Summary HYPERTENSION AND HIGH CHOLESTROL FULLY SUMMARIZED NOTES

HYPERTENSI
ON

bybl
ackdol
lar
4

 Hype
rte
ns i
on :140/ 90>o rcurrentu s eo f
a n ti
hyp ertensives
o Di rectrelation shipbetwe enHTNa n dCVD
o Av erag eo ftwoo rmo rep rope rl
yme asure dBPr eadingso ntwo or
 mo reo ff
icev i
sits
 T akea tleaston emi nutea p artonb otharms
 F e etf l
ato nfl
oor
 Pl acep t.arma th ea r
tl evel res t
ingo na su rf
ace
o Si l
en tkiller:asBPi ncreas ess owi l
l r
iskf orMI ,h ear
tf ai
lure,s
troke,renaldi
seaseà
pt.willHTNt r
iest okeepBPu n der 140/90
o Af ri
ca nAme ri
can shaveh ighe stpr eva l
en ce,me nu nde r
<45,
 wo me n> 64
 Bl
oodpressure=Ca rdiacOu tputXs ystemi cv ascu l
arresistance
o Ar terialBP:p ressureexerte db yb lo oda gainstwa l
lsofb l
oo dvessel
o Sy stolic:p eakp ressuree xe r
te da ga insta r
terieswh enL Vcon tr
acts
o Di astoli
c :res i
dua lpressurel eftina rteri
a lsystemwh enrelaxed
o Pu l
sep re ssu r
e:d i
fferenceb etwee ns ystoli
c–d iastol
ic,shou l
db e1/3
 o fs ystol
icBP
o F actorsin f
lu encingBP
 Ca rd i
aco ut
put:howmu chv ol
u mei sina rteri
a lsy
s t
ema n
d
 h owmu c hv olumeh e a
rth ast op ump
 I nfluencedb y:
 ú Car di
ac :hea r
trate,con t
ractil
ity
,conduct
ivi
ty
 ú Ren alfl
u i
dv olumec on tr
o l
:RAAS, nat
riu
reti
c
 p ept i
d es
 Sy ste micv ascul
a rr e
s istanc e:for c
eop pos i
ngmov eme nt
ofb loodwithi
n
b l
o odv es sel
s
 I nfluencedb y:
 ú SNS:a l
p ha1a nd2a drenergicrecept
ors
 ( v a
s oc ons tr
icti
on ),beta2a dre n
e r
gicr ecept
ors
 ( v a
s od il
ation )
 ú Ne uroho r
mo na
l:vasoc onstri
c t
ors
–a n giotens i
n ,norep i
nep h
rine
 ú Loc alregulation:vasod i
lat
or s–prost
aglandi
ns,
 n it
rico x i
de ;vas o
c onstri
ctors–e ndotheli
n
 HowSNSRe gu lates BP
o Re actsi ns ec ondsa ft
erBPd rop
o Ba rore cptorsi nc aro
tida rteri
e sa nda orti
ca rchs e n
seBPc hanges,
 s e ndi nfotov asomot orc en terse ventu al
lyd ecreasi
ngSNSa cti
vit
y
 o rs t
imu lati
ngp ara symp ath e t
icàd ecreas eHRv iava gusn erve

,o No
rep
inephrineact
ivat
esSNSreceptor
s(a1,a2,b1,
b2)
 Alp haadrene
rgiccau
sev a
s o
const
ric
tiond/t
norepi
 Be ta1r e
spondw/incr
easeHR( ch
ronotro
pic)
,inc
reased
for
ceofc
ont
rac
tio
n
(
inotro
p i
c)andinc
rease
dc ondu
cti
ons peed(dr
omotro
pic)

,  Be ta2c ausev asod i
lationd /tepin e
p hrine
o Vasomo torce nter
:ma intai
n sn or ma lBPu nde re xerci
s e,st
ress,p ai
ntop r
e v
ent
di
z zi
n ess/syncope
o Barorecptors:wh enBPi nc r
e ase s, theyi nhi
b i
tSNSt od ecreaseHR,
 c ontracti
onf or cea ndv a sod il
a t
iona ndv ic
ev e rsawhenBP
 d ecreas es
 HowVascularendoth e
liumr e gulatesBP
o Nitr
ico xi
d eandp ros tacycli
nma inta i
nl owa rterialt
on e
o Endothelin:v
a socons tri
ctor
 Howrena
l systemr egu l
atesBP:c on t
ro lli
n gs od i
ume x creti
o n/ECF
o volume
o Sod i
umr etentionultima telyinc rea se sCOa ndBP
o RAAS:
 An giotensinI Iincrease sBPb yv as
oc on stri
ctiona ndin
cre as
e
 SVRa ndwor ksa tl oc allevelofh earta ndbloodv essel
s
o Prostaglandins:vasod i
lati
on effe ct
 Howendocri
n esys t
emr egu latesBP
o Adren alme dul
larele asese p i
ne p hrinein creasin gCOa nd a
c t
iva
te s
 b eta2r eceptor sc ausingv a sodilat
ion
o Releaseofa ldosteron e
i
nc re
a sesCOPr ehype rtension:120- 139/ 80-89
o Is
o l
ateds ystol
icHTN:a verageSPBof140>w/a verageDBPo f90<E t
iol
ogy
o Prima r
yHTN( e s
sen tialorid i
op a t
h ic)MORE COMMON
 E levatedBPw/ oiden t
ifie dca use
 Re lati
ngf acto rs/
p at
h o:i ncr ease dSNSa cti
vit
y ,incr
ease dsodium
retenti
on/vas oco nstri
ctio n, overwe i
gh t, DM,E TOH,smo king,fa
mi l
yh i
stor
y,
ethnici
ty,sed en t
ary,stre ss
o Secon daryHTN:c aus eca nb eI De da n dcorr
e cte d
 I fp eoples udd enlyd eve lopav e
r yhigh BP
o Cli
n i
calma nifestat
ion s
o Symp tomss e c
o ndaryt oe ff
e ctso nb loodv ess elsino rgans/t
issuesortoin cr
eased
workloado fhea r
t
o Fati
gu e,di
z z
ine ss
,p alpitati
o ns, an gina,dysp nea
o HTNc ri
sis:severeh e adache s,a nx iety,nose blee ds
 Compl
ica
tions:mos tc ommon l
yo nta rge torga ns
o HTNh eart
d i
sea se
 Co r
o narya rteryd is
e ase :HTNd i
srupt
sc oronary
a r
tery
 e ndotheliu mc aus i
nga th eroscle r
osisàCAD, MI,angi
na
 L Vh ypertr
oph y:c ardi
a cwo rk l
oa dincre as ed;primaril
ycomp ensatory
bute ventual
lyc a nleadt oh e art
fa i
lure
 He a r
tfa i
lur
e :h eartcan n otp u mpb loodt ome e tbody’
sdema nds;
contracti
li
ty, SV, COd ec rea sed
o Cereb r
ova scul
a r
disea se

,  HTN=r i
s kforc er ebral a
t her
o sclerosisan dstr
oke
 I fBPt ooh i
ghf orb odyt oa utoregulate,ce r
e br
al ede
ma cand ev
elopandlea
d
toinc reaseini ntra cr
a nialpr
e ssure
o Pe ri
pheralv ascu l
ardisea se
 HTNi ncrease sris kfo rathero scl
e r
osisl eadingtoPVD, aort
ic
 a neurys m/ disse c
tion
 I nt
e rmittentc l
a ud i
c a
tio n:legp ainw/a c t
ivity,
reli
eve dw/ rest
o Ne phroscl
e rosis
 Re na ldisea s
ed /tisch emi aài ni
tial
lyn eph ronscan
 c omp en sateb u teven tual
lyre nalfailur
e
 1stsign :nocturia
o Re ti
naldama ge :
 Da ma gewi llbeb lu r
ryv ision,retinalhe mo r
rhage ,v
ision l
oss
 E xten tofd ama gec anp ro vi
dei nfoa bouts everi
ty/dura t
ionofHTN
 Di
agnos
tic
studies
o L abwo r
kd on etor uleou tsec ond ar
yHTN, evaluatetargetorga n,
 o vera l
l cardi
or isk ,esta bl
ishb ase l
ineb eforetherapy
 Re na linvolveme n t:urin a
lysis,BUN, crea t
inine
 E lectrolytes(p otas si
u m)–d etectshyp eraldoster
o n
ism
 BS:d iagn osi
sDMt ype2
 L ipi
d s:riskfa ctorsf ora therosclerosis,CVD
 E CG:b aselinec ard i
acs t
a t
us, I
DL VH, ische mia,prev
io usMI
 E yee xam
o Amb ul
atoryBPmon i
to ri
n g
 Pt .c ans elfmon ito rifthe yha vewh it
ec o atsyndrome –
 n oninva sive,me asuresBPa tin t
erva l
sthruou t24h rs
 Pt .s houldk eepa record
 Ot he rp t.thatma yn e edt hisa reo nest h atwo ul
db er esist
anttoa n
tiHTN
drugs ,h y p
o tens ive s ymp toms w/ a nti HTN d r
u gs,
epis
odic HTN,
SNSd ysfunction
 F orp e opletha ta rea ctiv
ed u ri
n gthed ayitwi l
lbeh igh est
wh entheyfi
rst
wak eu p
 Cl
ini
cal
manif
e s
tation s
o Go als
:ac hi
e ving/ma intaininggo alBP, reducingc a rdi
o/tar
ge torgan
 d isea serisk–h o meBPmo nitori
n g
o L i
fest
y l
emo d i
ficati
on s:a llHTNa ndp reHTNp t
.s houldd ot heseb utmo stHTNpt
.
wil
lsti
llnee dd urgtherap y
 We i
g htre ducti
onàl osso f22l bsc and ecreaseSPBb y 5-20
 Re du cec alori
e s,s alt
, fat
s ,cholesterol;ad equateint
a kep o
ta s
sium
andc alci
u m
o DASHe ati
n gp l
an
 F rui
ts ,veggies ,fatf r
e emi lk,wh olegra i
ns ,fi
sh,poul
try ,
 b eans, see ds, nutsàl essr edme at,sal
t,suga r(beve r
ages)