Hypertension Review
- American Heart Association defines Hypertension as blood pressure of 140/90 or greater in adults 18 years & older.
- Pre-Hypertension is when the blood pressure is greater than 130/90 but below 140/90
- Normal blood pressure is < 120 mmHg systolic & < 80 mmHg diastolic in adults
- Hypertension is the most common primary diagnosis in the United States
- Hypertension is usually asymptomatic until there is significant damage to organs or tissues
- Hypertension can happen with fear, anger, pain & stress as a result of stimulation of the sympathetic nervous system
- Hypertension increases the risk of stroke, angina, myocardial infarction, heart failure, renal failure & retinopathy
- Most people have Primary Hypertension. Primary Hypertension has no known cause & it may be genetic.
- Some causes linked to primary HTN: elevated peripheral resistance, endothelial dysfunction, elevated lipids,
- Hyperinsulinemia (insulin insensitivity), sympathetic nervous system disorder caused by insensitivity of baroreflexes, & dysfunction of the renin-angiotensin system
Factors controlling blood pressure are:
- Cardiac output
- Vascular resistance
- Volume
- Viscosity
- Elasticity of arterial walls
- Primary Hypertension (Essential or Idiopahic Hypertension)
Modifiable risk factors for Primary Hypertension
- Obesity
- Sedentary Lifestyle
- Metabolic Syndrome
- Dietary Factors (Increase fat, sodium, low potassium & calcium)
- Smoking
- Elevated blood sugars
- Elevated total cholesterol
- Elevated triglycerides
- Decrease in HDL (good cholesterol)
- Elevated LDL (bad cholesterol)
Non-Modifiable Risk Factors for Primary Hypertension
- Increasing Age
- Family History
- Gender
- Ethnicity
****The treatment for Primary Hypertension includes lifestyle modifications & drug therapy****
Primary Hypertension
- Used to be termed “essential” HTN
- Elevated B/P without a cause
- Most patients have primary HTN
Secondary Hypertension
- Hypertension that is caused by a systemic disease process that raises peripheral vascular resistance (hypertension that has a specific identifiable cause)
- Hypertension in infants & children is usually Secondary Hypertension
- In children younger than 6 years of age, the most common cause of Secondary Hypertension are renal disorders or coarctation of the aorta
- Some examples of Secondary Hypertension are: Diabetes, tumors, Renal artery stenosis, Renal failure, Glomerulonephritis, Hyperthyroidism, Cushing disease, Guillain Barre Syndrome, Increased
- intracranial pressure, COPD, sleep apnea, pregnacy.
Isolated Systolic Hypertension - Elevated systolic blood pressure caused by increases in cardiac output, total peripheral vascular resistance or both.
Isolated Systolic Hypertension (ISH)
- Elevated systolic with normal diastolic
- Due to reduced vascular compromise in large arteries
- A predictor of CV problems in the elderly
- Fluid overload can cause ISH
Complicated Hypertension (Chronic Hypertension)
- Complicated Hypertension is chronic hypertension that causes damage to the walls of blood vessels.
- The smooth muscle cells of the arteries undergo hypertrophy & fibrosis develops in the tunica intima & media
- Malignant Hypertension
- Hypertension that happens rapidly
- Diastolic pressure is > 140 mmHg
Malignant hypertension
- A medical emergency
- Some causes of Malignant Hypertension are: Autonomic dysreflexia (spinal cord injuries), withdrawal of Beta Blockers, ETOH & some medications (cocaine, sympathomimetic agents, caffeine, licorice & more)
- Malignant Hypertension has 2 subgroups: Hypertensive Emergency & Hypertensive Urgency. In both Hypertensive Emergency & Hypertensive Urgency, the diastolic blood pressure is usually > 120mm Hg
- Hypertensive Emergency- characterized by sudden increase in either or both systolic & diastolic pressures with evidence of acute organ damage
- Hypertensive Urgency- similar blood pressure elevations but without end organ damage
White-Coat Hypertension
- White Coat Hypertension is blood pressure readings that are higher in the doctors office than at home
- May signal that the patient is at risk for developing hypertension & will need further evaluation