7- Pathophysiology of HTN

Question 1

diagnosis of HTN

Answer 1

2 or more recordings taken in seate position at 2 or more office visits

Question 2

THN

Answer 2

> 140/90

Question 3

are white-coat hypertensives at risk?

Answer 3

actually yes- at a higher risk for some of the cardiovascular related events seen in overtly hypertensive patients

Question 4

the risk for MI, stroke, and HF doubles with a ___ increase in systolic or _____- increase in diastolic

Answer 4

20 stytolic or 10 diastolic

Question 5

T or F: aging is a risk factor for hypertension

Answer 5

90% risk of developing HTN in normal middle aged adults

Question 6

after age 50, _____ decreases while ____ continues upward trend

Answer 6

diastolic decreases while systolic continues to increase

why? (aginf impars cardiac function = reduce diastolic, alters vascular function = increase systolic)

older individuals are more likely to have isolated systolic hypertension than both HTN, younger more likely isolated diastolic

Question 7

where are arterial baroreceptors located?

Answer 7

carotid sinus

Question 8

moemnt-to moement modulation of blood pressure

Answer 8

nerual reflexes

Question 9

where are the cardiopulmonary receptos

Answer 9

atria and pulmonary arteries

Question 10

what activates a baroreceptor?

Answer 10

distending pressure in teh carotid or atria

increased stretch genereates an action potential

Question 11

receptors respond only to stretch: T or F

Answer 11

both the actual stretch and how the strech is changing with time

Question 12

why aren’t baroreceptors involved in long-term maintenance of blood pressure

Answer 12

resetting after extended periods of activation

Question 13

integrating site for baroreceptor information

Answer 13

nucleus of the solitary tract NTS in the medulla of brainstem

Question 14

an increase in afferent activity in a negative feedback loop will reslut in…

Answer 14

reduction in efferent nerve traffic

Question 15

a fall in arterial oxygen, icnrease in carbon dioxide or decrease in pH stimulates…

Answer 15

vasoconstriciton and bradycardia

Question 16

ANG II causes…

Answer 16

direct vasoconstriction and moderate sodium reabsorption

and stimulataes aldosterone secretion –> even greater sodium reabsorption

Question 17

“pressure naturesis”

Answer 17

high pressure, through an icnrease in resistance, will transiently increase sodium excretion. since water follows sodium, this also results in a reduction in blood volum. Blood pressure is therefore restored.

Question 18

reduction in kidney mass, enhance reabsoption of sodiu,, or decrease in glomerular capillary filtration ( reduce filtration coefficient or increase preglomerular resistance) WILL –>

Answer 18

hypertension

Question 19

underlying pathology of HTN is known

Answer 19

secondary HTN

because these are secondary forms of hypertension, the elevation of blood pressure is an apporpriate response to the intial stimulus

Question 20

pathologoy includes derangemen tof the chemoreflex due to intermittent hypercapnic/hypoxic episodes

Answer 20

obstructive sleep apnea

increased sympathetic activity results which not only changes ventilation but also peripheral resistance

Question 21

pheochromocytoma

Answer 21

NE/epi secreting tumor

Question 22

why has pharmacological treatment of RVD been cotnroversial

Answer 22

ANG II constricts afferent and efferent arteriole to maintain a constant GFR and changing renal hemodyanamic may impair renal function

Question 23

first line treatment for HTN

Answer 23

lifestyle modification

Question 24

weight reduction

Answer 24

5-20 mmHG/10kg weight loss

Question 25

DASH eating

Answer 25

8-14 mmHg

Question 26

sodium restriction

Answer 26

2-8 mmHg reduction

Question 27

physical activity

Answer 27

4-9 mmHg

Question 28

moderate alcohol consumption

Answer 28

2-4 mmHg

Question 29

resistant/refractory htn

Answer 29

blod pressure goal not reached with 3 or more pharmacological agents

Question 30

first pharmacological agent, then other combinations

Answer 30

1= diruetic
2= RAAS target, calcium channel blocker or beta blocker

Question 31

stage 1 HTN

Answer 31

140/90

Question 32

stage 2 HTN

Answer 32

160/100

Question 33

target BP for older than 60

Answer 33

150/90

Question 34

target BP for under 60 yo

Answer 34

140/90

Question 35

target BP for those with diabetes or chronic kidney disease

Answer 35

140/90

Question 36

each incremental increase in SBP (20 mm) __________ risk for MI, HF, stroke, kidney disease

Answer 36

doubles

risk increases exponentially

Question 37

most people have ______ HTN (95%)

Answer 37

essential/primary HTN

Question 38

plaques, fibrosis in renal artery or arterioles causes the intrarenal baroreceptors to sense what?

Answer 38

a decrease in renal blood pressure which activates the cascade causing an increase in blood pressure = HTN