HTN, COPD, CHF, PVD
Hypertension: The Silent Killer
A. Can hide for years
B. Quietly ravaging vital body organs
C. Assaults fragile tissues in eyes, brain, kidneys, and heart
D. Hardens arteries and arterioles
E. Enlarges and weakens the heart
F. Leads to CHF, PVD (peripheral vascular disease)
G. Primary cause of MIs and CVAs
H. Readily treatable once detected
I. Screening= important to test everyone for high blood pressure regardless of symptoms!!!
I. What Causes Heart Disease?
1 Heart disease leading cause of death in US
2 3 Major Contributors to Heart Disease:
3 hypertension (HTN)
4 hyperlipidemia
5 smoking
II. Definition
6 Amount of force of blood against the walls of the arteries as it is pumped through them-very important to be comfortable with this definition for teaching patient purposes.
7 Systolic=force of heart’s contraction as it pumps blood out of L ventricle.
8 HTN is persistent elevation of systolic pressure > 140 mmHg.
9 Among older adults, systolic bp readings are a better predictor of possible future events.
10 Diastolic=resting tone of the arteries.
11 HTN is persistent elevation of diastolic pressure > 90 mmHg.
12 Increased diastolic = overworking of the heart.
3. Worry about increased diastolic pressure b/c the heart should be resting!
13 Normal= less than 140/90
III. Incidence of Hypertension (which is polygenic and multifactorial)
14 50 million Americans age 6 and over r/t obesity and lack of exercise.
15 1/3 of the people with HTN do not know they have the disease
16 Of those people that are aware they have HTN, 70-75% not controlled with very high bp.
17 Primary/essential HTN= there is no single cause (95%); multitude of causes. Idiopathic-lifestyle, genetics, etc.
18 Secondary HTN: physical cause that can be treated or cured, adrenal gland tumors, kidney disorders, drugs (5%). Tumors can cause high bp, but once they are removed, that should cure the high bp. Meds such as birth control pills, alcohol, coaine can also cause high bp.
19 White coat HTN: elevated only at doctor’s office.
20 Malignant = diastolic >110, very serious, medical emergency-can lead to stroke or death.
IV. Major Risk Factors
21 Non-Modifiable
22 Family history
23 Age-older = increased incidence
24 Gender-Initially, M>W, then after menopause, W=M
25 Ethnicity – African American Women die the most from HTN.
26 Modifiable
27 Stress – emotional or physical
28 Obesity – upper body obesity/apple shaped is greater threat.
29 Nutrients – increased sodium and fat.
30 Substance abuse – alcohol intake, amphetamines, illicit drug use, and caffeine.
V. Symptoms – important to take thorough history: E.g. stress, family history, diet, exercise, habits, height, weight, proportions, blood pressure, etc. To take bp, patient should ideally wait 30 minutes before checking bp in Dr.’s office. Use correct cuff size and take b.p. on a bare arm. If elevated or abnormal, take it on both arms. Check pedal pulses, breath sounds, eyes with fundiscope for microhemorrhages, neck for bruits and distended veins. Check lab values on CBC, BUN, Creat, electrolytes, HDL, cholesterol and a 12 lead EKG!
32 Headache, sometimes with N&V
33 Drowsiness, confusion, fatigue
34 Blurred vision-target organs= brain, eyes, kidneys b/c of very tiny blood vessels & increased pressure can cause microvasculature problems.
35 Nocturia-due to kidney changes
36 Dependent edema-e.g. PVD in lower legs and dependent edema
37 Epistaxis-nose bleeds
38 ***Mainly, no symptoms!
VI. Assessment: Ideally bp should be taken 30 minutes after sitting with the right cuff on a bare arm. If elevated, take on both arms. Check for bruits in neck. Look at back of eye for micro-hemorrhages.
VII. Blood Pressure Stage: either systolic or diastolic elevations will bring diagnosis.
39 High-normal: 130-139/85-89
40 Stage 1: 140-159/90-99
41 Stages 2 and 3: >160/>100
VIII. Lifestyle Modification – can teach at anytime. Teach this if patient is at risk, or at high normal. These are the 1st recommendations!
42 Stop smoking
43 Reduce stress
44 Reduce alcohol intake: normal for men – two servings, women – one serving. Red wine dilates vessels and small anticoagulant.
45 Weight reduction-w/in BMI
46 Exercise – 3-4 times/wk for 30-45 mins.
47 Sodium restriction – American normal (5-15 g); should be 2-4 g.
48 Dietary fat modification – 20-30% or 25-35% of total Kcal.
49 Caffeine restriction
50 Potassium supplementation - diet change with reduced sodium and increased K, Mg, and Ca.
IX. DASH Food Plan (p. 1388): Dietary Approaches to Stop Hypertension
51 low fat, high in fruits and vegetables
52 lowfat or nonfat dairy products-e.g yogurt
53 rich in magnesium (potatoes), potassium (cantaloupe), calcium (dark green leafy), protein, and fiber
54 low in sodium
55 2000 calories/day
X. Drug Therapy – all do something a little different
56 Diuretics: may decrease electrolytes and increase glucose levels.; decrease blood volume, thereby decrease blood pressure. Fluid/urine output increases, so take in a.m., so they can reduce the risk of nocturia.
57 Thiazide:
58 Loop: Monitor K levels with Potassium depleting diuretics.
59 Potassium-sparing
60 Selective Beta Blocker-dilate blood vessels and decrease heart rate. Improve contractility. Before giving, check apical pulse. Do not give if hr is ................
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