HTN
is the consistent elevation of arterial blood pressure
Isolated systolic hypertension (ISH)
increased systolic pressure with normal diastolic pressure
Primary HTN (essential HTN)
has no known cause
Primary HTN:
RISK FACTORS
Positive family history
Advancing age
Gender: female >70 years of age; male <55 years of age
Race: black
↑Sodium (Na+) intake
Glucose intolerance (diabetes mellitus)/insulin resistance
Heavy alcohol use
Obesity
Cigarettes
↓Potassium (K+), magnesium (Mg++), calcium (Ca++)
sleep apnea
HTN:
Patho
↑CO (↑HR, ↑SV, or both)
increased peripheral resistance
or both
HTN:
system dysfunction
SNS
RASS
natriuretic peptides
bradykinin
is a potent endothelium-dependent vasodilator and mild diuretic, which may cause a lowering of the blood pressure
secondary HTN
is caused by an underlying dx process that raises peripheral vascular resistance or CO or ↑ blood volune
secondary HTN:
cuprits
kidneys,
hormonal changes,
changes in blood vessels themselves,
drugs
secondary HTN:
cuprits (Renal)
↓ sodium and water
stenosis of renal arteries ↑ renin
secondary HTN:
cuprits (Hormonal Changes)
Hyperaldosteronism(↑ aldosterone→ ↑na+ retention→ ↑blood volume
Cushing’s syndrome (excess cortisol stimulates aldosterone secretion)
hyperthyroidism (↑ CO)
↑ catecholamines (↑HR and vascular resistance)
HTN effect on:
myocardium
left ventricular hypertrophy
MI
HF
HTN effect on:
Coronary arteries
MI
sudden death
HTN effect on:
Kidneys
glomerulosclerosis
↓glomerular filtration
end stage renal dx
HTN effect on:
Brain
TIA cerebral thrombosis aneurysm hemorrhage acute brain infarction
Aorta
dissecting aneurysm
Arteries of Lower extremitites
intermittent claudication
gangrene
HTN:
CM
silent dx
↑ BP
HTN:
evaluation
measurement of BP on at least 2 separate occasions
averaging two readings at least 2 minutes apart.
complete medical hx
HTN:
treatment
Lifestyle modifications depends on severity DASH diet exercise stop smoking drugs
