Hypertension Quiz

High blood pressure occurs when systolic BP is at or greater than 140 mm Hg or diastolic BP is at or greater than 90 mm Hg for two or more assessments.
For individuals over 60 years of age, BP should be equal to or less than 150/90 mm Hg.
Essential hypertension (primary hypertension) is the most common type and has no known cause.
Secondary hypertension is caused by a disease or medication.
Pre-hypertension is a systolic blood pressure of 120 to 139 mmHg or a diastolic blood pressure of 80-89 mm Hg.
Prolonged, untreated, or poorly controlled hypertension can lead to peripheral vascular disease primarily affecting the heart, brain, eyes, and kidneys.
Increased risk with increased blood pressure.
Left ventricular hypertrophy: the heart pumps against the resistance caused by hypertension.
Health promotion and disease prevention: maintain a BMI less than 30, monitor and control blood glucose in patients with DM, limit caffeine and alcohol intake, manage stress, stop smoking, engage in exercise, and limit sodium and fat intake.

Arterial baroreceptors are located in the carotid sinus, aorta and left ventricle.
They are stretch receptors sensitive to pressure changes in the arterial walls.
Baroreceptors control blood pressure by altering heart rate and stimulating vasoconstriction and vasodilation.
Kidney function regulates body-fluid volume by retaining fluid when hypotensive and excreting fluid when hypertensive.
The renin-angiotensin-aldosterone system controls sodium and water balance by releasing renin, which converts into angiotensin II, causing vasoconstriction and stimulating aldosterone release.
Vascular autoregulation maintains blood flow relatively consistent in response to dynamic perfusion pressure changes.

Essential Hypertension: positive family history, excessive sodium intake, physical inactivity, obesity, high alcohol consumption, being African American, smoking, hyperlipidemia, stress, age greater than 60 or postmenopausal.
Secondary Hypertension: kidney disease, Cushing’s disease, primary aldosteronism, pheochromocytoma, brain tumors, encephalitis, medications, and pregnancy.

Obtain blood pressure readings in both arms when elevated.
Elevated: Systolic 120-129 mm Hg and Diastolic less than 80.
Stage 1 HTN: Systolic 130-139 mm Hg or diastolic 80 to 89 mm Hg.
Stage 2 HTN: Systolic greater than or equal to 140 mm Hg or diastolic greater than or equal to 90 mm Hg.

Lab tests are not used to diagnose hypertension.
Lab tests can identify the cause of secondary hypertension and target organ damage.
Elevated BUN/Creatinine levels can indicate kidney disease.
Elevated blood corticoids can indicate Cushing's disease.
Blood glucose and cholesterol levels are contributing factors related to blood vessel changes.

Thiazide diuretics (hydrochlorothiazide): inhibit water and sodium reabsorption, increase potassium excretion.
Loop diuretics (furosemide): monitor potassium levels every 2 weeks for the first few months and every 2 months thereafter.
Avoid potassium supplements or potassium-sparing diuretics.

Beta blockers (metoprolol, atenonol) block the sympathetic nervous system (beta adrenergic receptors), producing a slower heart rate and lower blood pressure.
Can cause fatigue, weakness, depression, and sexual dysfunction.
Do not suddenly stop: rebound hypertension.
Reduce some manifestations of hypoglycemia, such as tachycardia.

Central-alpha 2 agonists (clonidine) reduce peripheral vascular resistance and decrease blood pressure by inhibiting the reuptake of norepinephrine.
Educate patients on adverse effects: sedation, orthostatic hypotension, and impotence.

Alpha-adrenergic antagonists (prazosin, doxazosin) reduce blood pressure by causing vasodilation.
Start low and go slow.

Monitor for electrolyte imbalances.
Adhere to medication regimen.
Know the adverse effects of medications.
Monitor blood pressure at home.
Be aware of orthostatic hypotension.
Make lifestyle changes, including reducing sodium intake, following a diet low in fat, saturated fat, and cholesterol, limiting alcohol consumption, using the Dietary Approaches to Stop Hypertension (DASH) diet, reducing and maintaining weight, exercising at least three times per week, and managing stress.

Manifestations include severe headache, extremely high blood pressure (systolic > 180 mm Hg, diastolic > 120 mm Hg), blurred vision, dizziness, disorientation, and epistaxis.
Administer IV antihypertensive therapies (nitroprusside, nicardipine, labetalol).
Goal: lower blood pressure by 20-25% in the first hour but not to drop below 140/90 mm Hg.
Slow and steady approach: lowering blood pressure too abruptly can lead to inadequate cerebral, renal, and coronary blood flow.
Monitor blood pressure before, during, and after IV antihypertensive administration, every 5 min.
Assess neurologic status (pupils, level of consciousness, muscle strength) for cerebrovascular complications.

Life-threatening complication of uncontrolled hypertension.
Characterized by impaired cerebral perfusion, leading to cerebral edema, seizures, altered consciousness, and coma.
Early recognition and treatment are crucial, as it can lead to irreversible brain damage.