PBM- Hypertension Case Study – Flashcards
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Hypertension
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2 or more DBP readings above 90 mmHG on 2 subsequent visits 2 or more SBP readings of 140 May want to use home testing, white coat hypertension
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Stage 1 Hypertension
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SBP- 140 DBP- 90
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Stage 2 Hypertension
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SBP-160 DBP-100
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Stage 3 Hypertension
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SBP-180 DBP-110
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Hypertensionogenic Factors
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Alcohol intake- 2oz day Low potassium, or calcium intake NSAIDs, cold remedies Other typical stuff you know
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Hypertension Factors
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Increased Cardiac Output and Increased Systemic Vascular Resistance
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Cardiac Output Increases
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Due to Hypervolemia -renal artery stenosis, renal disease -hyperaldosteronism -hypersecretion of ADH -Aortic coartcation -Pregnancy Stress Or Pheochromocytoma
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Systemic Vascular Resistance Increases
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Due to: Stress Artherosclerosis Renal artery disea- increased ang II Pheochromocytoma Thyroid dysfunction Diabetes Cerebral Ischemia
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NSAIDs
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Inhibits COX 1 and 2's ability to convert arachnidonic acids to prostaglandins, prostacyclin and thromboxane
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Increased Sodium Intake
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Increases stroke volume
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Increased Alcohol Intake
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Dose-dependent BP increase, heart failure, arrhythmia, artherosclerosis
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Increased Caffeine Intake
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Increases catecholamine release
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Cigarettes Use
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Increase sympathetic activity and increases epinephrine release from adrenal glands
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Thiazides
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Decrease stroke volume and cardiac output Decrease vascular resistance by increasing H2O renal excretion Can cause electrolyte imbalances
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DHP
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Vascular Smmoth Muscle Relaation Lower extremity edema, reflex tachycardia
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Non-DHP
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Decreases HR, cardio selective, don't mix with Beta antagonists, both DHP and Non-DHP good pick for african americans as they are a low renin population
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Beta alpha receptor Antagonists
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Decrease contractility, HR- Beta Decrease vascular resistance- alpha Decrease renin secretion Lower CV outcomes in heart failure and after myocardial infarction
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ACE Inihibitors
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Vasodilation Decrease blood volume Reduces sympathetic activity by inhibiting angiotensin II Inhibit cardiac and vascular hypertrophy Increase cough(increase bradykinin) reduce kidney function due to decreased renal blood syppl Hypokalemia due to aldosterone effects Improve CV outocomes
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Angiotensin Receptor Antagonists
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Sartans Similar to ACE inhibitors but don't have bradykinin effects
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Sites of Blood Pressure Control
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1. Resistance- arterioles 2. Capacitance- Venules 3. Pump Output- Heart 4. Volume- Kidneys
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Beta Receptors of Heart Blockers
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Propanolol, metaprolol
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Angiotensin Receptors of Vessels
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Losartan and other angiotensin receptor blockers
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Kidney Tubules Medications
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Thiazides
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Beta-Receptors of Juxtaglomerular Cells that Release Renin
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Propanolol, other Beta blockers
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Vascular Smooth Muscle Medications
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Hydralzaine Minoxidl Nitroprusside Diazoxide Verapamil and other calcium channel blockers Fenoldopam
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Vasomotor Center Medications
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Metyhldopa Clonidine Gunabenz Guanafacine
