Control of Blood pressure

Question 1

what is blood pressure

Answer 1

driving force propelling blood to tissues

balance between organ perfusion and vascular damage

Question 2

resistance to flow is largely dictated by what

Answer 2

radius of the vessel

Question 3

what do natriuretic peptides do

Answer 3

long term BP regulation

- induce excretion of Na in the urine

Question 4

when are natriuretic peptides released

Answer 4

when myocytes are mechanically stretched by increase in plasma volume

Question 5

what is the classification of hypertension - what percentage of the population has it

Answer 5

greater than 140 or 90
sys/dy
30-45%

Question 6

what is the difference between primary and secondary hypertension

Answer 6

primary (90% of cases)
age - related
no identifiable cause - decrease in baroreceptor sensitivity
secondary (10%)
due to syndromes or diseases such as pre-eclampsia, cushings

Question 7

what is the difference in grads of clinical BP hypertension

Answer 7

1 = 140/90
2 = 160/100 
3 = 180 / 110

Question 8

what does hypertension do to the LV

Answer 8

left ventricular hypertrophy

Question 9

what is the law of laplace

Answer 9

LVH increases LV thickness, reduces LV cavity radius and therefore reduces wall stress
ie wall stress is directly proportional to LV cavity size and inversely to the thickness

Question 10

what is hypertensive heart failure

Answer 10

LVHwith diastolic dysfunction leads to increased stiffness which increases EDV in LV and increases LA pressure leading to pulmonary congestion and HF

Question 11

how does prolonged HTN affect vessels in small vs big arteries and disease

Answer 11

vascular remodelling
small arteries - eutrophic arteries - increase in media to lumen ratio
large arteries - hypertrophic remodelling - increases in media to lumen ratio and medial cross sectional area increases SBP
more prone to atherosclerosis

Question 12

how does hypertension affect the kidney

Answer 12

hypertensive nephropathy - renal arteriole thickening - lumen narrowing - ishchemia, tubular atrophy and fibrosis - haemoproteinuria

Question 13

how does hypertension affect the eyes

Answer 13

damages eye vessels - papilloedema, exudates, flame haemorrhages, cotton wool spot

Question 14

how do you manage hypertension

Answer 14

lifestyle management
drugs
treat underlying cause if secondary

Question 15

how can you change your life style to reduce BP

Answer 15

stop smoking
lipid control
diet/weight loss

Question 16

what are the three types of drugs for hypertension

Answer 16

A - ACEi, ARB
C - Calcium- channel blockers
D - diuretics

Question 17

what ACEi and A2RBs would you give to treat hypertension

Answer 17

ramipril and candesartan

Question 18

what do calcium channel blockers do to hypertension and what are examples

Answer 18

disrupt movement of Ca through channels (affect phase 2). negative chrono/iontropy
such as amlodipine and diltiazem

Question 19

how do diuretics affect hypertension and what are some examples

Answer 19

reduce circulating volume
can be thiazide or loop
such as bendroflumethiazide and furosemide

Question 20

how does bisoprolol affect blood pressure

Answer 20

acts as a beta blocker to reduce HR and also reduce renin secretion

Question 21

how would you choose which anti-hypertensive to use

Answer 21

younger than 55 and not black african or caribbean use ACEi - if older than 55 or black african originally use CCB

Question 22

which types of drugs are used in these times 
HF 
angina 
diabetes 
proteinuria

Answer 22

ACEi/A2RB or beta blocker
beta blocker
ACEi/A2RB
ACEi/A2RB

Question 23

when would you not use ACEi/A2RB
B blockers
CCB
diuretics

Answer 23

pregnancy, hyperkalaemia
asthma or 2nd/3rd AV block
2nd/3rd degree Av block
hypokalaemia, gout