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Hypertension Concept Map
18
HYPERTENSION
Taylor Macdonald
- Systolic BP >140
- Diastolic BP >90
- Cardiac Output & SVR
- RAAS
- Diet and Meds
- SNS
- Comorbidities
- Lifestyle Changes
- Medication
- Often asymptomatic
- Can be difficult to diagnose
- Widespread Vessel Damage
- Age, Race, Gender
- Metabolic Syndrome
- Unhealthy Lifestyle
Pathophysiology:
Pathophysiology
Primary HTN accounts for 95% of all HTN diagnoses. There are common risk factors that put a patient at an increased risk for developing HTN but they don't necessarily cause it.
Secondary HTN is much less common and accounts for the other 5% of cases. Meds and/or other diagnoses are directly responsible for secondary HTN.
Malignant HTN is also rare and is generally associated with acute or rapidly progressive organ dysfunction.
Increased Cardiac Output &
Peripheral Vascular Resistance
CO & PVR
Increased CO: Often results from volume and sodium retention by the kidney, leading to increased stroke volume. Increased cardiac output can also occur with cardiac stimulation by the sympathetic nervous system.
Peripheral/systemic vascular resistance: remodeling, vasoconstriction, and decreased elasticity of the vessels occur when hypertension is sustained. In this situation, cardiac output is generally normal or slightly reduced, and circulating blood volume is normal. Vessel changes can occur with:
- Diabetes
- Smoking/Tobacco Use
- Kidney Disease
- Chronic Hypoxia including OSA
RAAS
Renin is released with decreased renal perfusion, low salt intake, and in response to the stimulation of the SNS. Aldosterone release encourages water and salt retention to increase blood volume.
Lifestyle & Medication
Diet & Meds
Dietary choices such as excess salt, fat, and sugar in the diet can cause obesity and an increased risk for HTN. Having more than two alcoholic drinks per day can cause hypertension by activating the adrenergic nervous system and causing vasoconstriction and tachycardia.
Medications including amphetamines, decongestants, and even birth control can cause HTN through vasoconstriction and tachycardia.
Sympathetic Nervous System
Activation of the sypathetic nervous system can acutely raise blood pressure, but can also turn into chronic HTN if not managed.
One of the most common causes of SNS activation is stress. Stress causes an increase in catecholamine (epi and norepi) and cortisol which leads to increased vascular tone and increased cardiac output.
SNS
Comorbidities
Secondary HTN is directly caused by disease including:
- Kidney disease and renal artery stenosis
- Adrenal cortical disorders and tumors
- Coarctation of the aorta
- Oral contraception
- Hyperthyroidism
Comorbidities
Signs & Symptoms
Signs
&
Symptoms
*HTN is often asymptomatic*
Associated Findings
Associated Findings
Hypertension is often associated with many risk factors including:
- Obesity
- Poor Diet
- Physical Inactivity
- Genetics
- Age
- Metabolic Syndrome
Diagnosis and Evaluation
Per AHA
Diagnosis & Evaluation
- Determine if hypertension is primary or secondary
by ruling out causes of secondary HTN.
- HTN should never be diagnosed by a single blood pressure reading in the clinic. If you suspect "white coat HTN", send in an order for an at home blood pressure cuff and have the patient report readings after 1--2 weeks.
How to take an accurate blood pressure
BP Reading
Treatment of HTN
Treatment
Lifestyle Modifications
Lifestyle Modifications
Diet:
- Reduce salt intake (<2.3 grams daily)
- DASH Diet- whole grains, fruits, veggies, low-fat dairy, lean meats
- Limit alcohol and caffeine
Physical Activity:
- 150 minutes of exercise weekly
Smoking Cessation:
- Avoid all tobacco products
Stress Reduction:
- Meditation & yoga
- Acupuncture
- Psychotherapy
- SELF CARE!
Medications
Angiotensin-converting enzyme (ACE) Inhibitors:
- Lisinopril, Benazepril, Captopril
Calcium channel blockers:
- Amlodipine, Nifedipine, Verapamil
Angiotensin II receptor blockers (ARBs):
- Losartan, Valsartan
Diuretics:
- Hydrochlorothiazide, Spironolactone
Beta Blockers:
- Atenolol, Metoprolol, Propranolol, Carvedilol
Medications
Complications and Long-Term Effects
Widespread vessel damage that can lead to: