Assessment of Hypertension and PVD

Assessment and Diagnostics

• Hypertension (HTN), characterized by consistently elevated blood pressure, Peripheral Vascular Disease (PVD), which involves narrowing of blood vessels affecting blood flow, and Preeclampsia, a pregnancy-related hypertensive disorder, are critical conditions impacting organ perfusion and overall cardiovascular health.
• Family history and lifestyle habits are critical factors for assessing HTN.
• Previous diagnoses or treatments for HTN must be reviewed to inform current assessments.
• Key physical assessment findings include headaches, blurred vision, chest pain, and murmurs indicating rhythm changes.
• Peripheral assessments include capillary refill comparisons and checking for pulse presence and symmetry in lower extremities.
• Skin changes such as color, temperature, and hair loss indicate PVD.
• Edema may present as rapid swelling in face, hands, and feet in preeclampsia, requiring careful monitoring.

Diagnostics

• Ankle Brachial Index (ABI) is crucial for diagnosing PVD; a ratio of blood pressure in the ankle versus the arm signals potential vascular issues.
• Blood pressure readings of ≥140/90 suggest hypertension and necessitate further investigation.
• Thrombocytopenia (low platelet count) is associated with severe cases of preeclampsia and demands CBC assessment.

Concept: Perfusion

• Defined as blood flow through arteries and capillaries, delivering oxygen and nutrients to cells.
• Altered perfusion may lead to impaired tissue circulation, highlighting the need for timely assessment and intervention.

Risk Factors Related to Altered Perfusion

• Non-modifiable factors include:
  • Age: Increased risk with advancing years.
  • Genetics: Family history of conditions like Marfan syndrome can elevate risk.
  • Gender: Males face a higher risk.
  • Ethnicity: African Americans are noted to have higher incidences of vascular issues.
• Modifiable factors include:
  • Hypertension: Manageable through lifestyle changes and medication.
  • Smoking: Contributes to vasoconstriction and increased risk.
  • Diabetes and High Cholesterol: Modifiable through diet and exercise.
  • Obesity and Sedentary Lifestyle: Weight management is crucial for preventing vascular problems.
  • Chronic Stress and Alcohol Use: Addressing these can significantly improve perfusion health.

Prevention Strategies for Impaired Perfusion

• Primary prevention focuses on health education and promoting healthy blood pressure.
• Secondary prevention includes early diagnosis through methods like regular blood pressure analysis.
• Tertiary prevention aims to prevent complications such as strokes through lifestyle modifications, including diet, exercise, and smoking cessation.

Pharmacology for Management

• Medications for hypertension include:
  • Alpha Adrenergic Blockers (e.g., Atenolol, Metoprolol).
  • ACE Inhibitors (e.g., Lisinopril).
  • Angiotensin II Receptor Blockers (e.g., Losartan, Valsartan).
  • Calcium Channel Blockers (e.g., Diltiazem).
  • Diuretics (Loop, Potassium-sparing, Thiazide).
  • Vasodilators and Magnesium Sulfate are also relevant for managing severe cases.

Cardiac Output and Hemodynamics

• Cardiac output is defined as Heart Rate x Stroke Volume.
• Pre-load refers to the volume within the ventricles during relaxation; after-load reflects the resistance the heart must overcome to eject blood.
• Starlings Law indicates that increased ventricular stretch leads to an increase in stroke volume, emphasizing the importance of careful volume management in perfusion alteration scenarios.