PBM- Hypertension Case Study

Hypertension
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

Stage 1 Hypertension
SBP- 140
DBP- 90

Stage 2 Hypertension
SBP-160
DBP-100

Stage 3 Hypertension
SBP-180
DBP-110

Hypertensionogenic Factors
Alcohol intake- 2oz day
Low potassium, or calcium intake
NSAIDs, cold remedies
Other typical stuff you know

Hypertension Factors
Increased Cardiac Output and Increased Systemic Vascular Resistance

Cardiac Output Increases
Due to Hypervolemia
-renal artery stenosis, renal disease
-hyperaldosteronism
-hypersecretion of ADH
-Aortic coartcation
-Pregnancy
Stress
Or Pheochromocytoma

Systemic Vascular Resistance Increases
Due to:
Stress
Artherosclerosis
Renal artery disea- increased ang II
Pheochromocytoma
Thyroid dysfunction
Diabetes
Cerebral Ischemia

NSAIDs
Inhibits COX 1 and 2’s ability to convert arachnidonic acids to prostaglandins, prostacyclin and thromboxane

Increased Sodium Intake
Increases stroke volume

Increased Alcohol Intake
Dose-dependent BP increase, heart failure, arrhythmia, artherosclerosis

Increased Caffeine Intake
Increases catecholamine release

Cigarettes Use
Increase sympathetic activity and increases epinephrine release from adrenal glands

Thiazides
Decrease stroke volume and cardiac output
Decrease vascular resistance by increasing H2O renal excretion
Can cause electrolyte imbalances

DHP
Vascular Smmoth Muscle Relaation
Lower extremity edema, reflex tachycardia

Non-DHP
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

Beta alpha receptor Antagonists
Decrease contractility, HR- Beta
Decrease vascular resistance- alpha
Decrease renin secretion
Lower CV outcomes in heart failure and after myocardial infarction

ACE Inihibitors
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

Angiotensin Receptor Antagonists
Sartans
Similar to ACE inhibitors but don’t have bradykinin effects

Sites of Blood Pressure Control
1. Resistance- arterioles
2. Capacitance- Venules
3. Pump Output- Heart
4. Volume- Kidneys

Beta Receptors of Heart Blockers
Propanolol, metaprolol

Angiotensin Receptors of Vessels
Losartan and other angiotensin receptor blockers

Kidney Tubules Medications
Thiazides

Beta-Receptors of Juxtaglomerular Cells that Release Renin
Propanolol, other Beta blockers

Vascular Smooth Muscle Medications
Hydralzaine
Minoxidl
Nitroprusside
Diazoxide
Verapamil and other calcium channel blockers
Fenoldopam

Vasomotor Center Medications
Metyhldopa
Clonidine
Gunabenz
Guanafacine

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