AGNP (AANP) HTN REVIEW
Goals5of5Antihypertensive5Therapy5-5ans--
✔✔To5reduce5cardiovascular5morbidity5and5mortality
Ultimate5goal:5Maximally5reduce5CV5risk5without5decreasing5the5enjoyment5of5life
Risk5Factors5for5HTN5-5ans--✔✔Smoking
Dyslipidemia
Physical5inactivity
BMI5over5or5equal5to530
Diabetes5mellitus:5>555for5men5and5>655for5women(>60)
Male5gender5or5postmenopausal5female
Family5history5of5CV5disease:5women5<65,5men<55
Microalbuminuria5or5est5GFR5<60ml5/min.
Doubles5the5risk5of5CV5diseases,5such5as:5-5ans--
✔✔CHD,5CHF,5ischemic5and5hemorrhagic5stroke,5renal5failure,5and5peripheral5artery5
disease
In5African5Americans5-5ans--
✔✔HTN5appears5earlier,5is5generally5more5severe,5and5results5in5higher5rates5of5mor
bidity5and5mortality
Persons5who5are5normotensive5at555,5have5a5___%5lifetime5risk5of5developing5HTN5-
5ans--✔✔90%
African5Americans5develop5high5blood5pressure5more5often,5and5at5an5earlier5age,5tha
n5whites5and5Mexican5Americans5do.5Among5African5Americans,5more5women5than5m
en5have5the5condition5-5ans--✔✔Men5(%)5Women5(%)5
African5Americans542.2544.1
Mexican5Americans524.8528.65
Whites531.2528.35
All531.8530.3
,JNC5VII5Classifications5for5HTN5:::5"NORMAL"5-5ans--✔✔<1205systolic5<805diastolic
JNC5VII5Classifications5for5HTN5:::5"Pre-HTN"5-5ans--✔✔S:5120-1395D:580-89
JNC5VII5Classifications5for5HTN5:::5"Stage5I5HTN"5-5ans--✔✔S:5140-1595D:590-99
JNC5VII5Classifications5for5HTN5:::5"Stage5II5HTN5"5-5ans--
✔✔S:5equal5or5>1605D:5equal5or>100
JNC5VII5Classifications5for5HTN5:::5"Persistent5-5Severe"5-5ans--
✔✔chronically5elevated5SBP5and5DBP5>110-120mm5Hg
HTN5Screening5Recommendations...5USPSTF5recommends5every5___5years5for5pers
ons5with5BP<120/805-5ans--✔✔25years
HTN5Screening5Recommendations...5JNC5VII5recommends5every5___5years5for5perso
ns5with5systolic5120-1395or5diastolic580-895-5ans--✔✔15year
Diagnosis5of5HTN5should5be5based5upon:5-5ans--
✔✔The5average5of5two5or5more5properly5measured5readings5at5each5of5two5or5more5
visits5after5an5initial5screen.
Blood5Pressure5Goals5of5Therapy5-5ans--
✔✔Uncomplicated5HTN5<140/90,5blacks5<135/85
Diabetic5patients,5proteinuric5chronic5kidney5disease:5<130/805(some5studies5recomm
end5<120/80)5
Atherosclerotic5CVD:5<5or5equal5to5130/80
Patients5with5renal5failure5and5proteinuria:5
5(>1gram5in5245hours)5<120/80
In5elderly5patients5with5severe5systolic5HTN:5
5<1605is5reasonable5if5attempts5to5reach51405result5
5intolerable5side5effects.
Prehypertension:5
120-1395systolic5or580-895diastolic5-5ans--
✔✔Slightly5elevated5BP5may5increase5stroke5risk5by5nearly580%
Progression5of5essential5HTN5-5ans--✔✔1.5Prehypertension(ages510-
30):5increased5CO
2.5Early5HTN5(ages520-40):5increasesd5peripheral5
5resisistance
3.5Established5HTN(ages530-50)
, 4.5Complicated5HTN(ages540-60)
HTN5tends5to5be5familial5and5is5likely5to5be5consequence5of5interaction5between5envir
onmental5and5genetic5factors.5-5ans--✔✔80-
95%5of5patients5diagnosed5with5HTN5have5primary5or5essential5HTN
Essential5or5primary5hypertension5-5ans--
✔✔Pathophysiology5and5causes5remain5areas5of5active5research
Many5theories5and5different5links5to5multiple5risk5factors
"Patients5who5develop5hypertension5are5known5to5develop5a5systemic5hypertensive5re
sponse5secondary5to5vasoconstrictive5stimuli."
Secondary5hypertension5-5ans--
✔✔Most5mechanisms5leading5to5secondary5HTN5are5understood...5A5Result5of5anothe
r5underlying5condition
Secondary5Hypertension:
5Causes5-5ans--✔✔Acute5stress
Vascular5disorders
Dissecting5AA
Endocrine5disorders
Adrenal
Neurologic-neurogenic
Obstructive5sleep5apnea
Medications
Pregnancy5complications-Preeclampsia,5Eclampsia
Renal5disorders,5renovascular5disorders
Severe5anemia
Tyramine-containing5foods
Mendelian5forms5of5HTN
Pathogenesis5of5HTN5-5ans--
✔✔Any5factor5producing5alteration5in5PVR(peripheral5vascular5resistance),HR(heart5ra
te),5or5SV(stroke5volume)5affects5systemic5arterial5BP5through5four5mechanisms:
5Arterial5baroreceptor5and5chemoreceptor5systems
5Regulation5of5body5fluid5volume5
5Vascular5autoregulation
5Renin-angiotensin-aldosterone 5system
Pathogenesis5of5Essential5HTN5-5ans--✔✔Complex5and5multifactorial
5Factors5affecting5blood5pressure
5Humoral5mediators
5Vascular5reactivity
5Circulating5blood5volume
5Vascular5caliber
5Blood5viscosity
Goals5of5Antihypertensive5Therapy5-5ans--
✔✔To5reduce5cardiovascular5morbidity5and5mortality
Ultimate5goal:5Maximally5reduce5CV5risk5without5decreasing5the5enjoyment5of5life
Risk5Factors5for5HTN5-5ans--✔✔Smoking
Dyslipidemia
Physical5inactivity
BMI5over5or5equal5to530
Diabetes5mellitus:5>555for5men5and5>655for5women(>60)
Male5gender5or5postmenopausal5female
Family5history5of5CV5disease:5women5<65,5men<55
Microalbuminuria5or5est5GFR5<60ml5/min.
Doubles5the5risk5of5CV5diseases,5such5as:5-5ans--
✔✔CHD,5CHF,5ischemic5and5hemorrhagic5stroke,5renal5failure,5and5peripheral5artery5
disease
In5African5Americans5-5ans--
✔✔HTN5appears5earlier,5is5generally5more5severe,5and5results5in5higher5rates5of5mor
bidity5and5mortality
Persons5who5are5normotensive5at555,5have5a5___%5lifetime5risk5of5developing5HTN5-
5ans--✔✔90%
African5Americans5develop5high5blood5pressure5more5often,5and5at5an5earlier5age,5tha
n5whites5and5Mexican5Americans5do.5Among5African5Americans,5more5women5than5m
en5have5the5condition5-5ans--✔✔Men5(%)5Women5(%)5
African5Americans542.2544.1
Mexican5Americans524.8528.65
Whites531.2528.35
All531.8530.3
,JNC5VII5Classifications5for5HTN5:::5"NORMAL"5-5ans--✔✔<1205systolic5<805diastolic
JNC5VII5Classifications5for5HTN5:::5"Pre-HTN"5-5ans--✔✔S:5120-1395D:580-89
JNC5VII5Classifications5for5HTN5:::5"Stage5I5HTN"5-5ans--✔✔S:5140-1595D:590-99
JNC5VII5Classifications5for5HTN5:::5"Stage5II5HTN5"5-5ans--
✔✔S:5equal5or5>1605D:5equal5or>100
JNC5VII5Classifications5for5HTN5:::5"Persistent5-5Severe"5-5ans--
✔✔chronically5elevated5SBP5and5DBP5>110-120mm5Hg
HTN5Screening5Recommendations...5USPSTF5recommends5every5___5years5for5pers
ons5with5BP<120/805-5ans--✔✔25years
HTN5Screening5Recommendations...5JNC5VII5recommends5every5___5years5for5perso
ns5with5systolic5120-1395or5diastolic580-895-5ans--✔✔15year
Diagnosis5of5HTN5should5be5based5upon:5-5ans--
✔✔The5average5of5two5or5more5properly5measured5readings5at5each5of5two5or5more5
visits5after5an5initial5screen.
Blood5Pressure5Goals5of5Therapy5-5ans--
✔✔Uncomplicated5HTN5<140/90,5blacks5<135/85
Diabetic5patients,5proteinuric5chronic5kidney5disease:5<130/805(some5studies5recomm
end5<120/80)5
Atherosclerotic5CVD:5<5or5equal5to5130/80
Patients5with5renal5failure5and5proteinuria:5
5(>1gram5in5245hours)5<120/80
In5elderly5patients5with5severe5systolic5HTN:5
5<1605is5reasonable5if5attempts5to5reach51405result5
5intolerable5side5effects.
Prehypertension:5
120-1395systolic5or580-895diastolic5-5ans--
✔✔Slightly5elevated5BP5may5increase5stroke5risk5by5nearly580%
Progression5of5essential5HTN5-5ans--✔✔1.5Prehypertension(ages510-
30):5increased5CO
2.5Early5HTN5(ages520-40):5increasesd5peripheral5
5resisistance
3.5Established5HTN(ages530-50)
, 4.5Complicated5HTN(ages540-60)
HTN5tends5to5be5familial5and5is5likely5to5be5consequence5of5interaction5between5envir
onmental5and5genetic5factors.5-5ans--✔✔80-
95%5of5patients5diagnosed5with5HTN5have5primary5or5essential5HTN
Essential5or5primary5hypertension5-5ans--
✔✔Pathophysiology5and5causes5remain5areas5of5active5research
Many5theories5and5different5links5to5multiple5risk5factors
"Patients5who5develop5hypertension5are5known5to5develop5a5systemic5hypertensive5re
sponse5secondary5to5vasoconstrictive5stimuli."
Secondary5hypertension5-5ans--
✔✔Most5mechanisms5leading5to5secondary5HTN5are5understood...5A5Result5of5anothe
r5underlying5condition
Secondary5Hypertension:
5Causes5-5ans--✔✔Acute5stress
Vascular5disorders
Dissecting5AA
Endocrine5disorders
Adrenal
Neurologic-neurogenic
Obstructive5sleep5apnea
Medications
Pregnancy5complications-Preeclampsia,5Eclampsia
Renal5disorders,5renovascular5disorders
Severe5anemia
Tyramine-containing5foods
Mendelian5forms5of5HTN
Pathogenesis5of5HTN5-5ans--
✔✔Any5factor5producing5alteration5in5PVR(peripheral5vascular5resistance),HR(heart5ra
te),5or5SV(stroke5volume)5affects5systemic5arterial5BP5through5four5mechanisms:
5Arterial5baroreceptor5and5chemoreceptor5systems
5Regulation5of5body5fluid5volume5
5Vascular5autoregulation
5Renin-angiotensin-aldosterone 5system
Pathogenesis5of5Essential5HTN5-5ans--✔✔Complex5and5multifactorial
5Factors5affecting5blood5pressure
5Humoral5mediators
5Vascular5reactivity
5Circulating5blood5volume
5Vascular5caliber
5Blood5viscosity
