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BS - Cardiovascular System > Blood Pressure Control > Flashcards

Blood Pressure Control Flashcards

1
Q

What is the equation for blood pressure?

A

Mean systemic arterial pressure =

cardiac output x total peripheral resistance

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2
Q

Why must blood pressure be closely auto-regulated?

A

To ensure there is a balance between organ perfusion and vascular damage

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3
Q

What is the equation for total peripheral resistance?

A

R = (8nL)/pi x r^4

R = resistance to blood flow
L = length of the vessel
n = viscosity of the blood
r = radius of the vessel
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4
Q

What component has the largest effect on the value for total peripheral resistance?

A

radius of the blood vessel

This, therefore, also has a large effect on blood pressure

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5
Q

What else can the value for TPR be affected by?

A

Autonomic nervous system

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6
Q

What are the aims of the short- and long-term control mechanisms to regulate blood pressure?

A

To balance any changes in blood pressure to maintain a consistent organ perfusion pressure

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7
Q

What is the role of baroreceptors and where are they located?

A

In the carotid sinuses and aortic arch

They detect arterial pressure

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8
Q

How will decreased arterial pressure affect the baroreceptors?

A

Decreased firing of the baroreceptors

This increases sympathetic tone and decreases parasympathetic tone

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9
Q

How will increased arterial pressure affect the baroreceptors?

A

Increased firing of the baroreceptors

This increases parasympathetic tone and decreases sympathetic tone

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10
Q

On which organs does the sympathetic nervous system act on to achieve:

i. positive chronotropy
ii. positive dromotropy
iii. positive ionotropy
iv. positive lusitropy

A

i. sino-atrial node
ii. atrioventricular node
iii. ventricles and atria
iv. atria and ventricles

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11
Q

What is meant by ‘positive chronotropy’?

A

The action of the sympathetic nervous system will increase the heart rate

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12
Q

What is meant by ‘positive dromotropy’?

A

The sympathetic nervous system increases conduction velocity through the AV node

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13
Q

What is meant by ‘positive inotropy’?

A

The sympathetic nervous system increases the strength of muscular contraction

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14
Q

What is meant by positive ‘lusitropy’?

A

The sympathetic nervous system increases the rate of myocardial relaxation after contraction

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15
Q

What are the other 2 actions of the sympathetic nervous system after activation by baroreceptors?

A
  1. activation of the renin-angiotensin-aldosterone system

2. suprarenal stimulation leads to the release of catecholamines from the adrenal glands

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16
Q

What are the 2 types of natiuretic peptide?

What type of blood pressure control are they involved in?

A

Long-term blood pressure regulation

ANP - atrial natriuretic peptide

BNP - brain natriuretic peptide

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17
Q

What is the role of natriuretic peptides in blood pressure regulation?

A

They induce the excretion of Na+ in urine

They try to reduce the pressure in the system by increasing fluid loss through urine

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18
Q

When are natriuretic peptides released?

What condition is diagnosed by measuring levels of natriuretic peptides?

A

When myocytes are mechanically stretched by increasing plasma volume

Measuring levels of natriuretic peptides is used in diagnosing heart failure

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19
Q

What is hypertension defined by?

A

Having a systolic blood pressure greater than or equal to 140 mmHg

and/or a diastolic blood pressure greater than or equal to 90 mmHg

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20
Q

What is hypertension a result of?

A

Blood pressure control mechanisms are dysfunctional or unable to compensate for stressors on the body

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21
Q

What are the 2 types of hypertension?

A
  1. Primary (essential) (90% of cases)

2. Secondary (10% of cases)

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22
Q

What is significant about the cause of primary hypertension?

A

There is no cause of hypertension

It happens due to pathological maladaptation of the blood system

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23
Q

What is significant about the cause of secondary hypertension

A

There is something wrong with the body that is causing the blood pressure to be high

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24
Q

What are the most common contributing factors to primary (essential) hypertension?

A
  1. over-activation of physiological mechanisms
  2. age-related decrease in baroreceptor sensitivity
  3. age-related vascular calcification
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25
Q

What are the 5 most common causes of secondary hypertension?

A
  1. renal - renovascular disease, parenchymal disease
  2. endocrine - Conn’s or Cushing’s syndrome
  3. cardiovascular - coarctation of the aorta
  4. tumour - pheochromocytoma
  5. pregnancy - pre-eclampsia/eclampsia
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26
Q

What is pheochromocytoma?

A

A tumour of the adrenal glands caused by overactivation and catecholamine excess

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27
Q

What is significant about calcification of the blood vessels with increasing age?

A

Blood vessels are not as compliant

The total peripheral resistance cannot change as much

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28
Q

Why are at least three readings needed to diagnose hypertension?

A

“White coat syndrome” makes people anxious in a clinical setting

This causes their blood pressure to rise

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29
Q

What is often used to overcome the complications of “white-coat syndrome”?

A

Ambulatory/home blood pressure monitoring

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30
Q

How does hypertension lead to left ventricular hypertrophy?

What is this?

A

It involves thickening of the left ventricular wall

It occurs in response to the increase in pressure in the left ventricle

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31
Q

What happens to the cells in left ventricular hypertrophy and what is the result of this?

A

The cells do not become more numerous, they get bigger

The result of this is to try and force more blood out of the heart

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32
Q

What is diastolic dysfunction?

How is it a result of left ventricular hypertrophy?

A

Impaired filling of the left ventricle during diastole

Thickening of the LV wall means that the ventricle cannot relax properly to allow it to fill with blood

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33
Q

How diastolic dysfunction and LVH affect LV end diastolic pressure?

A

LVH leads to increased stiffness

Diastolic dysfunction leads to impaired relaxation

Both of these factors will increase LV end diastolic pressure

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34
Q

How can increased LV end diastolic pressure lead to systolic heart failure?

A

The increase in pressure is transmitted back into the LA and into the lungs

This leads to pulmonary congestion that leads to heart failure

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35
Q

How does prolonged hypertension affect the blood vessels?

A

It leads to vascular remodelling

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36
Q

Where does eutrophic remodelling occur?

What is the result of this?

A

Small arteries

Media-to-lumen ratio is increased but medial cross-sectional area decreased

This increases systemic vascular resistance and leads to an increase in diastolic blood pressure

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37
Q

Where does hypertrophic modelling occur and what is involved?

A

Large arteries

Media-to-lumen ratio and the medial cross-sectional area are increased

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38
Q

How does hypertrophic remodelling lead to an increase in systolic blood pressure?

A

Thickening of the smooth muscle layer leads to an increase in the stiffness of the wall

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39
Q

What is significant about remodelling of the arteries increasing blood pressure further?

A

remodelling reduces the compliance of the arteries

This further increases the blood pressure

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40
Q

What conditions are the blood vessels more prone to in hypertension?

A
  1. large vessel structural damage

2. atherosclerosis

41
Q

Which parts of the body are affected by atherosclerotic disease?

A

All parts of the body are affected as all parts of the body contain blood

42
Q

What can atherosclerosis in the coronary arteries, kidneys and neck lead to?

A

Coronary arteries - heart failure, arrhythmias, angina, myocardial infarction

Kidneys - renal failure

Neck - stroke

43
Q

What are the 3 steps involved in hypertensive neuropathy?

A
  1. renal arteriole thickening leads to luminal narrowing
  2. the resulting ischaemia leads to tubular atrophy and interstitial fibrosis
  3. this leads to damage to the glomeruli, leading to haematoproteinuria
44
Q

What is the outcome of hypertensive neuropathy?

A

Damage to the glomeruli leads to increased leakage

Things that are not meant to pass through the filter., such as proteins, pass through and are detected in urine

45
Q

What is hypertensive retinopathy?

A

Popping of the small blood vessels in the eye due to high blood pressure

If untreated, a patient will eventually go blind

46
Q

What are the 4 visible signs of hypertensive retinopathy?

A
  1. papilledema
  2. exudates
  3. flame haemorrhages
  4. cotton wool spots
47
Q

What is papilledema?

A

Swelling of the optic disc

This is the point where the optic nerve enters the eye

48
Q

What is an exudate?

A

Any fluid that filters from the circulatory system into lesions/areas of inflammation

49
Q

What causes flame haemorrhages?

A

Accumulation of blood at the level of the nerve fibre

50
Q

What are cotton wool spots and what causes them?

A

Fluffy white patches on the retina

Caused by damage to the nerve fibres due to swelling of the retinal nerve fibres

51
Q

Why are hypertension investigations carried out?

A
  1. to look for a cause of secondary hypertension
  2. to assess end-organ damage

(signs of dysfunction in major organs which are affected by hypertension)

52
Q

What is a full blood count used to look at in hypertension?

A

Haemoglobin levels

This gives an indication of blood viscosity

53
Q

What is a urea and electrolyte test used to look at in hypertension?

A

It assesses kidney function

It looks for signs of renal impairment and hypernatremia

54
Q

What is hypernatremia?

A

A rise in serum sodium concentration

55
Q

Why are lipid and glucose levels measured when performing tests on hypertension?

A

To look for any other cardiovascular disease risk factors

e.g. glucose in urine indicates diabetes

56
Q

What are urine samples checked for in hypertension?

A

Haematuria and proteinuria

presence of blood and/or protein in the urine

57
Q

What is indicated by haematuria and/or proteinuria in hypertension?

A

If hypertension has affected the kidneys, blood and/or protein is present in urine

58
Q

What would be seen on an ECG of someone with left ventricular hypertrophy and why?

A

QRS complex has a high amplitude

Hypertrophied muscle has a higher electrical amplitude

59
Q

How could LVH be identified from an echocardiogram?

A

The thickness of the left ventricle wall can be measured to see if it is hypertrophied

60
Q

Why might the diameter of the left atrium be measured on an echocardiogram?

A

To see whether left atrial dilatation is present

61
Q

Why might left atrial dilatation be present?

What type of patients is this expected to be seen in?

A

High pressure in the ventricles due to LVH is transmitted back to the atria

This is present in patients who have had hypertension for a long time

62
Q

How can coarctation of the aorta be identified on an echocardiogram?

What is this?

A

By using the Doppler effect

There is an abnormal narrowing in the aorta which leads to high blood pressure

63
Q

What is fundoscopy?

Why is it used in patients with hypertension?

A

It involves looking at the retina in the back of the eyes

This is used to detect grade I - IV hypertensive retinopathy

64
Q

In the case of pheochromocytoma, what test may be performed?

A

24-hour urinary catecholamines are collected

65
Q

In the case of Conn’s syndrome, what test may be performed?

A

Plasma renin-aldosterone levels are measured

66
Q

What are the 5 lifestyle modifications involved in the management of hypertension?

A
  1. increased exercise helps with blood pressure control
  2. weight loss
  3. changing diet
  4. smoking cessation
  5. education
67
Q

Why does increasing exercise and weight loss help with management of hypertension?

A

Increased exercise helps with blood pressure control

Being overweight increases blood pressure and is associated with diabetes

68
Q

What dietary changes help in management of hypertension?

A

Cutting down on salt and reducing the amount of alcohol consumed

69
Q

What type of education may help people manage their hypertension?

A

Resources that allow people to make decisions for themselves

They do not like being told what to do directly

70
Q

What is high blood pressure a risk factor for?

How does this affect smoking cessation?

A

Cardiovascular disease

If you have another risk factor for CVD, this should try to be cut out as well as lowering the blood pressure

71
Q

If lifestyle changes do not work, what treatment is used for hypertension?

Why is this not the preferred method of treatment?

A

Pharmacological treatments

Medications have side effects so it is preferable that BP is lowered through lifestyle changes

72
Q

What is the A(B)CD of pharmacological management of high blood pressure?

A

A - ACE inhibitors and ARBs

(B) - Beta blockers

C - Calcium channel blockers

D - diuretics

73
Q

What is a commonly used ACE inhibitor and how does it work?

A

Ramipril

It inhibits angiotensin-converting enzyme (ACE)

angiotensin I cannot be converted to angiotensin II

74
Q

What is a common angiotensin II receptor blocker (ARB)?

How does it work?

A

Candesartan

It blocks the effects of angiotensin II, even though it is still present in the blood stream

75
Q

How do calcium channel blockers work?

A

They disrupt the movement of Ca2+ through calcium ion channels

76
Q

What are the 2 types of calcium channel blockers and an example?

A

Dihydropyridine (e.g. amlodipine)

Non-dihydropyridine (e.g. diltiazem)

77
Q

How do dihydropyridines lower blood pressure?

A

They cause vasodilation

78
Q

How do non-dihydropyridines lower blood pressure?

A

They cause vasodilation

They are also negatively inotropic (decrease strength of muscular contraction)

And negatively chronotropic (decrease heart rate)

79
Q

What is the result of blocking calcium channels on the heart and blood vessels?

A

It reduces total peripheral resistance

It also reduces cardiac output by decreasing the force and speed of contraction of the heart

80
Q

What are diuretics and how do they reduce the blood pressure?

A

They induce diuresis which reduces the circulating volume of the blood

This reduces the preload, and the blood pressure

81
Q

What are the 2 types of diuretics and examples?

A

Thiazide diuretics (e.g. Bendroflumethiazide)

Loop diuretics (e.g. furosemide)

82
Q

What is the difference between loop and thiazide diuretics?

A

Loop diuretics act on the loop of Henle in the nephron

Thiazide diuretics act on the distal convoluted tubule

83
Q

Why are beta blockers no longer used to treat hypertension?

A

They are not as effective as other treatments and have more side effects

84
Q

How does Bisoprolol affect the heart and blood vessels?

A

It is a beta blocker that also reduces renin secretion

It blocks the effects of the sympathetic nervous system on the heart

There is no suprarenal stimulation or activation of the RAAS

85
Q

What type of drug is doxazosin and how does it work?

A

It is an alpha-blocker which blocks the effects of adrenaline

Adrenaline causes blood vessels to narrow

86
Q

How do moxonidine and spironolactone work?

A

moxonidine lowers sympathetic nervous system activity

spironolactone is an aldosterone antagonist

87
Q

According to NICE guidelines, what are the 4 steps involved in a treatment plan for treating hypertension?

A

1 - Patients <55 start on A
Patients >55 or black start on C

2 - A + C

3 - A + C + D

4 - add another diuretic or a-blocker or b-blocker

88
Q

According to NICE guidelines, how should treatment for hypertension begin?

Why?

A

Patients are started on a low dose to allow their body to get used to the medication

This allows for a gradual change rather than a steep decrease in BP

89
Q

According to NICE guidelines, what happens if the initial dose of the first drug is not effective?

A

The dose can be increased over time until the blood pressure is significantly improved

90
Q

According to NICE guidelines, what happens if the patient reaches the maximum dose of the first drug and it is not effective?

A

If they reach the maximum dose and their blood pressure is still high, a second medication is added

The same process is repeated

91
Q

What should be done if a patient is on 3 different medications and their blood pressure has still not improved?

A

Ask the patient if they are taking their medication

Many patients stop taking medication as they do not like the side effects

92
Q

Which hypertension drugs are preferred in left ventricular systolic dysfunction?

A

ACE inhibitors and A2RBs

Beta blockers

93
Q

Which hypertension drugs are preferred in angina?

A

Beta blockers and calcium channel blockers

94
Q

Which hypertension drugs are preferred in diabetes/proteinuria?

A

ACE inhibitors and A2RBs

95
Q

When should ACE inhibitors and A2RBs not be used?

A
  1. pregnancy
  2. renal artery stenosis
  3. hyperkalaemia (high potassium levels)
96
Q

Why should ACEi/A2RBs not be used in renal artery stenosis?

A

This can lead to pulmonary oedema and a massive fall in blood pressure

97
Q

When should beta blockers not be used and why?

A

Asthma

Blue inhalers contain beta agonists

98
Q

When should diuretics not be used?

A
  1. hypokalaemia (low potassium levels)

2. gout

BS - Cardiovascular System (20 decks)

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