Transcript Hypertension - Iowa Heart Foundation

Mary J. Hackbarth MSN,FNP, ARNP-C
 Define
potential modifiable and nonmodifiable risk factors for the development
of hypertension
 Describe medication guidelines for the
treatment of hypertension
 Discuss key components of lifestyle
modification critical to adequate blood
pressure control in the hypertensive patient

Treatment of HTN is
the Most Common
Reason for Office
Visits in Non-Pregnant
Adults

Number of Patients
with HTN is Likely
Growing (Advancing
Age & Obesity)

Control of the Disease
is Far from Adequate
 Approximately
75 Million American Adults
(32%) or 1 of Every 3 Adults with HTN
 ONLY HALF (54%) with HTN are Considered to
Have HTN Controlled
 Another 1 in Every 3 Adults is Considered to
Have Elevated Blood Pressure (PreHypertension) Not Yet Treated
 HTN Costs the United States 46 Billion Dollars
Each Year for Health Care Services,
Medications, and Missed Days of Work
(CDC.GOV)
 More
than 410,000 American Deaths in 2014
Included HTN as a Primary Contributing
Cause (More Than 1,100 Deaths Each Day)
 About 7 of Every 10 People Having their First
MI Have HTN
 About 8 of Every 10 People Having their First
CVA Have HTN
 About 7 of Every 10 People with Chronic CHF
Have HTN
 About 1 in 5 Adults Unaware of their HTN
(CDC.GOV)
 African
Americans
44.3%
 Caucasian
Americans
32.6%
 Hispanic
Americans
28.4%

Primary (Essential) Hypertension

95% of all Hypertension Cases

Cause of Hypertension not Known


Genetic Factors – Inappropriate High Activity of
Renin-Anigotensin-Aldosterone System and
Sympathetic Nervous System Activation
Environmental Factors – Excessive Salt Intake,
Obesity, or Sedentary Lifestyle

Secondary Hypertension

5% of all Hypertension Cases – Cause Identifiable and sometimes
treatable
 OTC Medications - Oral Contraception with High Estrogen,
NSAIDs, Decongestants – Pseudoephedrine, Weight Loss
Medications
 Prescription Medications – TCAs, SSRIs, Prescription Weight
Loss Medications, Cyclosporine, Stimulants –
Methylphnidate & Amphetamines, Erythropoietin,
Glucocorticoids
 Illicit Drug Use (Methamphetamines & Cocaine)
 Renal Disease (Acute and Chronic)
 Renal Artery Stenosis
 Obstructive Sleep Apnea
 Pheochromocytoma
 Thyroid Disorders
 Coarctation of the Aorta

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Advancing Age
Obesity
Family History
Race – African Descent 2 x
as Common
High Sodium Diet
Excessive ETOH
Consumption
Physical Inactivity
Diabetes
Dyslipidemia
Personality Traits
(Depression, Hostility,
Impatience, etc.)
Nicotine Abuse
Systolic Blood
Pressure
Diastolic Blood
Pressure
Normal Blood
Pressure
<120mmHg
<80mmHg
Pre-Hypertension
120-139mmHg
80-89mmHg
Stage I Hypertension
140-159mmHg
90-99mmHg
Stage II Hypertension
>160mmHg
>100mmHg
 <150/90mmHg
for most patients 60 years and
older with NO diabetes or CKD
 <140/90mmHg for patients 18-59 without
comorbidities or >60 WITH diabetes or CKD
 Diagnosis of hypertension usually made after
2 elevated readings at 2 separate visits
(Unless dangerously high >180/110mmHg)
 Arm cuffs preferred vs. Wrist or finger cuffs
 Automatic cuffs preferred vs. Manual cuffs
 Proper cuff size with bilateral arm
measurements on initial evaluation – Arm
with higher reading utilized

Electrolytes



BUN / Creatinine




Elevated LDL / Low HDL –
Increased CV Risk
Anemia secondary to CKD
etc.
RBCs / WBCs

Infections etc.
Aluminuria – CKD and
Associated with Increased
CV Events
EKG –


Fatty Liver Disease
Urine Sample


Pheochromocytoma
LFTs

Hgb / Hct


Evaluate for Kidney
Disease (GFR)
Norepinephrine /
Norepinephrine Levels

Lipids


Elevated K+ Possible
Kidney Disease
Low K+ Possible
Aldosterone Excess

LVH / MI / Cardiac
Arrhythmias – Atrial
Fibrillation
Echocardiography –

LVH / Valvular Disease
LVH – EARLY and
Common Finding
(Lead to CHF, MI,
Sudden Death)
 Ischemic Heart
Disease (MI & PCI)
 Ischemic CVA
 Aneurysms /
Dissection / PVD
 Intracranial Bleed
 Chronic Kidney
Disease / ESRD
 Retinopathy


ACE-Inhibitor Therapy (Zestril - Lisinopril,
Lotensin - Benazepril)

ARB-Therapy (Cozaar - Losartan, Diovan Valsartan, Benicar - Olmesartan)

Thiazide-Type Diuretic Therapy (HCTZ,
Chlorthalidone)

Calcium Channel Blockers (Norvasc - Amlodipine)
 Beta-blockers
(metoprolol, atenolol)
 Alpha-blockers (doxazosin)
 Alpha1/beta-blockers (carvedilol)
 Vasodilating beta-blockers (nebivolol)
 Central alpha2-adrenergic agonists
(clonidine)
 Direct vasodilators (hydralazine)
 Loop diuretics (furosemide)
 Aldosterone antagonists (spironolactone)
 Peripherally acting adrenergic antagonists
(reserpine)
 ALL



patients with CKD regardless of ethnicity
ACE-Inhibitor Therapy
ARB Therapy
Can use the ACE-Inhibitor or ARB as first the line
therapy or in addition to first line therapy
 Avoid
the use of ACE-Inhibitor Therapy
simultaneously with ARB Therapy
 Calcium Channel Blockers and Thiazide Type
Diuretics – Preferred if Age > 75 with CKD
 African American Descent WITHOUT CKD



Calcium Channel Blocker Therapy
Thiazide Diuretic Therapy
ACE-Inhibitory – Less blood pressure response
 Updated
/ Maintained by the American
Geriatric Society (AGS)
 Guide for Potentially Inappropriate
Medication Usage in Adults > 65 Years of Age
 Leading Source of Information About the
Safety of Prescribing Drugs for Older Adults
 Help Prevent Medication Side Effects and
Other Drug-Related Problems in Older Adults
 Identifies Medications with Risks that may be
Greater than their Potential Benefit in
People over the Age of 65
 34
Medications are Identified as “Potentially
Inappropriate” for Individuals > 65
 Medications used for 14 Common Health
Problems are Potentially Inappropriate OR
may not be Completely Effective OR make
the Condition Worse
 Drugs on the Beers Criteria may still be
Utilized in the Adult > 65 as they may still be
the Best Choice but may need more Careful
Monitoring While Administered

DASH Diet
 Emphasize
– Fruits,
Vegetables, Whole
Grains, Low Fat Dairy
Products, Poultry, Fish,
Legumes,Nuts
 Limit – Intake of Sweets,
Sugar Beverages, Red
Meats
 Aim for Dietary Pattern
with 5-6% of Calories
from Saturated Fat

Sodium Restriction
 Sodium
– 2,400mg
(1,500mg Further BP
Reduction)
(ACC)
 PHYSICAL
ACTIVITY
 3-4
Sessions per
Week Lasting 40
Minutes per Session
 Moderate to
Vigorous Intensity
 Helps with Weight
Control and Lipid
Management as well
as Hypertension
(ACC)