Bio 252- Hypertension

Question 1

D/t circadian rythms bp highest @ and lowest @

Answer 1

highest in morning
declines throughout day
lowest at 2am-5am

Question 2

Hypertension ___ etiology

Answer 2

idiopathic

Question 3

BP=___ x ____

Answer 3

CO (cardiac output) x PR (peripheral resistance )

-at rest CO stable variable, PR is changing variable

Question 4

Hypertension

Answer 4

persistently increased bp >140/90

Question 5

Systolic

Answer 5

Pumping phase (contracting)

Question 6

diastolic

Answer 6

Filling phase (resting)

Question 7

Hypertension is classified by

Answer 7

type, cause & severity

Question 8

4 major control systems of (BP)

Answer 8

1. arterial baroreceptors: detect changes in pressure, alert nervous system (aorta, right ventricle, carotid)
2. Vascular autoregulation: localized vasoconstriciton & vasodilation
3. RAAS (Renin angiotensin aldosterone system)
4. Regulation of fluid volume: water & electrolytes via kidneys

Question 9

Normal blood pressure

Answer 9

S: <120
D: <80

Question 10

High normal

Answer 10

S: 120-139
D: 80-89

Question 11

Stage 1 (mild)

Answer 11

S: 140-159
D: 90-99

Question 12

Stage 2 (moderate)

Answer 12

S: 160-179
D: 100-109

Question 13

Stage 3 (severe)

Answer 13

S: >180
D: >110

Question 14

Primary hypertension or essential hypertension

Answer 14

• idiopathic
• aprox 90% of HTN pts
• both diastolic & systolic pressure
• multifactoral etiology: (defect in control systems?) kidney implicated–fluid & electrolyte balance affected or other 3 homeostatic mechanisms

Question 15

secondary hypertension

Answer 15

• aprox 5-10% OF CASES
• identifiable cause, most commonly d/t renal disease (renovascular hypertension)– decrease in renal perfusion —RAAS– leads to secretion of 2 hormones angiotensin & aldosterone have direct impact on kidneys
• normally cannot alleviate primary disease/cause of secondary HTN

Question 16

Systolic hypertension

Answer 16

• systolic pressure >140, but diastolic <90
• individuals 50+ @ greater risk:
  - w ageing tissue deteriorate, dilation less likely
  - decrease in compliance, decrease in accommodation

            -atherosclerosis (decrease in elasticity will increase systolic but not diastolic)

Question 17

3 other types of hypertension

Answer 17

Malignant hypertension: sudden excessive increase in hypertension, diastolic pressure >120, emergency situation, affects small blood vessels especially in retina

white coat hypertension: increased bp in health care setting

gestational hypertension: HTN caused by pregnancy, most women go back to original state after birth, leads to primary hypertension for some

Question 18

Mnfts of hypertension

Answer 18

“silent killer”

• during most of progression no obvious mnfts
• no early signs beside increase in bp
• mnfts of complications of HTN: those of progressive organ damage (heart, kidney, eyes, vessels)
• later: Am headaches (increase in bp in morning d/t circadian rythm), fatigue, palpitations ( SENSATION of forceful heartbeat, rapid, may be irregular), dizziness, blurred vision (retina has tiny # of blood vessels may erupt d/t pressure

Question 19

TX of uncomplicated HTN

Answer 19

1. Lifestyle Modifications: diet, weight, exercise, smoking, alcohol intake, sodium consumption, stress management

2: 1st line, Diuretics (monotherapy):
- loss of fluid & electrolytes via the kidneys, loss of fluid causes decrease in blood volume and then decrease in BP

3. Ca++ channel blocker:
   - reudces contratction of heart muscle by inhibiting Ca++ channels in heart causing decrease strength of contraction, decrease cardiac output and decrease in BP
4. Angiotensin II recpetor blocker:
   - Blocking receptor of Angiotensin II, angiotensin II works on adrenal glands & kidney, Angiotensin II works a level of kidneys causes vasoconstriction in arterioles (increase Bp), cause adrenal glands to secrete aldosterone which increases Na+ reabsorbed ( increase Bp)
5. ACEI (ACE inhibitors):
   - Prevents potent vasoconstrictor Angoitensin II
   - also prevents release of aldosterone & ADH vie angiotensin II

Question 20

Renin Angiotensisn Aldosterone system

Answer 20

-regulates Bp by bringing up
-Low Bp or Low serum sodium level (low sodium level
where sodium goes water follows)
-Liver releases hormone Angiotensinogen into blood
-in response to Angiotensinogen kidney shoots out enzyme Renin
-Angotensinogen & Renin react to equal Angiotensin 1
-In response to Angiotensin 1 circulating in blood stream, Lungs release Angiotensin Converting Enzyme (ACE)
-Angiotensin 1 + ACE = Angiotensin 2
-Angiotensin 2 works on adrenal glands & kidneys
-Angiotensin 2 works at level of kidneys causes vasoconstriction in arterioles (increasing bp)
-Angiotensin cause kidney & adrenal glands to release Aldosterone
-Aldosterone: increase Na+ reabsorbed (increasing Bp)
-decreases K+

Question 21

what is the most common identifiable cause of secondary hypertension

Answer 21

renal disease