Ch. 13 Hypertension
Prehypertension: higher than normal range but not high enough to be hypertensive
Normal BP: Less than 120/ less than 80
Prehypertension: 120-139/80-89
Stage 1 Hypertension: 140-159/ 90-99
Stage 2 Hypertension: 160 or higher/ 100 or higher
Hypertensive Crisis: greater than 180/ greater than 120
- Tx threshold for HTN in pt 60 or older w/o DM or CKD is BP greater than 150/90
- All pt w/ DM & or CKD should receive tx to keep BP below 140/90
Resistant Hypertension: pt whose conventional BP remains uncontrolled by 3 classes of
antihypertensive agents including diuretic
Pathophysiology
- BP is product of cardiac output (CO) multiplied by peripheral vascular resistance (PVR)
- CO is volume of blood being pumped by heart/min by stroke volume (SV), which is the
amount of blood pumped out from ventricles/beat
- PVR is related to diameter of blood vessel & viscosity of blood
- For HTN to develop there must be change in CO or PVR
- Management of HTN aims to decrease peripheral resistance or blood volume , or
strength, force, & rate of myocardial contraction
- BP is highest shortly after awakening & lowers throughout the day, reaches lowest point
between 2am-5am (dippers)
- Nondipper are at risk for CVD & kidney disease
Primary HTN: high BP from an unidentified cause (essential / idiopathic)
Secondary HTN: high BP w/ identified reason such as, narrowing of renal arteries/renal
artery stenosis, kidney disease, hyperaldosteronism, meds, pregnancy, coarctation of
aorta
White Coat HTN: normal ambulatory readings but elevated pressures in a medical office
Masked HTN: normal pressure in provider settings but elevated at home /work
Risk Factors
- Hereditary, obesity, sleep apnea, advancing age, renal changes, ethnicity/race, DM,
smoking type A personality, sedentary lifestyle, hypothyroidism, high sodium diet, low
potassium diet
- Contributing factors: increased sympathetic nervous system activity, increased renal
reabsorption of sodium, chloride, & water
- increased activity of renin-angiotensin-aldosterone system (expansion of extracellular
fluid volume & increased SVR/ dysfunction of vascular endothelium
- Insulin resistance, Type 2 DM, hypertriglyceridemia, obesity, glucose intolerance
- Increases w/ aging, systolic rises throughout life & diastolic rises until 50 yrs old
- Men younger than 55 more likely to have uncontrolled HTN & women after 65 are more
than likely to have uncontrolled HTN
- Black males, mexican-american males, and younger adults 20-39 uncontrolled HTN
Prehypertension: higher than normal range but not high enough to be hypertensive
Normal BP: Less than 120/ less than 80
Prehypertension: 120-139/80-89
Stage 1 Hypertension: 140-159/ 90-99
Stage 2 Hypertension: 160 or higher/ 100 or higher
Hypertensive Crisis: greater than 180/ greater than 120
- Tx threshold for HTN in pt 60 or older w/o DM or CKD is BP greater than 150/90
- All pt w/ DM & or CKD should receive tx to keep BP below 140/90
Resistant Hypertension: pt whose conventional BP remains uncontrolled by 3 classes of
antihypertensive agents including diuretic
Pathophysiology
- BP is product of cardiac output (CO) multiplied by peripheral vascular resistance (PVR)
- CO is volume of blood being pumped by heart/min by stroke volume (SV), which is the
amount of blood pumped out from ventricles/beat
- PVR is related to diameter of blood vessel & viscosity of blood
- For HTN to develop there must be change in CO or PVR
- Management of HTN aims to decrease peripheral resistance or blood volume , or
strength, force, & rate of myocardial contraction
- BP is highest shortly after awakening & lowers throughout the day, reaches lowest point
between 2am-5am (dippers)
- Nondipper are at risk for CVD & kidney disease
Primary HTN: high BP from an unidentified cause (essential / idiopathic)
Secondary HTN: high BP w/ identified reason such as, narrowing of renal arteries/renal
artery stenosis, kidney disease, hyperaldosteronism, meds, pregnancy, coarctation of
aorta
White Coat HTN: normal ambulatory readings but elevated pressures in a medical office
Masked HTN: normal pressure in provider settings but elevated at home /work
Risk Factors
- Hereditary, obesity, sleep apnea, advancing age, renal changes, ethnicity/race, DM,
smoking type A personality, sedentary lifestyle, hypothyroidism, high sodium diet, low
potassium diet
- Contributing factors: increased sympathetic nervous system activity, increased renal
reabsorption of sodium, chloride, & water
- increased activity of renin-angiotensin-aldosterone system (expansion of extracellular
fluid volume & increased SVR/ dysfunction of vascular endothelium
- Insulin resistance, Type 2 DM, hypertriglyceridemia, obesity, glucose intolerance
- Increases w/ aging, systolic rises throughout life & diastolic rises until 50 yrs old
- Men younger than 55 more likely to have uncontrolled HTN & women after 65 are more
than likely to have uncontrolled HTN
- Black males, mexican-american males, and younger adults 20-39 uncontrolled HTN
