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CVS > Control Of Blood Pressure And Hypertenison > Flashcards

Control Of Blood Pressure And Hypertenison Flashcards

1
Q

What is hypertension?

A

Sustained increase in blood pressure

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2
Q

What is BP measured in?

A

mmHg (millimetres of mercury)

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3
Q

What is the normal / ideal adult blood pressure?

A

90/60 mmHg to 120/80mmHg

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4
Q

What is classified as Stage 1 hypertension?

A

BP > 140/90 mmHg

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5
Q

What is classified as stage 2 hypertension?

A

BP > 160/100 mmHg

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6
Q

What is classified as severe hypertension?

A

BP > 180 systolic
Or
BP > 110 diastolic

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7
Q

What is primary hypertension?

A

When the cause of the hypertension is unknown

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8
Q

What is secondary hypertension?

A

The cause of the hyper tension can be defined

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9
Q

Give some examples of conditions causing secondary hypertension?

A

Renovascular disease
Chronic renal disease
Hyperaldosteronism
Cushing’s syndrome

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10
Q

What can hypertension damage?

A

Heart
Vasculature

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11
Q

What conditions can damage to the heart and vasculature cause?

A

Heart failure
Myocardial infarction
Stroke
Renal failure
Retinopathy

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12
Q

Which chamber of the heart is usually affected with hypertension and what happens to it?

A

Left ventricle
Left ventricular hypertrophy

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13
Q

How can hypertension lead to an atrophic kidney?

A

Hypertension increases the risk of atheromas (degeneration of artery wall due to formation of fatty plaques and scar tissue)

Renal artery stenosis develops (renal artery narrowed)
Reduced blood flow to kidney makes it atrophic

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14
Q

What is the equation of cardiac output?

A

CO = SV x HR

Cardiac output = Stroke volume x Heart Rate

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15
Q

What is the equation for mean arterial blood pressure? (In terms of CO and TPR)

A

Mean arterial BP = CO x TPR

Mean arterial Blood Pressure = Cardiac Output x Total Peripheral Resistance

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16
Q

What is the equation relating blood pressure to blood flow and resistance?

A

BP = Blood flow x resistance

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17
Q

What is the mechanism which is responsible for short term blood pressure regulation?

A

Baroreceptor reflex

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18
Q

How does the baroreceptor reflex adjust cardiac output?

A

Changes sympathetic and parasympathetic inputs to the heart

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19
Q

How does the baroreceptor reflex alter total peripheral resistance?

A

Adjusts level of sympathetic input to the blood vessel (a1 receptors = less stimulation by noradrenaline)

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20
Q

What adrenoreceptor is important in the sympathetic input of blood vessels?

What is the neurotransmitter that binds to it?

A

A1 (Alpha 1)

Noradrenaline

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21
Q

Where are the baroreceptors located that are important in the baroreceptor reflex?

A

Carotid sinus
Aortic arch

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22
Q

What happens in the baroreceptor reflex when mean arterial pressure is increased?

A

Baroreceptors stretch
Fire action potentials to medulla
Medulla reduces sympathetic stimulation of heart and blood vessels and increases parasympathetic stimulation of the heart

Bradycardia and vasodilation counteract inc in mean arterial pressure

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23
Q

What is the baroreceptor reflex good for?

A

Rapid changes in BP
NOT LONG TERM

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24
Q

What are the 4 neurohumoral pathways that control circulating blood volume therefore CONTROLLING BLOOD PRESSURE?

MEDIUM/LONG Term control of BP

A

Renin-angiotensin-aldosterone system (RAAS)
Sympathetic nervous system
Antidiuretic hormone (ADH)
Atrial natriuretic peptide (ANP)

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25
Q

How does the RAAS regulate (increase) blood pressure?

A

Hypovolaemia or Hypotension detected (Baroreceptors/reduced renal perfusion)
Renin produced/released from kidney

Angiotensinogen —> Angitotensin I —> Angiotensin II —> Increase in BP and blood volume

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26
Q

What is the function of Renin produced by the kidney?

A

Cleaves Angiotensinogen to Angitensin I

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26
Q

How is Angiotensin I cleaved to Angiotensin II?

A

ACE enzymes in the lungs

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27
Q

What parts of the body does Angiotensin II act on to increase blood pressure and increase blood volume?

A

Arterioles
Adrenal cortex (indirectly the kidney nephron)
Posterior pituitary (Indirectly the nephron)

28
Q

What effect does Angiotensin II have on the Arterioles to help increase blood pressure?

A

Vasoconstriction

29
Q

What effect does Angiotensin II have on the adrenal cortex and how does this increase blood pressure or blood volume?

A

Stimulates aldosterone production
Aldosterone stimulates Na+/K+ pump expression in the nephron
More Na+ reabsorbed back into blood (water follows the Na+) at expense of K+ being lost, increases the volume of water in the blood increasing BP

30
Q

What effect does Angiotensin II have on the posterior pituitary and how does this increase blood pressure or blood volume?

A

Angiotensin II stimulates production of ADH
ADH acts on collecting duct (kidney)
Increases translocation of aquaporins into the collecting duct of nephron
More water reabsorbed back into blood
Increases blood volume/pressure

31
Q

What part of the kidney is renin released from?

A

Juxtaglomerular granule cells

32
Q

What factors stimulate renin release for the juxtaglomerular granule cells?

A

Reduced NaCl delivery to kidney
Reduced kidney perfusion pressure
Sympathetic stimulation of the juxtglomerular granule cells

33
Q

There are 2 angiotensin II receptors AT1 and AT2, which receptor does most of the action occur at?

What type of receptor is this?

A

AT1

G protein coupled receptor

34
Q

Where is bradykinin normally found and what is its affect?

A

Lungs
Vasodilator
Lowers blood pressure

35
Q

What is the effect of ACE on bradykinin?

A

Breaks it down
Inhibits its affect of vasodilation by breaking it down into peptide fragments

36
Q

How can ACE Inhibitors cause Hypotension and a cough?

A

If ACE inhibited Bradykinin accumulates (not broken down) causing Vasodilation

Also causes cough

37
Q

What are some examples of ACE Inhibitors?

A

Captopril
Lisinopril
Perindopril
Enalapril

38
Q

What is the role of the sympathetic nervous system in increasing BP?

A

Reduces renal blood flow:
-Reduces GFR by vasoconstriction of arterioles
-Less Na+ and therefore water excreted

Stimulates renin release from Juxtoglomerular granule cells, INC Ang II levels, INC aldosterone = INC Na+ reabsorption = INC water reabsorption

39
Q

What is the role of ADH in BP?

A

Acts to INC blood volume therefore INC BP

40
Q

How does ADH increase BP?

A

INC translocation of aquaporins in collecting duct
Stimulates Na+ reabsorption (Na+/K+/Cl- co-transporter) water follows Na+

41
Q

How does Atrial Natriuertic peptide (ANP) affect BP?

A

Decreases BP

42
Q

How does Atrial Natriuretic peptide (ANP) reduce BP?

A

Promotes Na+ excretion (inhibits Na+ reabsorption)
Therefore increases water excretion reducing blood vol/pressure

Vasodilation of afferent Arteriole

43
Q

Where is ANP synthesised and stored?

A

Atrial cardiac myocytes

44
Q

When is ANP released from atrial myocytes?

A

When stretched a lot, more ANP is released

45
Q

What happens with ANP when BP is low/ low blood volume (Hypovolaemia)?

A

Atrial cells stretched less
Less stretch inhibits ANP release

46
Q

What is the role of Prostaglandins in BP?

A

Vasodilators
Act as a buffer to excessive vasoconstriction
Important when Ang II is high

47
Q

How does dopamine affect BP?

A

Decreases BP
Vasodilation + INC renal blood flow
Reduces reabsorption of NaCl (more water lost)
Inhibits Na+/K+ ATPase in PCT

48
Q

How can Renovascular disease cause Secondary Hypertension?

A

Renal artery stenosis (occlusion of renal artery) reduces perfusion pressure in that Kidney
Renin produced
RAAS activated
Other Kidney also has vasoconstriction and Na+ retention, more ADH made by posterior pituitary, More water retained

49
Q

How does Renal parenchymal disease cause Secondary Hypertension?

A

Loss of vasodilator substances
Na+ and water retention due to inadequate Glomular filtration

50
Q

What are parenchymal cells?

A

The functional tissue/cells of an organ (not the connective tissue)

51
Q

What is Conn’s syndrome?

A

Adrenal tumour secreting aldosterone

52
Q

What effect does Conn’s syndrome have on the body and why?

A

Elevated aldosterone
Hypertension
Hypernatraemia
Hypokalaemia

53
Q

What is Cushing’s syndrome?

A

Excess secretion of Cortisol

54
Q

What effect does Cushing’s syndrome have on BP and why?

A

At high [cortisol] can act on aldosterone receptors increasing Na+ retention, water retention and K+ excretion

55
Q

What is a tumour of the adrenal medulla called the secretes Catecholamines?

A

Phaeomochromocytoma (produces noradrenaline and adrenaline)

56
Q

How is a Phaeochromocytoma treated?

A

Alpha blockers + Beta blockers

Alpha blocker = Phenoxybenzamine
Beta blocker = Bisoprolol

57
Q

How can you non-pharmacologically try and treat hypertension?

A

Exercise
Diet
Reduce Na+ intake (salt)
Reduce alcohol intake

58
Q

How can you treat hypertension by targeting the RAAS?

A

ACE inhibitors
Angiotensin II receptor antagonists

59
Q

How do ACE inhibitors treat hypertension?

A

Prevent conversion of Ang I to Ang II
Prevents the vasoconstriction action it has and prevents the release of aldosterone

60
Q

What are some Angiotensin II receptor blockers? (Block action of Angiotensin II)

A

Losartan
Valsartan
Temisarta

61
Q

How does an L-type Ca2+ channel blocker act as a vasodilator?

A

Reduces Ca2+ entry into vascular smooth muscle
Relaxation of vascular smooth muscle

62
Q

What is an example of an L-type Ca2+ channel blocker?

A

Verapamil

63
Q

What affect does a drug which is an A1 receptor blocker have on the body?

A

Blocks A1 receptors on vascular smooth muscle
Reduces sympathetic tone by not allowing noradrenaline to bind
Vasodilation

Can led t postural hypotension

64
Q

What is an example of a drug which is an A1 receptor blocker?

A

Doxazosin

65
Q

How do diuretics treat hypertension?

A

Increased water excretion in urine

66
Q

What is spironolactone?

A

Aldosterone antagonist (Diuretics)

67
Q

What do Thiazide diuretics inhibit?

A

Na/Cl co-transporter

68
Q

How do Beta blockers treat hypertension?

A

Block B1 receptor
This is in the heart
Prevents noradrenaline binding
Heart rate reduced
Heart contraction strength reduced

CVS (21 decks)

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