Cardio II - HTN - Hypertension"The Silent Killer...

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Hypertension “The Silent Killer” Hypertension Overview 0. BP = CO x PR (cardiac output X peripheral resistance) 1. CO = HR x SV (preload, afterload, and contractility) 2. Hypertension can result from… 0. Change in cardiac output 1. Change in peripheral resistance 2. Or, both Primary hypertension reason for increased BP cannot be identified (90-95%) Secondary hypertension increased BP from an identifiable cause (5-10%) Causes of Hypertension o sleep apnea o drug-induced or related causes o chronic kidney disease o primary aldosteronism o renovascular disease o chronic steroid therapy and Cushing’s syndrome o pheochromocytoma o coarctation of the aorta o thyroid or parathyroid disease Cardiovascular Risk Factors Major Risk Factors o hypertension smoking o obesity (BMI 30+) physical inactivity o dyslipidemia Diabetes Hypertension Risk Factors Continued o Microalbuminuria or estimated GFR less than 60 mL/min o 55 years or greater for men 65 years or more for women o Family history of premature cardiovascular disease Target Organ Damage o Heart Left ventricular hypertrophy (increased workload, higher systemic pressure) Angina or prior MI Prior coronary revascularization Heart failure o Brain Stroke or transient ischemic attack (CVA or TIA)
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o Chronic kidney disease o Peripheral arterial disease o Retinopathy 3. Medications to treat decrease… 3. Peripheral resistance 4. Blood volume 5. Strength and rate of myocardial contraction Management of Hypertension includes lifestyle changes first, then meds if unsuccessful JNC VII Classification of Blood Pressure in Adults 18 or Over 4. Normal 6. Systolic < 120 7. Diastolic < 80 5. Prehypertension 8. Systolic 120 – 139 9. Diastolic 80 – 89 6. Hypertension 10. Stage 1 Systolic 140 – 159 or diastolic 90 –99 11. Stage 2 Systolic > 160 or diastolic > 100 -- Stage 3 Systolic greater than or equal to 180 or diastolic greater than or equal to 110 0. Normal 54% 1. Prehypertension 22% 2. Hypertension 24% Pathophysiology 3. Increased sympathetic nervous system activity 4. Increased renal reabsorption of sodium, chloride, and water 5. Increased activity of the renin-angiotensin-aldosterone system 6. Decreased vasodilatation of the arterioles 7. Resistance to insulin action Gerontologic Considerations 8. Decrease in the elasticity of the major blood vessels… 0. Increased peripheral resistance (accumulation of plague, increased collagen deposits, impaired vasodilation, decreased elasticity of blood vessels) 9. Isolated systolic hypertension is more common in older adults 1. Systolic > 140 2. Diastolic < 90 Monotherapy may simplify the medication regimen and make it less expensive
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Caregivers and family should be included in teaching Clinical Manifestations of Hypertension 7. May have no symptoms “The Silent Killer”
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This note was uploaded on 05/04/2008 for the course NURS 130 taught by Professor Dupuy during the Spring '08 term at Lady of the Lake.

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Cardio II - HTN - Hypertension"The Silent Killer...

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