HTN Pathophysiology and Lifestyle Management

Question 1

1. What condition is the most common primary diagnosis in the U.S. as well as the most common reason for use of prescription medication?

Answer 1

hypertension (HTN)

Question 2

1. Describe the relationship between blood pressure and age regarding both systolic and diastolic.

Answer 2

as patients age:
systolic pressure shows linear increase
diastolic increases until then 5th decade then decreases (due to increasing vascular stiffness as elastin is replaced by collagen, less blood volume during diastole- diastole run-off)

Question 3

1. Describe the relationship between aging men and women and the prevalence of HTN.

Answer 3

men have a higher prevalence until 45yo
after age 64yo women have a higher prevalence
(change attributed to hormonal changes of menopause

Question 4

1. What percent of the people without HTN at age 50yo will develop HTN before the age of 90?

Answer 4

90%

Question 5

1. Describe the relationship between increased systolic and diastolic pressures with mortality due to ischemic heart disease?

Answer 5

for every 20 mm Hg systolic and 10mm Hg diastolic, the risk of death due to IHD doubles

Question 6

1. Define normal, prehypertensive, stage 1 and stage 2 hypertension using blood pressure.

Answer 6

normal 160 or >100

hypertension is defined as the level of pressure associated with doubling of long-term CV risk

Question 7

1. Contrast primary and secondary hypertension.

Answer 7

essential or primary hypertension (95% HTN) is not cause specifically by another condition while secondary causes of HTN are specific disease processes that cause HTN (sleep apnea, thyroid disease etc.) ; patients with primary hypertension may still have co-morbidities that may be related to their HTN

Question 8

1. Name some of the contributing systems/factors that regulate blood pressure

Answer 8

goal: tissue perfusion

blood volume and viscosity
chemical mediators
cardiac output
vessel elasticity and neural input
kidney function (long term control)

all controls occur on differing time scales

Question 9

3. Persistent hypertension develops in response to an increase in ____ ____ or a ___ ____ ___

Answer 9

cardiac output (more common cause in young patients)
systemic vascular resistance (more common cause in older patients)

Question 10

2. Does the heart spend more time in diastole or systole

Answer 10

diastole, remember MAP is not calculated as a simple average (= DBP + ⅓ (SBP-DBP))

Question 11

2. Name 9 risk factor for developing elevated blood pressure.

Answer 11

age
tobacco use
lower SES
obesity
family history
sedentary lifestyle
psychosocial stressors
intrauterine abnormalities
dietary factors (primarily Na intake)

Question 12

2. Describe how HTN and endothelial damage are related. Also, why is leptin important?

Answer 12

endothelial dysfunction causes less release of NO a natural vasodilator
leptin is considered important in understanding the relationship between obesity and HTN

Question 13

2. What action does sodium have on the body that supports the development of HTN.

Answer 13

renal sodium retention > extra-cellular-fluid volume expansion
vascular smooth muscle contraction> increased systemic vascular resistance

Question 14

2. What is the major chemical mediator of the sympathetic nervous system’s control on blood pressure?

Answer 14

norepinephrine (activity increases with age, weight, and SVR to cause vasoconstriction, tachycardia, renin release, vascular remodeling and renal sodium retention)

CNS receives feedback as well as exerting systemic control

Question 15

4. What stimulates renin release, and what is renin’s consequent action?

Answer 15

renin release is a response to hypoperfusion or the activation of the SNS; it’s action is to convert angiotensinogen to angiotensin I

Question 16

4. What chemical metabolism does ACE complete and what is it’s (metabolite’s) associated receptor?

Answer 16

ACE converts angiotensin I to angiotensin II and angiotensin II binds to the AT1 receptor to trigger aldosterone release

ACE also metabolizes bradykinin (which can eventually effect NO release and vasodilation

Question 17

4. AT1 receptors can be found on what types of tissues? (5)

Answer 17

kidney, adrenal gland, vascular smooth muscle, CNS and myocardium; excess can cause heart failure, myocardial ischemia, stroke, nephrosclerosis and retinopathy

Question 18

5. Describe some of the benefits of lowering blood pressure on CV outcomes.

Answer 18

reducing blood pressure lowers CVD risk:
35-40% reduction in myocardial infarction
20-25% reduction in myocardial infarction
>50% reduction in heart failure

Question 19

6. Name 6 life style interventions that can be used in treatment of hypertension.

Answer 19

weight reduction (linear relationship, even small reduction important)
adopt DASH diet
dietary sodium reduction
physical activity
moderation of alcohol consumption
smoking cessation

Question 20

6. What are the components of the DASH diet?

Answer 20

(dietary approaches to stop hypertension)
low saturated fat and cholesterol
emphasizes fruits, veggies and low fat diary products
reduces red meat, sweets and sugar containing beverages

(can decrease BP in 2 weeks)

Question 21

6. Where does the majority of dietary sodium come from?

Answer 21

processed and restaurant foods