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CVS > Control Of Blood Pressure > Flashcards

Control Of Blood Pressure Flashcards

1
Q

Define Hypertension and state the normal BP range

A

Sustained increase in BP

Normal BP: 90/60 to 120/80

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2
Q

What range is Stage 1 Hypertension;

When Measured In clinic
When measured at home or in ambulance (HBPM/ ABPM)

A

Clinic: >/= 140/90

HBPM/ ABPM: >/= 135/85

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3
Q

What range is Stage 2 Hypertension;

When Measured In clinic
When measured at home or in ambulance (HBPM/ ABPM)

A

Clinic: >/= 160/100

HBPM/ ABPM: >/= 150/95

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4
Q

What range is Severe Hypertension when measured In clinic

A

Clinic: >/= 180 systolic or 110 diastolic

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5
Q

Differentiate between the 2 types of hypertension

Which of the 2 is more common, what percentage of al hypertension cases?

A

Primary: Unknown cause, 95% of all cases
Secondary: When cause can be defined

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6
Q

Name 5 target organs targeted by hypertension

A 
Brain 
Heart 
Arteries 
Eyes 
Kidneys
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7
Q

What are 2 ways of regulating BP

A 
Short term (Baroreceptor reflex)
Long term (Controls the balance of Na and thus ECF)
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8
Q

How does Baroreceptor affect TPR and CO to regulate BP

A

Adjust Sympathetic and Parasympathetic input to heart to alter CO

Adjust Sympathetic input to Peripheral Resistance Vessels to alter TPR

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9
Q

What are the 4 pathways that control BP in the long-term

A
  1. RAAS (Renin-Angiotension-Aldoesterone System)
  2. Sympathetic Nervous System
  3. Antidiuretic hormone (ADH)
  4. Atrial Nattiuretic Peptide (ANP)
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10
Q

In the RAAS, where is Renin released from

What 3 factors stimulate its release

A
  • from the Granular cells of the Juxtaglomerular apparatus (JGA)
  • Reduced NaCl delivery to distal tubule
  • Reduced perfusion pressure in kidney
  • Sympathetic stimulation to JGA
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11
Q

Describe the Pathway of substance conversions and the enzymes required

What are 3 functions of the final substance in the pathway

A
  • Angiotensinogen-> Angiotensin I by Renin
  • Angiotensin I-> Angiotensin II by ACE (Angiotensin Converting Enzyme)

Angiotensin II;

  1. Causes vasoconstriction
  2. Stimulates Na+ reabsorption at kidney
  3. Stimulates aldosterone (released from adrenal cortex)
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12
Q

What are the 2 types of Angiotensin II receptors are there?
Which receptor are the main actions via?

What are the actions of Angiotensin II at the following 5 sites;

  1. Arterioles
  2. Kidney
  3. SNS (Sympathetic)
  4. Adrenal cortex
  5. Hypothalamus
A

AT1 and AT2, Main actions via AT1

  1. Vasoconstriction
  2. Stimulates Na+ reabsorption
  3. Increased NA release
  4. Stimulates Aldosterone release
  5. Stimulates ADH release
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13
Q

Describe the action of aldosterone on the kidney in 4 steps

A
  1. Acts on cells of collecting duct
  2. Stimulates Na+ (and thus H2O reabsorption)
  3. Activates apical Na channel (ENaC) and apical K channels
  4. Increases Na extrusion via Na-K Pump
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14
Q

Explain the relationship between ACE and Bradykinin

How does Bradykinin affect vasculature? What does ACE therefore further cause vasoconstriction

A

As well as converting Angiotensin I-> II, ACE breaks down Bradykinin to Peptide Fragments.

Bradykinin is a vasodilator, so because of ACE, less vasodilation takes place

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15
Q

What 2 effects do ACE inhibitors have

What builds up and how can this present

A
  1. Prevent Angiotensin I—> II
  2. Prevent Bradykinin-> Peptide Fragments

Bradykinin buildup-> Dry cough (Vasodilation in lung)

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16
Q

What are 3 effects of the SNS Pathway in Long-term BP Regulation

A
  1. Reduce renal blood flow
  2. Stimulate Na reabsorption in PCT
  3. Stimulate renin release
17
Q

What is the main role of ADH, how does it affect water reabsorption

What 2 things stimulates ADH release

A

Formation of concentrated urine by retaining water.
Increased water absorption in distal nephron

  • Increased plasma osmolarity
  • Severe hypovolaemia
18
Q

Name 2 non-main functions of ADH (Arginine Vasopressin)

A

Stimulates Na reabsorption in thick ascending limb

Vasoconstriction

19
Q

What do natriuretic peptides promote
Where are they synthesised and stored
When are they released

A

Na excretion

In atrial Myocytes, released in response to stretch

20
Q

What does ANP cause, how does this affect Glomerular Filtration rate

what does it inhibit

A

Vasodilation, Increased GFR

Inhibits Na reabsorption

21
Q

What do Prostaglandins act as? name 2 effects
What do they buffer against
When are they important

A

Vasodilator, Enhanced GFR, reduced Na reabsorption
Buffer to excessive vasoconstriction
When AGII levels are high

22
Q

Where is dopamine formed
Where are their receptors present

What are 2 functions of Dopamine

A

Formed In kidney
Present on renal blood vessels and cells of PCT and Thick Ascending Limb

  • Vasodilation
  • Reduced Na reabsorption
23
Q

How does Renovascular disease cause (Secondary) hypertension in 4 steps

A
  1. Renal Artery Stenosis-> Reduced perfusion to that kidney
  2. Increased renin production (due to perfusion)
  3. Activation of RAAS
  4. Vasoconstriction and Na retention at OTHER kidney
24
Q

How does Renal parenchymal disease cause (Secondary) hypertension in 2 stages

A
  1. Earlier stage may be Loss of vasodilator substances

2. In later stage, Na and H2O retention due to inadequate glomerular filtration

25
Q

Name 3 adrenal diseases that cause hypertension and explain how

A

Conn’s Syndrome: Aldosterone secreted-> Hypertension and Hypokalemia

Cushing’s Syndrome: Excess cortisol acts on Aldosterone receptors-> Na and H2O retention

Tumour of adrenal medulla: Phaemochromocytoma secreted Adrenaline and NA

26
Q

What is the effect of an Angiotensin II receptor antagonist

A

Blocked action of Angiotensin II—> Diuretic and vasodilator effects

27
Q

What are 2 types of vasodilators that can be used to treat hypertension

What are 2 types of diuretics that can be used to treat hypertension

A

L-type Ca channels blockers
A1 receptor blockers

Thiazides diuretics (Reduce circulating volume)
Aldosterone antagonists
28
Q

Why are Beta Blockers less commonly used to treat hypertension

A

Blocked B1 receptors in heart-> Reduced heart rate and contraction force

CVS (15 decks)

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