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2. Cardiovascular System > 14. Long Term Control of BP > Flashcards

14. Long Term Control of BP Flashcards

1
Q

Is long term control of BP mediated by arterial baroreflex?

A

No

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2
Q

What does long term control of BP revolve around primarily?

A

revolves around the control of plasma volume by the kidney

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3
Q

What 3 hormone systems are involved in long term control of BP?

A
  1. renin-angiotensin- aldosterone system
  2. antidiuretic factor (ADH, vasopressin)
  3. atrial natriuretic peptide
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4
Q

What organ is primarily involved in long term control of BP?

A

kidneys

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5
Q

What are main functions of the kidney? (5)

A
  1. excretion of waste products
  2. maintenance of ion balance
  3. regulation of pH
  4. regulation of osmolarity
  5. regulation of plasma
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6
Q

Control of what is used to regulate MAP?

A

control of PLASMA VOLUME

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7
Q

What arteriole carries blood to the Bowman’s capsule?

A

afferent arteriole

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8
Q

Where does pressure filtration occur in the nephron? (filtration of blood to lumen)

A

in the Bowman’s capsule (in the glomerulus) which is under pressure from the heart

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9
Q

Where does reabsorption and secretion occur in the nephron? (3)

A
  1. proximal tubule
  2. distal tubule
  3. collecting duct (eventually leading to bladder for excretion)
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10
Q

Where does reabsorption occur? (lumen to blood) in the nephron?

A

in the loop of Henle

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11
Q

What does the kidney do in terms of long term control of BP?

A

regulates plasma volume

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12
Q

What does the renal system create outside the collecting duct in terms of osmolarity?

A

creates high osmolarity outside the collecting duct

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13
Q

What determines how big the osmotic gradient is?

A

control over Na tranport

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14
Q

What determines if the water follows that osmotic gradient or not?

A

control over the permeability of the collecting duct to water

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15
Q

Therefore what can kidneys regulate in terms of water? (2)

A
  1. control how much water is lost (in urine)

2. control how much water is retained (reabsorbed)

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16
Q

As filtrate moves through nephron where does Na concentration increase?

A

outside the collecting duct (Na is pumped out when it reaches last tube) as filtrate is lower in conc as you move along nephron

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17
Q

How can a size of conc. gradient be modified?

A

by modifying permability of collective duct

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18
Q

What is the filtrate osmolarity at the start and end of nephron in mOsm?

A

start: 300mOsm
end: 50mOsm

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19
Q

By making the collecting duct very permeable to water, what effect will this have on:

  • water reabsorption
  • urine
  • plasma volume
A
  • lots of water reabsorption from body capillaries and other vessels back into blood
  • little urine
  • plasma volume conserved (remans high)
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20
Q

By making the collecting duct very impermeable to water, what effect will this have on:

  • water reabsorption
  • urine
  • plasma volume
A
  • little reabsorption into the surrounding vessels (more liquid retained)
  • lots of urine (diuresis)
  • plasma volume reduced
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21
Q

What effect will a very permeable collecting duct have on hyper-osmotic urine?

A

small volume of hyper-osmotic urine produced only (not much at all and not very watery)

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22
Q

What conc. of urine is found when collecting duct is very permeable?

A

High conc. of urine (because lots of water crossing over back into body which means less urine made)

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23
Q

What conc. of urine is found when collecting duct is impermeable?

A

Low conc. of urine (because less water crosses over and more is retained which means urine is more diluted)

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24
Q

What effect will a very impermeable collecting duct have on hypo-osmotic urine?

A

large volume of hypo-osmotic volume

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25
Q

Where is renin (hormone) produced?

A

fro the juxtaglomerular of the kidney (granule cells)

26
Q

What triggers renin production? (3)

A
  • activation of sympathetic nerves to the juxtaglomerular apparatus
  • decreased distension (expanding) of afferent arterioles (the renal baroreflex) triggers renin production
  • decreased delivery of Na/ CL through the tubule
27
Q

What is the renin production a sign of?

A

all of these are signs of low MAP

28
Q

Where are granule cells found in a nephron?

A

found on afferent arterioles

29
Q

What 3 things triggers release of renin? (signals reduced MAP)

A
  1. Reduced delivery of Na/CL signals reduced MAP in macula densa just before Loop of Henle
  2. Decreased distension signals reduced MAP in afferent arteriole
  3. Sympathetic innervation signals reduced MAP
30
Q

What does renin do?

A
  • converts inactive angiotensinogen to angiotensin I
  • this is in turn converted by angiotensin converting enzyme (ACE) to angiotensin II
    (therefore it’s a precursor)
31
Q

What is the main hormone which “does stuff” in the angiotensin pathway?

A

angiotensin II

32
Q

What does angiotensin do?

A
  1. stimulates release of aldosterone from the adrenal cortex
  2. increases release of ADH from the pituitary
  3. is a vasoconstrictor
33
Q

What does aldosterone do? (3)

A
  • stimulates synthesis of more Na pumps, creating a bigger conc. gradient so more Na reabsorption in loop of Henle
  • reduces diuresis
  • increases plasma volume
34
Q

What does ADH do?

A
  • increases water permeability of the collecting duct
  • MORE water reabsorbed
  • less urine produced
  • increased thirst
35
Q

What effect does vasoconstriction have on TPR?

A

increases TPR

36
Q

Is renin-angiotensin-aldosterone system a negative feedback system?

A

yes

37
Q

What are the primary functions of negative feedback system? (3)

A
  • multiple mechanism detects any decrease in MAP
  • stimulates release of renin
  • it evokes multiple mechanisms which increase MAP
38
Q

Where is ADH produced?

A
  • synthesised in the hypothalamus
39
Q

Where is ADH released from?

A

released from posterior pituitary gland

40
Q

What 3 things stimulate ADH release?

A
  1. decrease in blood volume (sensed by cardiopulmonary baroreceptors and relayed via medullary cardiovascular centres)
  2. increase in osmolarity of interstitial fluid (as sensed by osmoreceptors in the hypothalamus)
  3. circulating angiotensin II (triggered by renin-angiotensin- aldosterone system)
41
Q

When is ADH released? (relating to plasma volume and/or MAP)

A

when signs of LOW plasma volume and LOW MAP

42
Q

What is the link between osmolarity and plasma volume?

A
  • high osmolarity means low plasma volume

- low osmolarity means high plasma volume

43
Q

What does ADH do in order to specifically increase MAP?

A
  1. increases permeability of collecting duct to water (more reabsorption) which reduces diuresis and increases plasma volume
  2. causes vasoconstriction (hence name vasopressin) which increases MAP
44
Q

What does diuresis mean?

A

Urination increase

45
Q

Is the ADH system a negative feedback system?

A

Yes

46
Q

What are the 3 main features of ADH hormone system?

A
  1. multiple mechanism detects any decrease in MAP
  2. stimulates release of ADH
  3. this evokes multiple mechanism which increases MAP
47
Q

Where are ANP (atrial natriuretic peptide) and BNP (brain natriuretic peptide) produced and released?

A

produced and released from myocardial cells in the atria

48
Q

What causes ANP and BNP release?

A

increased distension (expansion) of the atrium

49
Q

What does a distension/ expansion of atrium indicate about the MAP?

A

it means it’s a sign of increased MAP

50
Q

What do ANP and BNP do? (3)

A

Plans to DECREASE MAP by:

  1. increase excretion of Na (natriuresis)
  2. inhibits release of renin
  3. acts as medullary CV centres to reduce MAP
51
Q

Is the ANP and BNP hormone system a negative feedback system?

A

yes

52
Q

What are 3 primary features of ANP and BNP system?

A
  1. a mechanism that detects any increase in MAP
  2. stimulates release of ANP
  3. this evokes multiple mechanisms which reduce MAP
53
Q

What is primary hypertension?

A

hypertension of unknown cause

54
Q

What is secondary hypertension?

A

hypertension due to a known cause

55
Q

What percentage of hypertension is classed as secondary?

A

only 5-10% (most are vastly due to unknown cause)

56
Q

What are drugs for managing hypertension targeted at?

A

targeted at kidney function

57
Q

What types of drugs are given for treatment of hypertension? (5)

A
  1. Ca channel antagonists
  2. b1 adrenoreceptor antagonists
  3. thiazide diuretics (stop Na transport)
  4. angiotensin converting enzyme inhibitors
  5. angiotensin II antagonist
58
Q

What does long term control of MAP revolve around?

A

revolves around hormones acting on the kidney to control plasma volume

59
Q

When is renin-angiotensin-aldosterone system stimulated and what does it do?

A
  • stimulated when decrease in MAP

- it aims to increase MAP

60
Q

When is ADH (vasopressin) system stimulated and what does it do?

A
  • stimulated when decrease in MAP

- it aims to increase MAP

61
Q

When is ANP and BNP system stimulated and what does it do?

A
  • stimulated when increase in MAP

- it aims to decrease MAP

2. Cardiovascular System (42 decks)

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