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SALMAN HARRISON'S > 271 - Hypertensive Vascular Disease > Flashcards

271 - Hypertensive Vascular Disease Flashcards

1
Q

Which disease are doubled in frequency due to HTN (HyperTensioN)?

A
  1. CHD
  2. CHF
  3. Stroke (ischemic/ hemorrhagic)
  4. RF (Renal failure)
  5. PAD (Peripheral Arterial Disease)
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2
Q

_____ and _____ are strong independent risk factors for HTN

A
  1. Obesity

2. Weight increase

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3
Q

The ratio between ____ and ____ in the urine has higher correlation to HTN risk than when considered separately

A
  1. Sodium

2. Potassium

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4
Q

_____ of patients with HTN are > ____ overweight

A
  1. 60%

2. 20%

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5
Q

____ and ____ are the two determinants of arterial pressure

A
  1. Cardiac output

2. Peripheral resistance

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6
Q

What are the two adrenergic receptor groups

A
  1. Alpha (A1, A2)

2. Beta

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7
Q

Explain what are the Alpha1 receptors (4)

A
  1. Activated by norepinephrine
  2. Found in the post synaptic cells of smooth muscle
  3. Cause vasoconstriction when stimulated
  4. Increase tubular absorption of sodium in kidney
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8
Q

Explain what are the Alpha2 receptors (2)

A
  1. Found in the presynaptic membrane- synthesizing norepinephrine.
  2. When stimulated by catecholamines they create negative feedback- blocking norepinephrine release
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9
Q

How HTN drugs affect A1 and A2?

A
  1. Inhibit A1 receptors

2. Act as agonists for A2

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10
Q

Beta receptors are activated by ____

A

Epinephrine

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11
Q

How does the activation of B1 receptors increase CO?

A

Increase the rate and contractility of the heart

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12
Q

Activation of B2 receptors by ____ cause ____ of smooth muscle and _____

A

Epinephrine
Relaxation
Vasodilatation

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13
Q

the RAAS system contribute to the regulation of _____ mainly by _____ of _____ and sodium absorption by_____

A

Arterial pressure
Vasoconstriction
AT2
Aldosterone

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14
Q

Where does renin ins mostly synthesized from?

A

Afferent arteriole

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15
Q

What are the 3 triggers for the release of renin?

A
  1. Decrease in the transition of NaCl to the distal part of the thick ascending limb bordering the macula densa
  2. Decrease in the pressure inside the afferent arteriole (baroreceptor mechanism_
  3. Sympathetic stimulation of the renin-secreting-cells through B1 receptors
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16
Q

____ is the main factor leading to the synthesis and secretion of _____ from the zona glomerulosa in the ______

A

AT2
Aldosterone
Adrenal cortex

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17
Q

AT2 is a growth stimulator and when in excess may contribute to process such as (3)

A
  1. Atherosclerosis
  2. Cardiac hypertrophy
  3. RF
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18
Q

Aldosterone is a potent mineralocorticoid which increase ____ absorption through ____ in the _____ cells in the cortical collecting duct

A

Sodium
ENaC (Epithelial sodium channel_
Principle

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19
Q

Which organs are affected due to HTN?

A

Heart
Brain
Kidney
Peripheral arteries

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20
Q

What is the range for: Normal, Prehypertension, Stage 1 hypertension, Stage 2 hypertension, Isolated systolic hypertension?

A
  1. <120 / <80
  2. 120-138 / 80-89
  3. 140-159 / 90-99
  4. > =160 / or >=100
  5. > =140 / and <90
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21
Q

____% of patients are diagnosed with primary HTN while ____% have a secondary reason for HTN

A

80-95

2-20

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22
Q

Primary HTN tends to be more ______and is a combination of _____ and _____ factors

A

Familial
Environmental
Genetic

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23
Q

In BMI of > ____ developing HTN is more likely

A

30

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24
Q

What is the metabolic syndrome?

A
  1. Insulin resistance
  2. Visceral fat and weight gain
  3. Dyslipidemia
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25
Q

HTN exist in more than ____ of patients with CRF. Proteinuria of > ____ and urine sediments are indicative for primary ______ disease

A

80%
1000 mg/dl
Renal

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26
Q

What are the two in risk groups for renal artery blockage?

A
  1. Old age patients with a blocking plaque in the proximal renal vein
  2. Patients with fibromuscular dysplasia (usually Caucasian young females0
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27
Q

What is the gold standard for diagnosing and assessing renal artery lesions?

A

Contrast arteriography

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28
Q

How much of the artery needs to be blocked to have a functional effect?

A

70%

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29
Q

What are the most effective treatments for HTN

A

ACEI

ARBS

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30
Q

How many of HTN patients have primary aldostrenism?

A

15%

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31
Q

Most of the primary aldosteronism patients are symptomatic, but may suffer from:

A
  1. Polyuria
  2. Polydipsia
  3. Paresthesia/ muscle weakness (due to hypokalemia/ alkalosis)
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32
Q

A good screening test for primary aldosteronism is____ taken in the morning

A

PA (Plasma Aldosterone) / PRA (Plasma Renin Activity)

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33
Q

A ratio of > ____ together with ____ serum concentration of > ____ has high specificity and sensitivity for _____

A

30:1
Aldosterone
555 pmol/L
Aldosterone producing adenoma

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34
Q

In patients with increase ratio diagnosis may be based on showing failure for _____ _____ in the plasma to a level below ____ after giving ___ liters of isotonic saline within ___ hours

A

Aldosterone suppression
277 pmol/L
2
4

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35
Q

The two most common causes for primary aldosteronism are____, ____. together they comprise ____ of cases

A
  1. Aldosterone producing adenoma
  2. Bilateral adrenal hyperplasia
  3. 90%
36
Q

Aldosterone producing adenoma is almost always ____, and measures < ____ cm

A

Unilateral

3

37
Q

Most of the patients with aldosterone producing adenoma have higher levels of aldosterone in the _____, reflecting the ____

A

Morning

ACTH cadence

38
Q

What is the best way to differentiate between unilateral and bilateral PA?

A

Bilateral adrenal venous sampling for aldosterone plasma levels

39
Q

Which adrenal related HTN patients may benefit from surgery?

A

patients with adenoma

40
Q

What does Cushing syndrome has to do with?

A

Excessive synthesis of cortisol due to hyper secretion of ACTH or non-dependent ACTH synthesis of cortisol

41
Q

HTN develops in ___ of patients

A

80%

42
Q

How would you diagnose patients with clinical signs for Cushing’s syndrome?

A 
1. Urine free cortisol for 24 hours 
 or 
2. Dexamethasone suppression test 
 or
3. Late night salivary cortisol
43
Q

Pheochromocytoma are ______ producing tumors found in the ____ of the _____ or in the ______ tissue

A

Catecholamines
Medulla
Adrenal gland
extra adrenal pre ganglionic

44
Q

What is the definitive treatment for pheochromocytoma?

A

Surgical excision, leading to treatment in 90% of cases

45
Q

What is the most common reason for HTN due to innate cardiovascular defect?

A

Coarctation of the aorta

46
Q

Coarctation of the aorta is usually sporadic , but occurs in ____ of ___ cases

A

35%

Turner’s syndrome

47
Q

The basic laboratory test for the renal system in HTN include: (3)

A
  1. Microscopic urinalysis
  2. Albumin exertion
  3. BUN and/ or creatinine
48
Q

The basic laboratory test for the endocrine system in HTN include:

A

Serum electrolytes (Na, K, Ca) and TSH

49
Q

The basic laboratory metabolic lab test in HTN include:

A
  1. Fasting blood glucose
  2. Total cholesterol
  3. HDL and LDL
  4. Triglycerides
50
Q

We recommend ____ for patients with per-HTN and HTN

A

Life style interventions

51
Q

Using drugs to decrease systemic BP in ___ (systolic) and ___ (diastolic) maylead to a decrease of ____ in risk for CHD and 16% for risk of ____

A

10-12 mm/Hg
5-6 mm/Hg
40%

52
Q

Thiazide inhibit _____ in the ____, therefor increase ____ excretion

A

Na/Cl pump
Distal convoluted tubule
Na

53
Q

In the long range thiazides act as _____

A

Vasodilators

54
Q

Thiazides have an additive effect when combined with: (3), adding ____ is less effective

A
  1. BB
  2. ACEi
  3. ARB
  4. CCB
55
Q

What are the side effects of thiazides?

A
  1. Hypokalemia
  2. Insulin resistance
  3. Increase in cholesterol levels
56
Q

Give an example for 2 thiazide drugs

A
  1. Hydrochlorothiazide

2. Chlorthalidone

57
Q

Loop diuretics such as ____ act on the co transporter NA-K-2Cl in the ____ of the ____. They are used in patients with HTN and ____, ____, ____.

A 
Furosemide 
Thick ascending limb
Loop of Henle
GFR decrease ( Cr>2.5 mg/dL)
CHF
Edema for other reasons
58
Q

ACEi decrease the synthesis of ____ and increase the levels of ____ therefor turn down ____

A

AT2
Bradykinin
Sympathetic system activity

59
Q

ARB selectively block ____ receptors and the effect of ___ on the unblocked AT2 receptors, which may lead to their ____ effect

A

AT1
AT2
Hypotensive

60
Q

RAAS drugs such as ACEi and ARB have a benefitable effect on ____ function, and reduce the S/E of ___ on glucose metabolism

A

Insulin

Diuretics

61
Q

ACEi S/E are: (4)

A
  1. RF
  2. Hypokalemia
  3. Dry cough
  4. Angioedema
62
Q

Name 3 ACEi drugs:

A
  1. Captopril
  2. Lisinopril
  3. Ramipril
63
Q

Name 3 ARB drugs:

A
  1. Losartan
  2. Valsartan
  3. Candesartan
64
Q

The aldosterone antagonist _____ is a non selective agent that can be used alone or together with ____

A

Spironolactone

Thiazides

65
Q

Spironolactone is effective treating patients with ____, ____, and _____

A

Low renin primary HTN
Resistant HTN
Primary aldosteronism

66
Q

Spironolactone binds to ___ and androgenic receptors leading to S/E such as: ___,___, and ____.

A

Progesterone
Gynecomastia
Impotence
Menstrual abnormalities

67
Q

____ is a selective aldosterone antagonist

A

Eplerenone

68
Q

BB are especially effective in patients with _____ and _____

A

HTN

Tachycardia

69
Q

Labetalol and Carvedilol block both ____ and ____ receptors

A

Alpha

Beta

70
Q

Name 2 cadioselective BB

A

Atenolol

Metoprolol

71
Q

Name a nonselective BB

A

Propranolol

72
Q

Name 3 CCB drugs

A
  1. Nifedipine
  2. Verapamil
  3. Diltiazem
73
Q

What are CCB S/E

A
  1. Blushing
  2. Headache
  3. Edema
74
Q

Decreasing BP in young patients is more effective using: ___, and ____

A

BB

ACEi

75
Q

Decreasing BP in old patients is more effective using: ___, and ____

A

Diuretics

CCB

76
Q

What is the BP goal we try to reach using HTN drugs?

A

under 135-140/80-85

77
Q

What is resistant HTN?

A
  1. > 140/90 although taking >=3 different HTN drugs

2. More common in patients >60

78
Q

What is malignant HTN?

A

A syndrome associated with an abrupt increase of blood pressure in a patient with underlying HTN or related to the sudden onset of HTN in a previously normotensive individual

79
Q

What should we pay attention to when suspecting malignant HTN?

A

The rate of HTN increase

80
Q

What is malignant HTN associated with?

A
  1. Diffuse necrotizing vasculitis
  2. Arteriolar thrombi
  3. Fibrin deposition in arteriolar wall
81
Q

What is the clinical signs of malignant HTN?

A
  1. Progressive retinopathy
  2. Renal deterioration + proteinuria
  3. Microangiopathic anemia
  4. Encephalopathy
82
Q

What is the first step in treating malignant HTN?

A

Decrease MAP in no more than 25% within minutes- to 2 hours to a BP in the range of 110-160/110 mm/Hg

83
Q

What is the go to drug treating malignant HTN?

A

Nitroprusside IV

84
Q

When the patient suffering from malignant HTN has no encephalopathy how long will we prefer the decrease in BP to last?

A

better hours than minutes

85
Q

In patients with ____ who are not candidate for ____ one recommended guideline is to institute antihypertensive therapy only for patients with a ____. If thrombolytic therapy is to be used, the recommended goal BP is _____

A

Cerebral infraction
Thrombolytic therapy
Systolic BP >200 mmHg or diastolic BO> 130 mmHg
<185/119

SALMAN HARRISON'S (163 decks)

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