Adult Cardio 4 (Hypertension) Flashcards
____ is sustained elevation of systemic arterial blood pressure
Hypertension
Hypertension may also be explained as a state of abnormal ___ function and structure associated with endothelial dysfunction, vascular smooth muscle constriction or remodeling, increased impedance to left ventricle ejection, and propensity for atherosclerosis, often but not always manifested by elevated blood pressure
Arterial
Is systolic BP on the top or bottom of the BP reading?
Top (systolic/diastolic)
Normal blood pressure is…
<120/<80
Elevated blood pressure is…
120-129 systolic AND <80 diastolic
Stage 1 hypertension is…
130-139 systolic OR 80-89 diastolic
Stage 2 hypertension is…
140+ systolic OR 90+ diastolic
A hypertensive crisis would indicate what BP readings?
180+ systolic OR 120+ diastolic
Before menopause, women tend to have ____ blood pressure than men but its flips after menopause
Lower
Blood pressure relationship to the risk of ___ ___ is continuous, consistent, and independent of risk factors
Cardiovascular disease
Each increment of __/__ mmHg doubles the risk of cardiovascular disease across entire blood pressure range starting from 115/75 mmHg
20/10
At early stages of hypertension, there are no manifestations, therefore it is difficult to achieve treatment ____
Compliance
AT early stages, the inconvenience of ___ ___ or side effects of the medication may be worse than nonexistent symptoms
Lifestyle modifications
What can happen if elevated blood pressure is not detected?
-Hypertension becomes established
-It promotes accelerated atherosclerosis and CVD beginning at age 30
-End organ damage
Lowering blood pressure can reduce risk of stroke by ___-___%
35-40
Lowering blood pressure can reduce the risk of MI by ___-___%
20-25
Lowering blood pressure can reduce the risk of heart failure by ___%
50%
The etiology of hypertension is unknown, but seems to result from a complicated interaction between ___ and the ___
Genetics, environment
An increase in __ __ and __ __ causes sustained increases in blood pressure
Vascular tone, blood volume
What environmental factors can increase risk of hypertension?
-Inactivity
-Stress
-Obesity
-Tobacco
-Age
-Salt
-Alcohol
Blood pressure is equal to ___ x ___
Cardiac output x peripheral resistance
Hypertension means ____ cardiac output and/or ___ peripheral resistance
Increased, increased
Cardiac output is equal to ___ x ___
Heart rate x stroke volume
A small change in diameter (vasoconstriction) results in large changes in ___
Resistance
Increased vasoconstriction=increased resistance–> major factor in generating increased pressure leading to ____
Hypertension
The kidneys release renin which leads to the creation of ____ and ____ which both lead to vasoconstriction
Angiotensin I and Angiotensin 2
What type of drug prohibits the formation of angiotensin II, leading to decreased vasoconstriction?
ACE inhibitors
A shift in the ___-____ relationship can influence total plasma volume
Pressure-natriuresis (sodium excretion)
For a given blood pressure, patients with hypertension tend to secrete ___ salt in their urine
Less
The pressure-natriuresis relationship is believed to be a central process in the pathogenesis of ____
Hypertension
There “sensor” in the kidney can sense blood flow because it is the ___ organ to receive blood flow; so, if the kidney is getting enough blood, every other organ should also be getting enough (if it is not, that means other organs are likely not getting enough)
Last
What things can lead to decreased renal salt excretion (indicative of hypertension)?
-Genetics
-Increased sympathetic nervous system response
-Increased renin, angiotensin, aldosterone (especially aldosterone)
-Endothelial dysfunction
-Dysfunction of the natriuretic hormones
-Renal glomerular and tubular inflammation
-Obesity
-Insulin resistance
-Increased dietary sodium intake
-Decreased dietary potassium, magnesium, and calcium
What genetic/environmental factors contribute to sustained hypertension?
-Insulin resistance
-Dysfunction of the SNS, RAA, adducin, and natriuretic hormones
-Inflammation
-Vasoconstriction
-Renal salt and water retention
-Increased peripheral resistance
-Increased blood volume
Black people have variations of the ____ ___ gene associated with hypertension and renal disease
Apolipoprotein L1
What genetic factors can lead to higher risk of hypertension?
-Family history
-Age
-Gender
-Black race
-High dietary sodium intake
-Glucose intolerance
-Cigarette smoking
-Obesity
-Heavy alcohol consumption
-Low dietary intake of K+, Ca++, and Mg++
Increased sympathetic nervous system activity can cause…
-Increased heart rate and peripheral resistance
-Increased insulin resistance
-Vascular remodeling
-Procoagulant effects
-Endothelial dysfunction
-Narrowing of vessels and vasospasm
-Hypertension
The renin-aldosterone-angiotensin system causes persistent increases in ___ ___ __ and __ ___ __
Peripheral vascular resistance; renal salt retention
Angiotensin II is responsible for…
-Remodeling
-Endothelial dysfunction
-Platelet aggregation
-Myocardial hypertrophy
Aldosterone leads to…
-Sodium retention
-Toxic to the cardiovascular system
Endothelial injury/tissues ischemia leads to ____ release
Cytokine
The release of cytokines leads to…
-Vascular remodeling
-Smooth muscle contraction
-Decreased production of vasodilators (nitric oxide)
-Increased production of vasoconstrictor (endothelin)
Decreased renal perfusion leads to ___ ___ and ___ ___
Tubular ischemia and preglomerular arteriopathy
Decreased renal perfusion caused decreased sodium ___ and increased sodium ___
Filtration, retention
Membrane-bound ____ located on the endothelium converts angiotensin I to angiotensin II locally, and metabolizes the endogenous vasodilator, bradykinin
ACE
Powerful vasoconstrictors that act on vessel smooth muscle include proteins known as ____ and the local action of ACE on the endothelium
Endothelins
Endothelins are ___ times more potent than angiotensin
10
Endothelins (ET-1, ET-2, and ET-3) are extremely powerful ____
Vasoconstrictors
ET-1 is produced in a variety of tissues including…
-Endothelial cells
-Vascular smooth muscle cells
-Neurons
-Astrocytes
-Endometrial cells
ET-2 and ET-3 are produced within the ___ and ____
Kidney and intestines
There are ___ receptors for the ET isoforms
3
Endothelin-A receptor is found largely in ___ ___ ___ and ___ and is responsible for mediating vasoconstriction
Vascular smooth muscle and myocardium
Endothelins are hightly active, potent, pleiotropic protein molecules that are involved in…
-Vasoconstriction
-Platelet aggregation
-Neutrophil adhesion
-Development of atherosclerosis
-Pulmonary hypertension
-Mediation of vascular and cardiac remodeling
Vasoactive substances that cause constriction tend to induce ___ ___
Cell growth
Substances that cause ___ tend to inhibit cell growth
Dilation
If the homeostasis between substances that cause constriction vs dilation is not maintained, ___ ____ develops
Endothelial dysfunction
Endothelial cells produces ___ ___
Nitric oxide
Endothelial dysfunction means that endothelial cell layers lose their ability to balance ____ vs ___ ___ (leads to focus on endothelin which causes prolonged vasoconstriction)
Endothelin vs nitric oxide
What things modulate renal sodium excretion?
-Atrial natriuretic peptide
-B-type Atrial natriuretic peptide
-Urodilanton
What can cause dysfunction of natriuretic peptides?
-Increased vascular tone
-Shift in pressure of natriuresis curve
Leptin and adiponectin together result in…
-Vasoconstriction
-Salt and water retention
-Renal dysfunction
Obesity increases ___ and ___
Leptin and adiponectin
Functions of leptin:
-Increases SNS activity
-Decreases renal sodium excretion
-Promotes inflammation
-Stimulates myocyte hypertrophy
Functions of adiponectin:
-Insulin resistance
-Decreased nitric oxide
-Activation of SNS and renal angiotensin aldosterone system
___% of patients with hypertension are insulin resistant
50
Insulin leads to increased endothelial cell production of ___ ___
Nitric oxide
Insulin resistance leads to ____ and endothelial dysfunction
Hyperinsulinemia
Insulin resistance causes…
-Activation of noreppy and angiotensin II (myocardial toxins)
-Increased blood pressure
-Increased dyslipidemia
Insulin resistance contributes to target ___ damage
Organ
If sodium and chloride concentrations in the blood are decreased, there is a decrease in secretion of ___ ___ which leads to decreased water intake, increased salt intake, and diluted urine
Antidiuretic hormone
If sodium and chloride concentrations are increased, there is an ___ in the secretion of antidiuretic hormone which leads to concentrated urine, thirst, and increased water intake
Increase
Sodium intake of more than ___ meq/day (2.3 grams) contributes to hypertension
100
Hypertension is rare when sodium intake is less than ___ meq/day (1.2 g)
50
Reducing sodium intake from ___ to ___ meq/day can reduce normotensive BP 2/1 mmHg and hypertensive BP 5/3 mmHg
170 to 100
What types of lifestyle modifications may slow down endothelial dysfunction and possibly reverse it?
-Physical activity
-Stopping smoking
-Weight reduction
-Reducing alcohol consumption
-DASH diet
-Low salt diet
-Adequate intake of potassium, calcium, and magnesium
-Stress management
