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What is considered prehypertension
Decrease BP in LUE and femoral artery
Coarctation of the aorta
Whats the difference between primary and secondary hypertension
- Primary 95%-unknown etiology
- Secondary 5%-known etiology
Name the types of secondary hypertension
renovascular, coarctation of aorta, phenochromocytoma, OSA, exogenous substance.
–-males in all age group
–In the third and fourth decades, it is more than twice as common among men as in women.
–Men have a substantially higher complication rate than women
AGE RISK factors
- –BP rises steadily into the fifth and sixth decades of life
- –By then the prevalence of HTN approaches 50% > 50 yrs
- –The complication risk also rises steadily with age
–African American marked increase prevalence–Compared to Caucasians, the prevalence is
–Severe HTN is 5 times more common in African Americans–CVA of AA due stoke > mortality
- –Clients with BMI > 30 have a 3-5 times risk of developing HTN than people of normal weight.
OTHER RICK FACTORs
–Positive family history
–Psychological stress (difficulty to identify and quantify)
WHEN to Screen
- –First screening at age 3
- –-all adult
- - BP at lease 2 times. Any time take BP is screening
Where to screen
–Screen everyone at clinic
–Malls, grocery stores, schools, etc.
–Must be able to refer if in a booth in mall
.–Must have a plan
- –Reliable equipment
- –Correct cuff size 80% of arm
- –Correct position (feet on floor, arm relaxed, sitting position)
- –Correct technique
- •Systolic measured when first sound heard
- •Diastolic measured when sound disappears
- •Arm positioned at heart level
- •BP should be taken in both arms with client seated
- •Averages of two successive measurements in each arm are recorded
Other Causes > BP
•Recently exercised (last 4-6 hrs)
•-caffeine (last 6 hrs)
- •Diagnosis–The diagnosis of HTN must never be made on the basis of a single reading. (on 2 occasion)
- –If elevated during routine screening, recommend client have a recheck within one week. Must have 2 reading.
- Can recheck at home if believe relable methhod
–Greater than 140/90 on two or more readings taken at two or more visits
–Diabetics:130/80 goal on ace (<130/80)/ need low BP to reduce risk
- •Diagnosis HTN–First step is to look for it.
- –Make sure it is measured correctly.
- –May be falsely elevated with:
- •Previous activity
- •-tobacco if smoke heavyly ( treat for BP
–A single reading of >210 sys &/or >115 diastolic is adequate to make the diagnosis and treat.
•Isolated systolic HTN is common (diastiloc is normal)
ICD 9 Codes
•-elevated bp (796.2) not labeled for life
•-HTN (401.1) for life and on medical records
will have >BP at other time in life.
Follow closely with frequent check
- •Differential Diagnosis–Eliminate secondary causes
- •-HTN for first time in individual <25 (rarely have do full work up)
- •Acute onset of severe ( >210 DBP >110)HTN at any age
- •Adherent individuals whose BPs do not lower with antihypertensive medications ( not able to control so consider complete work up)
Patients with certain clinical manifestations
–Central obesity, ecchymosis Cushing
–-acute anterior chest and mid back pain (Anuersym)
–Weight loss, nervousness, exophthalmos (hyperthyriodism)
–Paroxysmal complaints of headache, perspiration, palpitations (Phenochromcytoma) PPP comes and go
•-arteriscortic vascular disease
- •Sedentary life-style
- •-type A
- •Family history
- •Previous history of HTN
- •Make sure they understand why they were on it
- •Patient ED is important