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Hypertension: The Silent Killer
Terms in this set (53)
About how many US adults have high blood pressure?
What is high blood pressure a major risk factor for?
Heart disease, stroke, congestive heart failure, kidney disease
What is the blood pressure control rate among all hypertensive patients?
25% of American adults has blood pressure numbers that are higher than normal, but not yet in the high blood pressure range
What is the number 1 killer of women age 20 and over?
What two factors determines blood pressure?
1. Cardiac output
Volume of blood pumped by the heart each minute
To blood flow in the vessels, primarily the arterioles
A result of friction as blood flows through the vessels; the smaller the diameter of the vessels the higher the resistance
What is the relationship among pressure, flow, and resistance?
Pressure= Flow x Resistance
When does blood pressure increase?
-When there is an increase in the volume of blood the heart is pumping per minute (increase in flow)
-A decrease in the diameter of vessels (increase in resistance)
What is the top number in a blood pressure reading?
The top number measures the pressure in the arteries when the heart beats (when the heart muscle contracts)
What is the bottom number in a blood pressure reading?
The bottom number measures the pressure in the arteries between heartbeats (when the heart muscle is resting between beats and refilling with blood)
What is normal blood pressure?
Below 120/80 mmHg
How is blood pressure regulated?
-Through the autonomic nervous system
-Sympathetic stimulation: Adrenaline rush, increases both the rate and force of contraction of the heart to increase cardiac output, causes contraction of vascular smooth muscle and increases resistance
Who is more likely to develop high blood pressure?
a. People with family members who have high BP
d. Pregnant women
e. Women who take birth control pills
f. People over age 35
g. People who are overweight or obese
h. Inactive people
i. People who drink alcohol excessively
j. People who eat too many fatty foods or foods with too much salt
k. People who have diabetes, chronic kidney disease, thyroid or adrenal disorders
How does the kidney function in relation to blood pressure?
-Kidneys regulate blood pressure through regulation of extracellular fluid volume
-In a healthy person, kidneys act to excrete excess salt and water if excessive intake occurs, maintaining ECFV normal
-If excess water and salt is retained rather than excreted, extracellular fluid volume may stay above normal causing a long term increase in blood pressure
-Pathological changes in kidney tissue can cause hypertension
Lifestyle changes useful to control hypertension
1. Weight: 5-20 mmHg systolic reduction rate
2. DASH diet
3. Dietary sodium
Possible consequences of untreated hypertension
Stroke, chronic high blood pressure, blood vessel damage, heart attack or heart failure, kidney failure
What is the fourth leading cause of death for both men and women?
What is one of the leading causes of long term disability?
What percentage of strokes are preventable through risk management factors?
Heart attacks ____________, strokes ________________
Heart attacks kill, strokes cause disability
Do strokes kill more or less American women every year compared to breast cancer?
Strokes kill more than twice as many American women per year than breast cancer
Women and stroke
-Women suffer greater disability after stroke
-More women than men die from stroke and the risk is higher for women due to increased life expectancy
-Women suffer greater disability after stroke
What is the definition of a stroke?
Sudden brain damage due to lack of blood flow to the brain caused by a clot or rupture of a blood vessel
What are the two types of stroke?
a. Ischemic stroke (clot)
b. Hemorrhagic stroke (bleed)
What are the two types of ischemic stroke?
Embolic and thrombotic
What percentage of all strokes are thrombotic strokes?
What is a hemorrhagic stroke defined as?
Bleeding around/into the brain
Embolic ischemic stroke
Parts of thrombus travel in the blood stream
What are the two types of hemorrhagic stroke?
1. Intracerebral hemorrhage (ICH)
2. Subsrachnoid hemorrhage (SAH)
-Most common type of hemorrhagic stroke (IMPORTANT)
-Occurs when an artery in the brain bursts, flooding the surrounding tissue with blood
-Mostly due to hypertension
-Bleeding in the area between the brain and the thin tissues that cover it
Pathogenesis of stroke
-Sudden onset of loss of function (movement, feeling, speaking, etc.) due to an interruption of blood flow to the portion of the brain responsible for controlling that function
-Brain depends on continuous blood flow to deliver oxygen and glucose as well as remove metabolic waste products such as carbon dioxide
-Once blood flow is interrupted, within a few minutes neurons lose their ability to function and die rapidly
-Communication with other neurons ceases
-Change in electrical state sets into motion programmed cell death (apoptosis) of the neuron
-That part of the brain dies
Warrants the same degree of emergency care as a heart attack
-Time is important because brain cells are dying
-Treatment is most effective if administered within the first three hours after experiencing symptoms
-It takes the average American 12 to 24 hours to get to the hospital after experiencing the first stroke symptom
F: Face, ask the person to smile
A: Arm, ask the person to raise both arms
S: Speech, ask the person to speak a simple sentence
T: Time, to call 911
Warning stroke: Transient ischemic attack is a warning sign of a future stroke, up to 40% of TIA patients will have a future stroke
-Symptoms of TIAs are the same as stroke
-TIA symptoms can resolve within minutes or hours
-Needs immediate medical attention
-Similar to angina
Stroke prevention guidelines
1. control blood pressure
2. check for atrial fibrillation (a type of irregular heartbeat)
3. stop smoking
4. moderate alcohol consumption
5. control cholesterol
6. control diabetes
7. exercise, adopt a low sodium diet if needed
8. if symptoms are experienced, call 911 immediately
What is CKD?
Chronic Kidney Disease:
-Major worldwide public health problem
-20 million Americans suffer from CKD
-Untreated can lead to End Stage Renal Disease which requires treatment with dialysis or renal transplantation
-Prevalence of ESRD expected to rise with the ongoing epidemics of diabetes and hypertension
End stage renal disease:
occurs when kidney function is inadequate to sustain life on an irreversible and chronic bases such as when chronic dialysis or transplantation is necessary
Process where blood is cleared of toxins and excess fluid (hemodialysis, peritoneal dialysis)
Glomerular filtration rate (a test for kidney function)
Normal kidney function
The kidneys remove wastes and water from the blood to form urine, urine flows from the kidneys to the bladder through the ureters
Main functions of the kidneys
1. Excretion of metabolic end products and foreign substances
2. Every day, a person's kidneys process about 200 quarts of blood to sift out about 2 quarts of waste products and extra water
3. Hormone synthesis: renin, erythropoietin, etc.
Risk factors for chronic kidney disease
Hypertension, diabetes, autoimmune diseases, low birth weight, exposure to certain drugs like NSAID's, family history of kidney disease, older age, ethnicity (African American, Native Americans, and Hispanics), low income/education
Causes for Chronic Kidney Disease
-Diabetes and hypertension= major causes
-Other: kidney diseases, obstructions, drugs, trauma, HIV etc.
-Each kidney has about 1 million nephrons
-When there is renal injury, the kidney compensates to maintain glomerular filtration rate by hyper filtration, hypertrophy of remaining nephrons
-The above causes increase capillary pressure in the glomeruli and lead to glomerulosclerosis (kidney damage), which leads to glomerular hypertension
Natural history of disease
-Gradual and permanent loss of kidney function over time leads to CKD
-Takes place over months to years
-Im some cases disease can progress very rapidly; CKD is often silent (no symptoms) until late in the course of the disease when glomerular filtration rate is diminished below 10-15% of normal
Clinical features of CKD
-Need to urinate frequently especially at night
-Swelling of the legs and puffiness around the eyes (fluid retention)
-High blood pressure
-Fatigue and weakness (from anemia or accumulation of waste products in the body)
-Loss of appetite, nausea, and vomiting
-Itching, easy bruising, and pale skin (from anemia)
-Shortness of breath from fluid accumulation in the lungs
-Headaches, numbness in the feet or hands (peripheral neuropathy), disturbed sleep, altered mental status
Tests for kidney disease
-Measurement of blood pressure
-Checking for level of urine protein excretion
-Assessment of glomerular filtration rate using serum creatinine concentration levels and other measures
-Albumin to creatinine ratio, etc.
Management and control of CKD
-Early detection is important
-Optimizing management of risk factors for CKD, especially in high risk population
-Increasing patient and healthcare personnel awareness of the morbidity and mortality of CKD
-CKD poses challenges to quantity and quality of life
-Also, treatment is very expensive and difficult (Transplants are very costly and organs are difficult to procure)
CKD as a public health issue
-CKD meets all the requirements for a public health issue, including: high disease burden, higher incidence in certain ethnic groups, increased prevalence in underprivileged and low socioeconomic groups, availability of preventive measures that can be implemented at the community level
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