHg and/or DBP >120mmHg)

- Abruptly stopping medications CAUSES Rebound Hypertension

200

What is the MAIN GOAL for HTN URGENCY as opposed to HTN EMERGENCY?

GOAL FOR HTN URGENCY: 

- MANAGE BP AND PREVENT ORGAN DAMAGE

GOAL FOR HTN EMERGENCY: 

- MANAGE BP and REVERSE/TREAT the ORGAN DAMAGE that has already been done

300

How do we medically manage a HTN URGENCY PATIENT?

1. ORAL DOSES OF INCREASED DOSE 

2. FAST-ACTING HTN MEDS (CLONIDINE - lowers bp within 30 minutes)

• Assess vital signs frequently

• Assess neuro status for signs of stroke

• Monitor I&Os for kidney function

400

What clinical manifestations typically appear in a patient undergoing a HTN EMERGENCY (symptomatic as opposed to HTN URGENCY)?

• Severe chest pain

• Severe HA and blurred vision

• Change in mental status (confusion)

• N/V

• Dyspnea

• Severe anxiety

500

How do we manage patients with a HTN EMERGENCY?

• BP must be lowered within the first hour

• IV medication

  • Continuous slow IV infusion of a beta blocker: Labetalol

    • Want to keep reducing BP over 24-48 hours

    • DO NOT RUSH! If patient has constant BP of 160 and it suddenly gets drop to 120, the patient could develop rebound HTN

Vasodilator: Hydralazine or Nitroprusside