HTN

Question 1

high-normal BP?

Answer 1

130-139 or 85-89

Question 2

Stage 1 HTN:

Answer 2

> 140-159 or >90-99

Question 3

Stage 2 HTN:

Answer 3

> 160-170 or 100-109

Question 4

Stage 3 HTN:

Answer 4

> = 180 or >=110

Question 5

How is HTN diagnosed in non-urgent situations?

Answer 5

• If BP is >140/90 - 2 more readings during that visit, first reading is eliminated and next 2 are averaged
• No caffeinated drinks
• No smoking
• No alcohol
• Use same blood pressure cuff every time you take a reading
• Ideally use a manual cuff and use proper size cuff – do not take BP over clothing

Question 6

Why are we concerned about hypertension?

Answer 6

• Target organ damage
• Increase stress on heart -> L ventricular hypertrophy
• Increased stress on blood vessels -> atherosclerosis, CVA
• Renal disease (hypertensive neuropathy)

Question 7

Modifiable risk factors of hypertension:

Answer 7

• Stress
• Abdominal obesity
• Substance abuse
• Oral contraceptives
• Dyslipidemia (hyperlipidemia)
• Personality traits
• Non-adherence
• Poor dietary habits (Increased Na+ and trans & Saturdated fats)
• Sedentary lifestyle

Question 8

non-modifiable risk factors:

Answer 8

• Age >= 55
• Male gender
• Family history and premature CV disease (age <55 in men and <65 in women)
• African American population is at greater risk for developing hypertension

Question 9

Why is HTN called a silent killer?

Answer 9

because ppl are usually asymptomatic

Question 10

Symptoms that can occur:

Answer 10

o	Breathlessness
o	Headache
o	Bleeding from nose
o	Blurred vision
o	Fatigue and sleepiness
o	Tinnitus
o	Profuse sweating

Question 11

What do the kidneys secrete renin in response to?

Answer 11

1) decreased arterial pressure in the kidneys
2) decreased sodium in the blood
3) increased sympathetic tone

Question 12

What are the different actions of Angiotensin 2?

Answer 12

• stimulates aldosterone secretion in adrenal glands promoting sodium and fluid retention
• stimulates muscle hypertrophy and fibrosis in the heart
• sympathetic outflow in the brain
• vasoconstriction

Question 13

BP considerations for children?

Answer 13

o Normally lower and gradually to adult BP in
adolescence
o Obesity in children today -> HTN, hyperlipidemia
o Type 2 diabetes

Question 14

Orthostatic HTN, the causes and how it is measured:

Answer 14

o Change in BP from lying to standing
o Wait for 2-3 full minutes between taking BPs
- SBP >/= 20 mmHg
- DBP >/= 10 mmHg

• Causative factors:
o Prolonged bed rest (fluid volume, venous tone)
o Aging
o Tall, thin people; adolescents; those with low BPs
o Some medications (diuretics)
o Hypovolemia

Question 15

Teaching/learning for orthostatic HTN:

Answer 15

• Instructing pt to sit, then stand slowly, then start walking slowly if she/he has orthostatic HTN
• Use a walker as necessary for balance
• Teach expected symptoms, dizzy, light headed, possible syncope

Question 16

Diagnostics for HTN:

Answer 16

• Urinalysis
• Electrolytes and fasting blood glucose
• BUN and creatinine
• Lipid profile (Total Chol, HDL, LDL, Triglyceride)
• CRP
• 12-lead ECG
• Echocardiogram

Question 17

3 step approach to treating HTN:

Answer 17

1. Lifestyle changes
2. Pharmacology
3. Combination pharmacology

Question 18

lifestyle modifications:

Answer 18

• Smoking cessation
• Decrease ETOH use – 1-2 standard drinks/day
• Diet/weight loss – DASH
• Exercise: Leight weights/ aerobic
• Blood glucose control for people diabetes
• Patient education

Question 19

pharmacological approach to HTN:

Answer 19

•	Start with one drug at a low dose and increase if necessary:
o	Thiazide/loop diuretics
o	Calcium channel blockers
o	ACE inhibitors, ARBs
o	Beta blockers
o	Vasodilators

Question 20

target organ damage for HTN:

Answer 20

o	Heart
o	Brain
o	Kidney
o	PVD
o	Retinopathy

Question 21

How do diuretics lower BP? side effects? common diuretics used?

Answer 21

o They work on your kidneys by increasing the amount of salt and water that comes out through your urine. Too much salt can cause extra fluid to build up in your blood vessels, raising your blood pressure. Diuretics lower your blood pressure by flushing salt out of your body, taking this unwanted extra fluid with it.

• Hypotension, electrolyte imbalances, dehydration
• Furosemide, HCTZ, spironalactone (K+)

Question 22

Common side effects of ACE inhibitors:
Pre/post assessment:
common drugs (-pril):

Answer 22

Pre/post assessments: BP, potassium (excess), hematocrit
Common side effects: Hypotension, increased potassium, cough

*same side effects and assessments for Angiotensin 2 receptor blockers
Enalapril (Vasotec), Captopril
-pril = usually an ACE inhibitor

Question 23

Pre/post Ax for calcium channel blocker, common side effects and common drugs:

Answer 23

• How do CCBs work: Decrease force of contraction of the heart –relaxes arteries so they don’t constrict as much.
• Pre/post assessments: NP, HR
• Common side effects: Hypotension, worsen heart failure
• What juice do you not give: Grapefruit juice
• Norvasc, Renidil, Diltiazem, Verapamil

Question 24

pre/post Ax for beta blockers, common side effects, common drug:

Answer 24

• Pre/post assessments: BP, HR – hold if BP 90 sys and/or HR <50 bpm
• Common side effects: Hypotension, dizziness, bradycardia
• Atenolol, Metroprolol, Propranolol
• Doxazosin, Terazosin

Question 25

pre/post Ax for direct vasodilators, common side effects, common drugs:

Answer 25

o Typically used in hypertensive crisis (ER/ICU) o Pre/post assessments: BP q5 min if given IV, watch for reflex tachycardia o Common side effects: Rapid hypotension, reflex tachycardia, headache, dizziness o Hydralazine, Nipride