BP and Hypertension Patho

Question 1

What are the 2 major components of BP?

Answer 1

CO and SVR

Question 2

Short Term BP Regulation

Answer 2

• Need to quickly accommodate BP (may be behavioral, emotional, physiologic)
• Mediated by sympathetic nervous system
• Influences HR and SVR

Question 3

Long Term BP Regulation

Answer 3

• RAAS system
• Neural/hormonal/renal interaction
• Connected with fluid volume homeostasis
• Influences HR, SV, SVR

Question 4

RAAS

Answer 4

Renin Angiotensin Aldosterone System

Question 5

Renin

Answer 5

• Baroreceptors sense decrease in volume or BP so signals kidneys to release renin into the bloodstream
• Renin converts angiotensinogen to angiotensin I in liver

Question 6

Angiotensin I

Answer 6

• Angiotensin I is converted to angiotensin II in lungs

- Converted by Angiotensin-converting enzyme

Question 7

Angiotensin II

Answer 7

• Primary player in regulation
• Causes potent vasoconstriction and release of aldosterone
• Vasoconstriction increased PVR which increases BP

Question 8

Aldosterone

Answer 8

• Causes sodium and water retention
• Retained sodium and water increase blood volume
• Increased blood volume causes increased BP

Question 9

Long term circulating Angiotensin II

Answer 9

• Long term vasoconstriction
• Long term HTN
• Decreased blood flow to brain may cause stroke
• Decreased blood flow to kidneys causes repeat of this cycle

Question 10

End Organs and RAAS system

Answer 10

• HTN can cause long term negative effects in end organs: brain, heart, adrenal glands, kidneys, efferent arterioles
• Preventable downstream effects

Question 11

Hypertension Definition

Answer 11

• Increase in BP
• Most common primary diagnosis in the US
• About 30% of population and increasing, also increasing in global population
• More chronic illness with less infectious disease

Question 12

Primary HTN

Answer 12

• 90% of cases

- Idiopathic = unknown cause

Question 13

Secondary HTN

Answer 13

• 10% of cases
• Specific cause
• Examples: ingesting something that causes HTN (salt, meds, supplements, caffeine, food), sleep apnea, pregnancy
• Most of these are preventable causes

Question 14

Risk Factors for HTN

Answer 14

• Most are Preventable/Modifiable
• Having 2+ risk factors significantly increases your risk for stoke/heart attack/heart disease/etc
• Smoking, diabetes, dislipidemia, overweight/obesity, physical inactivity, unhealthy diet, chronic kidney disease, family history, increased age, low SES, male, sleep apnea, psychosocial stress, race/ethnicity, genetics

Question 15

Childhood/Adolescent Risk Factors for HTN

Answer 15

• Maternal smoking
• Gestational HTN
• Diet
• Low birth weight followed by rapid growth
• Low SES of mom
• Inadequate calcium in pregnancy
• Breastfeeding reduces risk

Question 16

HTN Evaluation

Answer 16

• BP
• Cholesterol/Triglycerides
• Blood sugar
• Weight
• Risk factors

Question 17

HTN Treatment

Answer 17

• Lifestyle modifications!!!!!

- Pharmacology for HR, SVR, SV

Question 18

4 HTN disorders in Pregnancy

Answer 18

• Preeclampsia/eclampsia
• Chronic HTN
• Chronic HTN with superimposed preeclampsia
• Gestational HTN

Question 19

Risk Factors for HTN in Pregnancy

Answer 19

• Maternal age
• First pregnancy
• In-vitro fertilization
• Morbid obesity
• Multifetal gestation
• Chronic renal disease
• Chronic HTN
• Family history of preeclampsia
• Diabetes mellitus
• Rheumatoid arthritis
• Lupus

Question 20

What are the 2 major mechanisms behind preeclampsia

Answer 20

1. Placental ischemia: blood not getting to placenta and baby
2. Maternal vascular dysfunction: may or may not be related to pregnancy
   - Placenta may be abnormal with arterial resistance
   - Endothelial dysfunction
   - CV and inflammatory changes have systemic effects (kidneys, liver)

Question 21

Clinical Manifestations of Preeclampsia

Answer 21

• BP over 140/90 on 2 occasions, 4 hours apart
  AND
• Proteinuria
  OR
  thrombocytopenia, increased liver enzymes, RUQ pain, elevated serum creatinine, pulmonary edema, visual disturbances/cerebral

Question 22

S/S of Preeclampsia

Answer 22

• Headache
• Edema
• Weakness
• Clonus
• Hyperreflexia
• Vomiting
• Oliguria
• Jaundice

Question 23

Diagnosis of Preeclampsia

Answer 23

• History and Physical

- Labs: platelets, proteinuria, liver enzymes

Question 24

Treatment for Preeclampsia

Answer 24

• Mild: bed rest, fetal monitoring

- Severe: birth, vasodilating drugs, antihypertensive, seizure prophylaxis