HYPERTENSION
Consistent elevatations of systemic arterial BP, It is progressive cardivascular syndrome with many cause that result in both function and structural changes in the heart and vascular system.
PRIMARY- AKA essential hypertension 90% of those with high blood pressure estential hypertension cause unknown but we do have many risk factors.
SECONDARY- Reultes in underlying disease or secondary complication of other primary disease, EX: Renal disease, Cardiovascular in orgin, Nerologi in orgin ICP, Sleep apnea.
How to diagnoses hypertension:- 2 blood pressure at 2 seperate visits greater than 140 systolic, greater than 90 diastolic, make sure patient has not smoked or have caffeeine within 30 mins of taking BP.
Classification
Normal BP 120/80
Prehypertension 130-139 (systolic) 80-89 (diastolic).
KNOW THESE: Stage 1 hypertension 140-150 (systolic), 80-89 (diastolic).
Stage 2 hypertension greater than 160 (systolic), greater than 100 (diastolic).
Arterial Pressure
Cardiac output the amount of blood leaving the (left ventricle) amount ejected from the heart.
(Each minute)
CO=SVxHR
PATHOPHYSIOLOGY
Baroreceptors-Found in arch of the aorta, the wall of the left ventricle, and the carotid sinus. Carotid sinus is at the bifurcation of the external and internal carotids. Monitor BO when BP becomes to high the body will try to decrease the pressure by vagal stimulation. This mean heart rate decreases, vasidulation which will decrease BP. Hyperstension this system dosen't respond.
KNOW RAAS
Regulation of Fluid- Excess sodium causes us to retain more water, increasing blood volume, Increasing blood pressure. Normally, we can get rid of extra fluids on our own, we will need to use diurectics to get the excess fluid outnow.
How does high BP happen: all these system fail!
Silent disease
GOAL- Prevent end organ target damage.
SYMPTOMS: of more advanced hypertension- Headaches, Nose bleed, Visual changes.
NON-Modifiable- Family hx, Ethincity, Age, Diseease diabetes, renal disease, hyperlipedemia.
Modifiable: Smoking, Inactivity,Inactivity, Obesity, Hyperlipedemia,ETOH, Diet choice (sodium intake 1500ml), Hypertension.
Asses
History: who?, Smoke what? How Long?, Alcohol intake how much? What they drin? How long have they been drinking?,Diseases diabetes cholesterol levels, Current weight gain or loss, Exercise do they exercise.
End target organ disease complete assessment.
Physical Assessment: Check BP both arms, limit cafffine and smoking. Need to be seen 2 consective days, Check for JVD, List for bruits, listen to heart rate and rhythm, Peripheral pulses, Skin assessment, White coat syndrome BP goes up because they see health care providers.
Diagnostics:- Look at EKG arrythmias or dysrhymias, UA looking for kidney disease (proteinuria albimin in urine), Chest
X-ray looking for cardiac enlargment, ventricular hypertrophy, Chem panel checking electrolytes, BUN and creatinine levels, Lipdi panel, TSH thyroid stimulation hormone checking the function of the thyroid gland because has been a connection between hyperthyriodism and hypertension.