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Hypertension (Risk Factors (Age, family history, race, stress, obesity,…
Hypertension
Risk Factors
Age, family history, race, stress, obesity, high sodium/fat diet, smoking,
excessive ETOH consumption, reduced nephron number, sedentary lifestyle
Environmental:
Indoor/outdoor allergens
Occupational sensitizers
Passive smoking
Respiratory infections
Types of Asthma
Atopic
Non-atopic
Drug induced
Occupational
Exercise induced
Epidemiology
31% of adults in the US have hypertension (HTN)
African Americans have the highest prevalence-37%
90%-95% of US pop. Has primary hypertension or high blood
Pressure of unidentified cause.
5%-10% of this grp has secondary HTN
HTN is termed the “silent killer: because 24% with pressures
140/90 mmHg were unaware.
Pathophysiology
Pathophysiology of Hypertension: The pathophysiology is poorly understood but is most like the result of numerous genetic and environmental factors that have multiple compounding effect on cardiovascular and renal structures and functions. Maintenance of arterial blood pressure is needed for organ perfusion. The primary factors determining the blood pressure are the sympathetic nervous system, the renin-angiotensin-aldosterone system, and the plasma volume, mediated by the kidneys (mayoclinic.com).
Presentation
Clinical signs/symptoms: HTN is called the silent killer because it doesn’t usually produce symptoms until vascular changes brain, heart or kidneys have occurred. The location of vessel damage determines the symptoms. For example, TIA/stroke in the brain, MI in the heart, proteinuria and edema in the kidneys.
Diagnosis
Ambulatory blood pressure monitoring is the “gold standard” and is confirmed if mean daytime blood pressure is ≥130/≥80
Home blood pressure monitoring mean is ≥130/≥80
Three serial in office-based readings of ≥130/≥80
Testing: Electrolytes (include Ca+) and creatinine, Fasting glucose, U/A (include albumin: creatinine), CBC, TSH, Lipid, EKG
Treatment
SABA: albuterol, levalbuterol: Inhaled corticosteroids: QVAR Pulimcort, Flovent
LABA:
Foradil,Serevent,Brovana
Combo: Advair
Dulea
Symbicort
Leukotrienes:
Accolate, Singular