HYPERTENSION emsseo.com

Introduction Incidence Morbidity/Mortality 50 million Americans 1 in 5 Americans or 18% Undiagnosed 15 million (30% of the 50 million) 1 in 18 Americans or 5% Morbidity/Mortality Gender – Male=49.7. Female=50.3 Death Rate (per 100,000) – White Males=14.4, Black Males=49.6, White Females=13.7, and Black Females=40.5. emsseo.com

Define Systolic blood Pressure: Normal Define Blood Pressure Define Systolic blood Pressure: Normal Define Diastolic Blood Pressure: Normal What are blood pressure perimeters that indicate high pressure. What are some factors that determine blood pressure. Formula What factors may affect blood pressure determination. emsseo.com

Blood Pressure Regulation Mechanisms Autonomic Nervous System Kidneys (Renin-Angiotensin-Aldosterone) Endocrine System emsseo.com

RENIN An enzyme released by the kidney that stimulates production of angiotensin. A protein secreted by the kidneys that raises blood pressure back to normal when it begins to fall. emsseo.com

ALDOSTERONE The main electrolyte-regulating hormone secreted by the adrenal cortex: primarily controls sodium and potassium balance. Released by the adrenal glands that increases blood pressure by signaling the kidneys to retain sodium, which increases blood volume. emsseo.com

Angiotensin A peptide that is produced by a biochemical reaction caused by the enzyme Renin. Hormone that has two forms: angiotensin I which is inactive and angiotensin II which is the active form. The latter raises blood pressure by causing arteries to constrict and triggering the release of aldosterone. emsseo.com

Renin-Angiotensin KNOW THIS Renin stimulates formation of angiotensin I: Then converts to angiotensin II Angiotensin II is a potent vasoconstrictor Stimulates ADH secretion Results in: Reabsorption of sodium and water Elevation in blood pressure Activation of renin-angiotensin system emsseo.com

ADH ADH is a hormone released by pituitary gland but made elsewhere (in the hypothalamus). ADH has an antidiuretic action; it suppresses the rate of urine production. ADH is also known as vasopressin. emsseo.com

Blood Pressure Regulation Mechanisms Autonomic Nervous System Baroreceptors – Measure stretch (heart, great vessels) Chemoreceptor's – Measure hypoxemia, acidosis…pH & PO2 (carotid, aortic bodies) Results in vessel dilation or constriction emsseo.com

Blood Pressure Regulation Mechanisms Kidneys (Renin-Angiotensin-Aldosterone) Decreased BP Renin secreted by kidneys. Works on angiotensinogen to produce angiotensin I Angiotensin I converted to angiotensin II by angiotensin converting enzyme (ACE) Vasoconstriction & secretion of aldosterone and ADH (AKA: Vasopressin) Results in water and sodium retention and higher blood pressure emsseo.com

Blood Pressure Regulation Mechanisms Kidneys (Renin-Angiotensin-Aldosterone emsseo.com

Sketch the Renin – Angiotensin –Aldosterone mechanism. emsseo.com

Myocardial hypertrophy Starlings Law Peripheral Vascular Resistance Define Hypertrophy Myocardial hypertrophy Starlings Law Peripheral Vascular Resistance emsseo.com

CHF, HTN, & Renal Failure Long term untreated HTN leads to hypertrophy (LV). The Starling effect is compromised and the LV is not fully emptied during systole. Decreased Stroke Volume (SV) and Cardiac Output (CO). Blood backs up causing CHF Less cardiac output = major organs (vessels, kidneys, brain, eyes) not adequately perfuse Cells are then damaged, begin to fail, and die emsseo.com

Hypertension Development Recognized Factors CAD Age Heredity Ethnicity African-Americans, Puerto Ricans, Cubans, Hispanics Diet Cholesterol Fats Sodium Weight Obesity Smokeless Tobacco Users Stress/Type A Personalities emsseo.com

Hypertension Etiology Primary Hypertension No specific identifying cause Arteriole wall vasoconstriction, wall damage Many risk factors Develops over years May or may not be symptomatic Treatment aimed at lowering BP through diet and medications Patient Home Medications - Cardiac emsseo.com

Hypertension Etiology Primary Hypertension Patient Home Medications – Cardiac Beta Blockers Calcium Channel Blockers Adrenergic Inhibitors ACE Inhibitors Diuretics emsseo.com

Calcium Channel blockers ACE Inhibitors ACE? Diuretics Describe the therapeutic actions for each class & identify several medications that are used. Beta Blockers Calcium Channel blockers ACE Inhibitors ACE? Diuretics emsseo.com

Hypertension Etiology Secondary Hypertension Often has an identifying cause 10% of hypertension cases Abrupt onset Commonly renal in origin Renal artery stenosis Polycystic disease Fibro-muscular disease of renal artery Adrenal tumors emsseo.com

Anatomical Damage from Hypertension Vessels Kidney Brain Heart emsseo.com

Anatomical Damage from Hypertension Vessels Large vessels – Sclerosis (hardened) Narrowed lumen – tunica media hypertrophy, tunica intima with endothelium damage (allows vascular content leakage) Lose of elasticity Decreased blood flow Occlusion, tear, rupture (aneurysm) Increased PVR Aorta – Weakens and leads to aneurysms Small vessels Damage to intima layer Scar tissue Fibrin strands/clot formation Obstruction emsseo.com

Anatomical Damage from Hypertension Kidney Poor perfusion leads to organ damage Decreased function…failure In many cases, leads to renal dialysis emsseo.com

Anatomical Damage from Hypertension Brain Stroke/CVA – Cerebral Vascular Accident TIA – Trans Ischemic Attack emsseo.com

Anatomical Damage from Hypertension Heart As described earlier AMI Vessel obstruction from poor blood flow (coronaries) Hypertrophy Outgrows blood supply Smaller chamber size Decreased CO – Incomplete LV emptying CHF – Congestive Heart Failure (result of increased PVR) Poor perfusion of other organs, related to CO emsseo.com

Pre-hospital Hypertensive Crisis Pathophysiology can cause intercerebral or subarchnoid bleeding and cerebral infarcts Cerebral edema BP generally greater than 100 mmHg diastolic Other key organs can be damaged as well Common cause is sudden discontinuation of HTN medications Pregnancy Induced Hypertension is a common cause (5% of pregnancies) emsseo.com

Pre-hospital Hypertensive Crisis Signs/Symptoms – Marked BP Elevation Headache Nausea Vomiting Confusion Restless Seizure Stroke Coma Frequent LOC checks AMI Arrhythmias EKG monitoring Nosebleeds Airway issues emsseo.com

Pre-hospital Hypertensive Crisis Management Rapid lowering of BP can be dangerous Slow lowering (2-6 hours) of BP is preferred Ischemia and infarct is possible Nitroprusside Nitroglycerine is not preferred in the EMS environment Pre-hospital therapies: Airway control, as needed Calm, reassure patient Oxygenation & Ventilation IV – TKO EKG Monitoring LOC reassessment Vital signs emsseo.com

Long Term Treatment of Hypertension Slight decrease (5%) in BP will decrease the risk of stroke by 35-40% Adequate treatment of high blood pressure will decrease: Heart failure 52% (Higher risk for CHF) Often develops into CHF 91% Stroke 38% LV Hypertrophy 35% Cardiovascular Mortality 21% emsseo.com

Hypertension Prevention & EMS Role EMS has a role in educating the public Prevention Programs On-scene Education emsseo.com

Hypertension Prevention & EMS Role What to educate: Lifestyle changes @ early age Good diet Reduce cholesterol, lipids, and triglyceride levels Exercise Avoid tobacco Take prescribed medications emsseo.com

Hypertension Prevention & EMS Role EMS Activities FD station BP checks, educate as needed Organized healthcare screenings, educate as needed On-scene treatment and education emsseo.com

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