Hypertension

Hypertension

1. define as a systolic bp of 140 mmHg or ↑ and diastolic bp of 90 mmHg or ↑

2. Primary Hypertension: aka "essential"; affects 95% of pts; unidentifiable cause

3. Secondary Hypertension: affects 5% of pts; renal disease; sleep apnea; pregnancy related

4. Prevalent in African American community

5. Usually no symptoms however symptoms related to organ damage are seen late and are serious i.e → retinal/eye damage; renal damage; MI; cardiac hypertrophy; stroke

6. Patient Assessment

   • History and Physical Exam: retinal exam
   • Lab Tests: urinalysis; blood chemistry
   • ECG

7. Management

   • HTN can never be cured but can be maintained
   • maintain bp: <140/90; <150/90 (older adult); Lifestyle Modifications: weight reduction; DASH diet; decrease sodium intake; regular physical activity; reduced alcohol consump.
   • Stage I HTN: usually given thiazides for treatment
   • Pharmacologic therapy: ↓ peripheral resistance & blood volume; ↓ strength and rate of myocar. contraction; Meds= diuretics; beta blockers; alpha1 blockers, ace inhibs., vasodilators, calcium channel blockers,
     • Diuretic: decreases serum sodium levels and BV
     • ACE Inhibs: blocks conversion of angiotensis I to II; blocks effects of angiotensin on blood vessels
     • Beta-Blockers: decrease HR and contraction strength and vasodilates
     • Calcium Channel Blockers: relaxes muscle contraction or other autonomic blockers
     • Vasodilators: acts on vascular smooth muscle causing muscle relaxation, leads to vasodilation and ↓ BP

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