HTN Pathophysiology Lecture Fall (4) (1)

Years will prevent 1 death for every 11 patients

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years will prevent 1 death for every 11 patients treated In the presence of CVD or target organ damage, only 9 patients would require such BP reduction to prevent a death.11
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Complications of Hypertension Aspects of hypertension that confer increased risk for cardiovascular events Elevation of systolic pressure Left ventricular hypertrophy Increased myocardial oxygen demands Left sided heart failure Disproportionate rise in pulse pressure Greater stretch of arteries Damage to the elastic elements of the vessel Predisposes to aneurysms and development of the intimal damage that leads to atherosclerosis and thrombosis Diastolic pressure is a limiting factor in coronary perfusion Coronary perfusion is greatest during diastole
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Diagnosis Hypertension may be systolic BP (SBP), diastolic BP (DBP) or both Hypertension is ASYMPTOMATIC Measurements of elevated BP values on at least 2 separate days are needed The average of 2 values separated by up to 5 minutes are used for clinical evaluation
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JNC VII HTN Classification Scheme
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HTN Treatment Goals Most patients < 140/90 mmHg Patients with diabetes < 130/80 mmHg Patients with chronic kidney disease < 130/80 mmHg
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HTN Treatment Goals Goal for most patients is a BP < 140/90 mmHg Goal for most patients is a BP < 140/90 mmHg Patients with DM, CKD, CAD Patients with DM, CKD, CAD * the goal should be < the goal should be < 130/80mmHg 130/80mmHg Patients with left ventricular dysfunction Patients with left ventricular dysfunction * , the goal , the goal should be <120/80 mmHg should be <120/80 mmHg Achieve SBP goal especially in persons Achieve SBP goal especially in persons > > 50 years of 50 years of age age * Comes from the 2007 AHA Comes from the 2007 AHA Treatment of Hypertension in the Prevention and Management of Ischemic Heart Disease
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Collecting Your HTN Database Evaluation Evaluation of hypertension has 3 objectives, what are of hypertension has 3 objectives, what are they? they? 1. 1. Assess lifestyle and identify other CV risk factors or concomitant disorders that may affect and/or guide concomitant disorders that may affect and/or guide treatment treatment 2. Reveal identifiable causes of high BP Reveal identifiable causes of high BP 3. 3. Assess the presence or absence of target organ Assess the presence or absence of target organ damage damage Doesn’t have to be done in this order This is done via subjective and objective data This is done via subjective and objective data
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How does the body regulate blood pressure?
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Mechanisms of Blood Pressure Regulation 1. Neural 2. Humoral 3. Extracellular fluid volume 4. Tissue auto-regulation
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Neural Mechanisms Integration & modulation of the autonomic nervous system (ANS) Located in the reticular formation of the medulla and the lower third of the pons ANS Sympathetic nervous system fibers run down the spinal cord to the heart and periphery
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