Questions and Answers
What percentage of U.S. adults had hypertension in 2018?
What does hypertension mean?
High blood pressure
What does systolic blood pressure (SBP) measure?
Pressure in the arterial wall during cardiac contraction
What is the equation for mean arterial pressure (MAP)?
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Which of the following is a characteristic of primary hypertension?
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What is the recommended limit for alcohol consumption for women?
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What is considered elevated blood pressure during a clinical encounter?
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White coat hypertension occurs when office blood pressure is normal and out-of-office blood pressure is elevated.
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What percentage reduction in stroke incidence can be achieved by lowering blood pressure?
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The average blood pressure threshold for general clinical conditions is _____ mm Hg.
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What is the definition of orthostatic hypotension?
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What lifestyle modification is recommended for managing hypertension?
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Study Notes
Hypertension Overview
- Hypertension is a significant risk factor for cardiovascular disease (CVD), leading to high mortality and disability rates.
- In 2010, high blood pressure was the leading cause of death and disability globally.
- Hypertension accounts for 34% of incident end-stage renal disease (ESRD) cases in the U.S., second only to diabetes.
Epidemiology
- As of 2018, 34% of U.S. adults had hypertension; estimates rose to 46% following new BP threshold guidelines in 2017.
- Prevalence varies by age:
- Ages 20-44: 30% men, 19% women
- Ages 65-74: 77% men, 75% women
- Ethnic and sex disparities exist:
- Black: 59% men, 56% women
- White: 47% men, 41% women
- Asian: 45% men, 36% women
- Hispanic: 44% men, 42% women
Blood Pressure Definitions
- Systolic Blood Pressure (SBP): Pressure during cardiac contraction (measured in mmHg).
- Diastolic Blood Pressure (DBP): Pressure during ventricular filling (measured in mmHg).
- Pulse Pressure: Difference between SBP and DBP, indicating arterial stiffness; high values correlate with increased cardiovascular risk.
- Mean Arterial Pressure (MAP): Average arterial pressure during a cardiac cycle; calculated as MAP = 1/3(SBP) + 2/3(DBP).
Hypertension Etiology
- Primary Hypertension: Unknown cause, influenced by genetic and environmental factors such as diet, activity level, and obesity.
- Secondary Hypertension: Known causes, requiring identification and management of underlying conditions.
Target Organ Damage
- Hypertension can cause damage to the brain (stroke), eyes (retinopathy), heart (hypertrophy, heart failure), kidneys (chronic disease), and peripheral arteries.
Diagnosis
- Confirm hypertension with an average of two BP measurements taken across multiple clinical encounters.
- Measure BP in both arms, using the higher reading for future assessments.
- White Coat Hypertension: High readings in clinical settings but normal at home.
- Masked Hypertension: Normal readings in office but elevated externally.
Blood Pressure Monitoring
- Home Blood Pressure Monitoring (HBPM) enhances BP control and diagnosis.
- Ambulatory Blood Pressure Monitoring (ABPM) tracks BP over 24 hours to assess variations and treatment efficacy.
Blood Pressure Measurement Protocol
- Ensure patient readiness (rested, bladder emptied) before measuring.
- Take multiple readings and average them for accuracy.
Benefits of Lowering Blood Pressure
- Reduces risk of stroke incidence by 35-40%, myocardial infarction by 20-25%, and heart failure by 50%.
- Each increase of 20/10 mmHg doubles CVD risk starting from 115/75 mmHg.
Goals of Therapy
- General BP goal for patients with CVD or 10-year ASCVD risk ≥10% is <130/80 mmHg.
Lifestyle Modifications
- Effective management includes dietary changes, physical activity, and reduced alcohol intake.
- Limit alcohol to ≤1 drink daily for women and ≤2 for men.
Patient Evaluation Objectives
- Evaluate lifestyle and CV risk factors to guide treatment.
- Identify potential causes of hypertension.
- Assess for target organ damage and presence of CVD.
Treatment Considerations
- Design antihypertensive regimens for patients with specific indications.
- Tailor treatment approaches for elderly and pregnant patients.
- Monitor for orthostatic hypotension and provide management strategies.
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Description
This study guide covers key concepts related to hypertension, including definitions of blood pressure metrics, factors contributing to hypertension, treatment benefits, and specific blood pressure goals. Ideal for pharmacy students and healthcare professionals, it provides a foundational understanding necessary for effective cardiovascular pharmacotherapy.
