38 Hypertension

Question 1

What is hypertension level? symptomatic or asymptomatic?

Answer 1

sustained 140/90 mmHg, asymptomatic

Question 2

What is the JNC7 classification of hypertension for 
Normal?
Prehypertension?
Stage1?
Stage2?

Answer 2

High= 160 or >100

Question 3

Do systolic or diastolic BP tend to decrease after 50 years old?

Answer 3

Diastolic–systolic seems to just keep increasing

Question 4

What is 90-95 % of all hypertension and has an unknown etiology? What does the unknown etiology arise from?

Answer 4

1. Essential hypertension

2. Polygenetics and altered regulation of arterial pressure

Question 5

How does a tumor of the adrenal cortex cause hypertension? Adrenal medulla?

Answer 5

1. increase mineral corticoids–> increase blood volume

2. increase epinephrine–> vasoconstriction

Question 6

What does renal artery stenosis do to cause hypertension?

Answer 6

Increase renin release–increase angiotensin II Also other kidney will eventually hold off its higher volume because of TGF

Question 7

What is the definition of MAP?

Answer 7

Cardiac output x total peripheral resistance

Question 8

What are the 2 major determinants of stroke volume?

Answer 8

Ventricular filling pressure and myocardial contractility

Question 9

What is the most important neural sensory mechanism for blood pressure?

Answer 9

Arterial baroreceptors (also chemoreceptors and muscle metaboreceptrs

Question 10

What are the two main outputs from neural control on BP?

Answer 10

ParaSNA=Heart

Sympathetics= heart vessels and kidney

Question 11

What is the neuronal route from the carotid sinus to the SNA input to the kidney?

Answer 11

carotid sinus–>NTS—>RVLM–>SNA IML etc.

Question 12

What are the 2 underlying causes of abnormal baroreceptor function?

Answer 12

loss of afferent function=oxygen radicals, atherosclerosis, less distensible
central defect= angiotensin II, loss of baroreceptor pathways, emotional or reactive stress

Question 13

What does normal fluid regulation look like in the kidney?

Answer 13

up arterial pressure–> up renal perfusion–> down Na and H2O reabsorption and down renin release

Question 14

What percentages of people have high, low and normal renin but have hypertension?

Answer 14

15% high, 25% low, 60% normal, but drugs attacking the renin are still very effective

Question 15

Vasopressin, aldosterone, catecholamines have what general effect on BP?

Answer 15

Increase CO and peripheral vascular resistance

Question 16

What does angiotensin II feedback inhibit?

Answer 16

Renin- at renal B1 receptors [blocks angiotensinogen from becoming angiotensin II]

Question 17

Which angiotensin II receptor leads to increased aldosterone? Is this a slow or fast pressor response?

Answer 17

AT1 [this is a slow pressor response]

Question 18

How does ACE inhibitor modulate the bradykinin system?

Answer 18

Blocks kininase II from degraded bradykinin which leads to B2 effects of vasodilation and B1 effects of inflammation

Question 19

What are the 3 endothelial-derived vasodilators? how do each lead to vasodilation

Answer 19

1. PGI2- up adenylyl cyclase–>incr. cAMP–>SM relax
2. NO- up guanylyl cyclase–> incr. cGMP–> SM relax
3. EDHF–> k channels and SM hyperpolarization effect

Question 20

Does abnormal vascular function in CV disease arise from abnormal endothelial function or abnormal smooth muscle function?

Answer 20

Both

Question 21

What is smooth muscle function determined by?

Answer 21

Intracellular calcium concentration and calcium sensitivity of contractile proteins

Question 22

What are the 3 endothelial-derived vasoconstrictors? What happens in the smooth muscle cell?

Answer 22

1. endothelin-1
   TXA2
   AngII
2. Increase Ca2 concentration

Question 23

Does NE cause vasodilation?

Answer 23

Vasoconstriction

Question 24

Does endothelin-1 on ETa or ETb lead to constriction?

Answer 24

ETa…ETb does dilation

Question 25

What 4 things are in the diet modification or initial strategy for decreasing BP?

Answer 25

Body weight reduction
Restrict sodium intake
restrict fat intake
decrease alcohol

[also want physical activity, but is not diet]

Question 26

Does excess sodium effect vascular resistance at all?

Answer 26

Yes- it increases it.
[promotes intracellular Ca, increased basal tone of VSM, increases response of NE and ANGII, Increase vessel stiffness, increase fluid retention, increase NE and EPI release]

Question 27

What is the mechanism of obesity leading to hypertension?

Answer 27

insulin dependent increase in Na+ reabsorption or increase in central-mediated vasoconstriction