Chapter 23: Disorders of Blood Pressure Regulation

Question 1

What is systolic pressure?

Answer 1

pressure at the height of the pressure pulse, the stroke volume ejected from the heart, the aorta stretches

Question 2

What is diastolic pressure?

Answer 2

the lowest pressure, energy stored in the aorta’s elastic fibers, and resistance to blood flow from the peripheral blood vessels

Question 3

what is pulse pressure?

Answer 3

the difference between systolic pressure and diastolic pressure

Question 4

what is the mean arterial pressure?

Answer 4

the average pressure in the arterial system during ventricular contraction and relaxation

Question 5

What is involved in short term regulation of blood pressure?

Answer 5

the correction of temporary imbalances through neural mechanisms like baroreceptors and chemoreceptors that can cause vasoconstriction or vasodilation, and humoral mechanisms like the RAAS pathway and vasopressin (ADH) that encourage water resorption

Question 6

What do baroreceptors and chemoreceptors do?

Answer 6

regulate temporary imbalances in blood pressure by causing vasoconstriction and vasodilation

Question 7

What is involved in long term regulation of blood pressure?

Answer 7

renal mechanisms

Question 8

What is circadian regulation of blood pressure?

Answer 8

the daily variations in blood pressure depending on the time of day – lowest in the morning and rises as the day goes on

Question 9

For a diagnosis of HTN what does your blood pressure need to be?

Answer 9

systolic over 140 and diastolic over 90

Question 10

For a diagnosis of pre-hypertension what does your blood pressure need to be?

Answer 10

systolic between 120-139 and diastolic between 80-89

Question 11

What is hypertension blood pressure for someone with diabetes?

Answer 11

130/80

Question 12

What is essential hypertension?

Answer 12

primary hypertension - chronic elevation in blood pressure from no other cause, generally due to modifiable and non-modifiable risk factors

Question 13

what are non-modifiable risk factors?

Answer 13

things you cannot correct yourself like family history, age, race

Question 14

What are modifiable risk factors?

Answer 14

things you can change like smoking, drinking, weight, diet, stress, high salt intake, sedentary lifestyle…

Question 15

What are the target organs for damage in essential hypertension?

Answer 15

the heart, kidneys, brain, peripheral vascular, retina

Question 16

What are heart complications in essential hypertension?

Answer 16

hypertrophy: the heart has to work harder due to the increase in resistance so it starts to expand and add more muscle to combat the increase in resistance

Question 17

What are brain complications in essential hypertension?

Answer 17

dementia and cognitive impairment

Question 18

What are peripheral vascular complications from essential hypertension?

Answer 18

atherosclerosis

Question 19

what are kidney complications from essential hypertension?

Answer 19

nephrosclerosis – damage to the capillaries in the kidneys

Question 20

What are retinal complications from essential hypertesnion?

Answer 20

aneurysms, hemorrhage in retinal blood vessels

Question 21

What is the treatment for essential hypertension?

Answer 21

lifestyle changes, pharm agents like diuretics, beta blockers, ACE inhibitors ARBs, Calcium channel blockers, vasodilators

Question 22

What is secondary hypertension?

Answer 22

elevation of blood pressure from another disorder

Question 23

What causes secondary hypertension/what are the conditions it occurs with?

Answer 23

kidney disease (most common), adrenal cortical disorders, pheochromocytoma, oral contraceptives

Question 24

Why can secondary HTN occur during kidney disease?

Answer 24

due to renal artery stenosis due to atherosclerosis

Question 25

Why can secondary HTN occur during adrenal cortical disorders?

Answer 25

you are producing too much aldosterone = higher absorption of sodium and water = high BP

Question 26

why can secondary HTN occur during pheochromocytoma?

Answer 26

it is an adrenal tumor that causes the release of catecholamines that increase HR and increase BP

Question 27

What are the hypertension disorders that occur during pregnancy?

Answer 27

gestational hypertension -- occurs after 20 weeks gestation chronic hypertension -- if you had it previous to pregnancy preeclampsia -- HTN, and can lead to clotting disorders, delivery is the only cure

Question 28

How do you treat HTN during pregnancy?

Answer 28

early prenatal care, refraining from alcohol and substance use, salt restriction, bed rest, antihypertensive meds (carefully chosen) or delivery

Question 29

Is primary or secondary HTN more common in children?

Answer 29

secondary

Question 30

What secondary HTN conditions can cause HTN in children?

Answer 30

kidney abnormalities, coarctation of the aorta -- narrowing of the aorta going into the abdomen so it causes blood to back up, and pheochromocytoma

Question 31

What is orthostatic HTN?

Answer 31

abnormal decrease in bp when standing up

Question 32

What does orthostatic HTN cause?

Answer 32

decrease venous return due to pooling of blood in extremities, decrease in cardiac output

Question 33

What causes orthostatic HTN?

Answer 33

things that decrease vascular volume like dehydration conditions that impair muscle pump function like spinal cord injuries or bed rest conditions that interferes with cardiovascular reflexes like certain meds, or disorders of the ANS

Question 34

What is the treatment for orthostatic HTN?

Answer 34

removing underlying cause avoiding diuretics drugs that increase bp consuming more salt