Hypertension (HTN) PDF

HYPERTENSION(HTN) S. Raaymakers, DHsc, PA-C, RDCS Lecture Objectives Define hypertension Be familiar with hypertension incidence and prevalence Recognize the risk factors and probably risk factors for hypertension Differentiate between the different types of hypertension Recognize symptom...

HYPERTENSION(HTN) S. Raaymakers, DHsc, PA-C, RDCS Lecture Objectives Define hypertension Be familiar with hypertension incidence and prevalence Recognize the risk factors and probably risk factors for hypertension Differentiate between the different types of hypertension Recognize symptoms of hypertension State basic pathophysiology of hypertension Explain complications of hypertension Discuss treatment options 2  Blood Pressure Force of blood exerting against the walls of blood vessels Complication: Damage the vessel walls due to irritation of the inner layer 3 Blood Pressure Systolic Pressure Pressure in the artery during the ventricular contraction phase of the heart cycle. The pressure in the vessel during systole. Diastolic Pressure Pressure in the artery when the ventricles are relaxed. Pressure is at the lowest point Doesn' t go to zero.Don' t want the vessels to be collapsing 4 Blood Pressure Increases Physical exertion/stressful moments Age Decreased elasticity over time.Stiffness Make blood more viscose,Smoking creates Smoking oxidants and they come in the vessels resulting in scarring Alcohol Stimulates sympathetic nervous system Caffeine Constricts the vessels,causing the heart to pump harder 5 Hypertension Definition Elevated systolic pressure Contraction AND/OR 140 90 Elevated diastolic pressure Rest 6  Iontropic is squeeze Hypertension Consistently elevated BP 7  Overtime,it makes the vessel thicker Hypertension Complications Coronary artery disease (CAD) Heart failure Chronic kidney disease Stroke Intracerebral hemorrhage Transient ischemic attack (TIA) Thickening of the Peripheral artery disease (PAD) arteries in the arms and legs Aortic regurgitation Usually closed but will leakoutside of the valve Atrial flutter Atria is not contracting properly. Mild cognitive impairment (MCI) Not receiving adequate oxygen to the brain 8 Global Burden of Hypertension 2025 Projection 29.2% of world’s adults will have hypertension 1.56 billion adults 60% increase overall Developed nations—24% increase Developing nations—80% increase Highest prevalence in economically developing continents (e.g., Asia, Africa) 75% of hypertensive patients (Unger et al., 2020) 9  47% of adults Only about ¼ controlled HTN Hypertension Men>Women Incidence and Prevalence in Non-Hispanic black >non-Hispanic white, non-Hispanic Asian, or Hispanic US Onset age 20-50 years (prevalence increases w/age) (CDC, 2023) 10 (CDC, 2023) 11  Less access to healthcare 2019 Consensus More Retirees living there Hypertension Less access to gyms Data More gas stations,less grocery stores 12 Centers for Disease Control and Prevention. Interactive Atlas of Heart Disease and Stroke. http://nccd.cdc.gov/DHDSPAtlas. Accessed on June 13, 2023 Types of Hypertension PRIMARY (ESSENTIAL) Most Common High blood pressure that's not the result of a medical condition D/T environmental and genetic factors SECONDARY Abnormally elevated blood pressure due to a medical condition (e.g., kidney disease, adrenal gland disorders, thyroid disease) or use of certain medicines 13  Classifications 140/90 is what' s common in all Definitions vary by professional organization 14 (DynaMed, 2022)  2017 American Heart Association(AHA)/American College of Cardiology (ACC) Guidelines Category Systole Diastolic BP levels should be based on an average of 2-3 readings on at Normal 10 mm Hg in repeated measurements, use the arm with the higher BP. If the difference is >20 mm Hg consider further investigation Standing blood pressure If concerns of postural hypotension (esp. elderly and/or diabetes): Mx after 1 min standing & again after 3 min https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA 19.120.15026 BP Measurement Confirmation After initial screening and before treatment of elevated BP BP measurements obtained outside of a clinical setting Ambulatory blood pressure monitoring [ABPM] & home BP monitoring Use 24 hour-ABPM if diagnostic uncertainty or suspected blood pressure variability 20 Masked Hypertension Elevated BP at home/ambulatory BP monitoring but normal office BP White Coat Hypertension Normal BP at home/ambulatory BP monitoring but elevated office blood BP 21  Pancreatitis and alcohol will bring up the triglycerides Additional Testing Blood tests (sodium, potassium, creatinine, fasting blood glucose [FBG], fasting lipid profile) High sodium (>2 g/day); higher intake = higher BP Low dietary potassium intake (below 40 mEq/day [1.5 g/day]) associated w/elevation in BP and increased risk of stroke Higher systolic and diastolic blood pressures associated w/higher serum creatinine levels (indicator of chronic renal disease) Higher fasting blood glucose(FBG) levels at baseline = independent risk marker for new development of HTN Advanced glycation end products, inflammation, oxidative stress, & vascular dysfunction even in nondiabetic individuals Cardiovascular dz associated w/HTN & increased blood levels of low-density lipoprotein (LDL), total cholesterol (TC), and triglycerides (TG) 22 Additional Testing cont. Dipstick urine test Assess for proteinuria (mostly albumin) Electrocardiogram (ECG) Detection of atrial fibrillation, left Elevates ventricular hypertrophy (LVH), QRS complexes ischemic heart disease More tissue to perfuse with narrow vessels 23 Other Tests to Consider Hemoglobin/hematocrit Hemoglobin carries oxygen Serum uric acid: May be d/t decrease in renal blood flow that accompanies the hypertensive state Echocardiogram if Hx, PE, or an ECG suggests LVH/other structural heart disease Right ventricle is pushing the blood to the pulmonary while the left ventricle pushes it to the rest of the body Fundoscopy: Retinal changes, hemorrhages, papilledema, tortuosity, AV-nicking Carotid ultrasound: Plaques (atherosclerosis), stenosis Targeted testing for suspected causes of secondary hypertension Drug such as cocaine 24 Blood Pressure Targets Depends on the organization As age increases,BP targets increases due to high fall risk 25 Cardiovascular Risk Factors >50% of hypertensive patients have additional cardiovascular risk factors MC CV additional risk factors Diabetes Lipid disorders (elevated low-density lipoprotein-cholesterol [LDL-C] and triglycerides) Hypothyroid ism Overweight-obesity Hyperuricemia Metabolic syndrome (group of conditions that together raise risk of coronary heart disease, diabetes, stroke, and other serious health problems). AKA insulin resistance syndrome) Unhealthy lifestyle habits (e.g., smoking, high alcohol intake, sedentary lifestyle) ASCVD (Atherosclerotic Cardiovascular Disease) 10 year Risk: https://tools.acc.org/ascvd-risk- estimator-plus/#!/calculate/estimate/ Provide up to date resources 26  BP Thresholds and Recommendations for Treatment & Follow Up BP Thresholds and Recommendations for Treatment and Follow-up Normal BP Elevated BP Stage 1 Hypertension (BP