Hypertension
Epidemiology
Clinical Presentation
Diagnosis and Treatment
Pathophysiology
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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.
Risk Factors
Excessive ETOH consumption, reduced nephron number, sedentary lifestyle
Age, family history, race, stress, obesity, high sodium/fat diet, smoking
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.
Home blood pressure monitoring mean is ≥130/≥80
Three serial in office-based readings of ≥130/≥80
Ambulatory blood pressure monitoring is the “gold standard” and is confirmed if mean daytime blood pressure is ≥130/≥80
Testing: Electrolytes (include Ca+) and creatinine, Fasting glucose, U/A (include albumin: creatinine), CBC, TSH, Lipid, EKG
Treatment
Lifestyle modification e.g low sodium/fat diet. DASH diet, exercise, smoking cessation, limiting ETOH use.
thiazide diuretics- ↓cardiac output, renal blood flow and blood volume
Ca+ channel and beta blockers- ↓heart rate and blood pressure
ACE- lowers peripheral resistance and conversion of angiotensin I to angiotensin II
ARB- inhibit binding of aldosterone(AHA.org).
Cardiovascular
Coronary Artery Disease- uncontrolled HTN can damage the heart. Coronary artery disease impact the arteries that supplies blood t the heat. Arterial stenosis from plaque buildup and hardening, decreases blood flow leading to chest pain, heart attack or arrhythmias.
HTN increases cardiac workload leading to left ventricular hypertrophy; limiting the ventricle’s ability to pump blood throughout the body thus increasing risk of heart attack, heart failure and sudden cardiac death.
HTN increases strain on the heart causing it to weaken and become inefficient. Overtime, the heart simply gives out and fails. Heart attacks increase the potential for heart failure.
Nervous System
HTN can contribute to atherosclerosis and clot formation both of which can temporarily disrupt blood flow to the brain causing a transient ischemic attack (TIA). TIAs are often foretellers of a stroke.
Stroke happen when the brain is deprived of nutrients and oxygen leading to cell death. Uncontrolled HTN lead to stroke by weakening and damaging the blood vessels of the brain
HTN can cause vascular dementia resulting from narrowing and arterial blockage in the brain’s blood supply leading to stroke.
HTN can cause cognitive impairment. Like in dementia, HTN blocs blood flow to the brain causing arterial damage