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Clinical Overview of Hypertension

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Define hypertension
Blood pressure > or = 140/90 mmHg
Blood pressure measurement
Sphygomomanometer. Inflate blood pressure cuff until it occludes arterial blood flow. Korotokoff sounds 1-5 w/ reoccurrence of blood flow. K1 = first sound heard = systolic blood pressure K5 = disappearance of sounds = diastolic BP
Korotokoff sound 1
Systolic blood pressure First sound you hear when deflating blood pressure cuff
Korotokoff sound 5
Diastolic blood pressure Disappearance of sounds
Elements of the proper technique for measuring blood pressure
1. Patient should be sitting with arm elevated at heart level 2. Pressure cuff should be put directly on skin, not over clothes. 3. Patient should be relaxed/resting for 3-5 minutes prior to measurement. 4. Properly-sized cuff should be used. Too small of a cuff will lead to falsely high blood pressure reading.
If the blood pressure cuff is too small, the BP reading will be falsely high/low.
High
Biggest risk factor for death in the U.S.
High blood pressure
What are the 5 principle organs damaged from hypertension?
Brain, heart, kidneys, vasculature, eye.
Hypertension damage to brain
Stroke, hemorrhage
Hypertension damage to heart
Left ventricular hypertrophy, congestive heart failure, coronary heart disease
Hypertension damage to the kidneys
Renal failure
Hypertension damage to the vasculature
Peripheral vascular disease
Hypertension damage to the eyes
Retinopathy
Hypertension is a significant risk factor for what 7 diseases?
1. Cerebrovascular disease 2. Peripheral vascular disease 3. Coronary heart disease 4. Renal failure 5. Dementia 6. Congestive heart failure 7. Atrial fibrillation
Old classification of blood pressure: what values were assigned to high-normal?
130-139/80-89 mmHg
How does a high-normal blood pressure affect the risk for cardiovascular disease?
It increases the risk for CV disease. This is why they re-classified \"high-normal\" as \"pre-hypertensive,\" because they found that BP in the range of 130-139 systolic and 80-89 diastolic had a significantly greater risk for developing CV disease than those in the \"normal\" category of blood pressures less than 120/80 mmHg.
Aging and blood pressure
As people age, their systolic BP tends to increase and their diastolic BP tends to decrease.
Systolic BP tends to increase/decrease with age.
Increase
Diastolic BP increases/decreases with age.
Decreases
Why does BP tend to increase with age?
As we age, elastic tissue in arteries is replaced with collagen, which makes the arteries stiffer. Stiffer arteries means increased resistance, which also leads to increased blood pressure. (Recall: BP = CO X TPR)
For people less than 50 years of age, systolic BP tends to be high/low and diastolic BP tends to be high/low.
Low, high.
For people over 50 years of age, systolic BP tends to be high/low and diastolic BP tends to be high/low.
High, low.
*ON TEST* Blood pressure classification (Slide 20)
Normal = <120 mmHg systolic, <80 mmHg diastolic Prehypertension = 120-139 mmHg systolic, 80-89 mmHg diastolic. Stage 1 hypertension = 140-159 mmHg systolic, 90-99 mmHg diastolic. Stage 2 hypertension = > or = 160 mmHg systolic, > or = 100 mmHg diastolic.
If a person\'s systolic and diastolic BP fall into two different categories, which should they be classified in (and thus receive associated treatment)?
The higher category. Ex: if a person had systolic BP of 135 but diastolic BP of 80, that person should be considered pre-hypertensive.
Out of the 65 million Americans with hypertension, what percentage are controlled, and what percentage are uncontrolled?
71% uncontrolled, 29% controlled
The numbers for the percentage of people who are aware that they have hypertension, are treated, and are controlled are increasing/decreasing.
Increasing. However, the numbers of controlled are still low.
How does the U.S. compare in controlling hypertension with other countries?
The U.S. actually has a greater percentage of controlled patients, but this is still not a good number.
Explain what happens to diastolic pressure as we age
It increases until age 50, then it starts to decrease
What kind of hypertension (systolic or diastolic) is most common in young individuals?
Isolated diastolic hypertension
What type of hypertension (systolic or diastolic) is most common in older individuals?
Isolated systolic hypertension
Why does the elasticity of the aorta matter in determining blood pressure?
When the aorta is more compliant (i.e. more elastic tissue, younger), it can absorb some of the pressure given off during contraction (systole), so that systolic pressure doesn\'t increase as much. When it\'s less compliant, it can\'t absorb this energy, and provides additional resistance against contraction, forcing an increase in systolic pressure to occur.
In young people, what type of hypertension is more important?
Diastolic
In older people, what type of hypertension is more important?
Systolic
T/F. Hypertension is harder to treat in African Americans.
True
T/F. Only those who eat salty foods develop hypertension.
FALSE. Everyone develops hypertension if they live long enough, because of the process of collagen deposition in the vasculature during aging.
White Coat Hypertension
High office blood pressure (>140/90 mmHg) but normal daytime ambulatory blood pressure (<135/85 mmHg) Thought to be a conditioned response and should be suspected when out-of-office BP readings are consistently lower than those obtained in clinic.
How prevalent is white coat hypertension?
20% of patients
Is there a relationship b/t white coat hypertension and true hypertension?
Yes. Eventually, the risk for CV disease with white coat hypertension becomes the same as for those with true hypertension.
Risk/contributing factors in the development of HTN
Older age Black race, female gender Overweight/obesity Physical inactivity High dietary salt ingestion Family history Lower socioeconomic status Diabetes Chronic kidney disease Sleep apnea
Hypertension summary
1. Most common disease in the U.S. (>65 million people) 2. Lifetime risk of developing HTN is greater than 90% 3. 70% of subjects with hypertension were not untreated or under-treated 4. Hypertension is a major risk factor for cardiovascular disease) 5. Risk largely reduced w/ effective treatment

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