Cardio 4

Question 1

What is the distribution of SBP in a population?

Answer 1

Unimodal with a skew towards upper values

Question 2

What are the variants that determine blood pressure?

Answer 2

Genetics (50%) and environmental (50%)

Question 3

What are the features of rare coding variants?

Answer 3

1 in 2000, affect coding sequence (2% of DNA that codes for protein structure) – a variant in this code stops normal protein function, 5mmHg

Question 4

What are the features of common non-coding variants?

Answer 4

1 in 3, alter non-coding parts of the genome, DNA involved with when and where the proteins are expressed, differentiates one cell from another,

Question 5

Is the sequence of DNA or its expression immutable? Why/why not?

Answer 5

Sequence of DNA is immutable but expression is not - epigenetics

Question 6

What is SBP at the start of life?

Answer 6

60 mmHg

Question 7

What happens at the point where people split to develop a higher or lower BP?

Answer 7

Specific genes relative to blood pressure are expressed

Question 8

Is there a correlation between parental and personal BP?

Answer 8

Yes, but not all people follow this trend

Question 9

What was a feature of renin levels in the high high and low low groups (parental and personal BP)?

Answer 9

High high had high renin and low low had lowest plasma renin

Question 10

What was a feature of the renal arteries in people with high BP?

Answer 10

High renal vascular resistance

Question 11

What are the features of the SHR?

Answer 11

Kidney function diminished - low GFR, high plasma renin, high BP

Question 12

What is a treatment to stop BP increasing later in life?

Answer 12

Perindopril - drops BP early in life and even after treatment stops BP is kept low

Question 13

What is the action of perindopril?

Answer 13

Blocks RAS system by inhibiting Ang II

Question 14

What are some effective forms of RAS inhibition?

Answer 14

ACE inhibitor, Ang I receptor antagonists, Ang 1 receptors antisense cDNA, renin antibodies

Question 15

What is the problem with calcium channel blockers and vasodilators?

Answer 15

Dropped BP during treatment but after treatment stopped the effects diminished

Question 16

When is action on BP most effective?

Answer 16

Puberty

Question 17

What is the feature of the milan rats?

Answer 17

Didn’t respond to BP treatment early in life - no effect later in life

Question 18

What happens if you transplant an untreated kidney into a treated animal?

Answer 18

BP rises to the high level it would have reached without treatment

Question 19

What are the long term physiological mechanisms of perindopril?

Answer 19

vascular structure (more supple CV system), sympathetic NS (rest internal set point), reduced angiotensinogen, renal function (lower renal vascular resistance and higher renal blood flow)

Question 20

What are the features of the TROPHY study?

Answer 20

772 participants, prehypertension, average 48 years, 2 years of treatment with angiotensin receptor blocker, during treatment - rates of hypertension were reduced - but study wasn’t followed through so unsure if it was a lifetime effect