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Year 1 CVS > Controlling BP > Flashcards

Controlling BP Flashcards

1
Q

Outline short term physiological BP control systems

A

Baroreceptor reflex alters sympathetic and parasympathetic stimulation of the heart. Sympathetic effects vasoconstriction levels as well.

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2
Q

List long term BP controllers.

A 
Neurohumeral responses control extracellular Na+. These include:
RAAS
Sympathetic innervation 
ADH
Naturetic peptides
Prostaglandins
Dopamine
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3
Q

What is hypertension?

A

Sustained increase in BP

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4
Q

How do we classify hypertension?

A

Stage 1 >140/90
Stage 2 >160/100
Stage 3 >180/110

Limits are lower if measured at home to account for white coat effect.

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5
Q

What causes hypertension?

A

95% is primary and unknown

5% is secondary to renal disease, renovascular disease, hyperaldosteronims or Cushings.

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6
Q

What can we target in HTN treatment?

A

In secondary- treat the cause
In primary- lifestyle advice, diuretics, L type Ca channel blockers, alpha antagonist, beta blockers, ACE inhibitors, AngII receptor blockers

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7
Q

What effect does angiotensin II have on the hypothalamus?

A

Increase thirst by increasing ADH secretion

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8
Q

How does aldosterone work?

A

Acts on principle cells of the kidney to stimulate Na+ and water reabsorption by activating Epithelial Na Channels or ENaCs. Increases extrusion through the basolateral membrane by Na/K-ATPase.

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9
Q

What is bradykinin and how does it interact with ACE?

A

ACE breaks down bradykinin which is itself a vasodilator.

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10
Q

What suffix to ACE inhibitor drugs have?

A

-pril

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11
Q

How does sympathetic innervation control BP

A

Increase HR and force of contraction
Increase TPR
Vasoconstriction means reduced renal perfusion stimulating JGA
Directly stimulates Renin release from JGA- activate RAAS
Activates apical Na/H exchangers and the K/NA pump in PCT.

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12
Q

How does ADH control BP.

A

Stimulates thirst which increases blood volume and increases SV which increases CO so BP increases

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13
Q

How does ADH control BP.

A

Stimulates thirst and helps retain water. Sodium is retained in the thick ascending limb due to stimulation of the NA/K/Cl co-transporter. Has direct vasoconstriction effects. All of which increases blood volume and increases SV which increases CO so BP increases

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14
Q

What stimulates ADH production?

A

Increase plasma osmolarity

Hypovolaemia

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15
Q

What effect so naturetic peptides have on BP?

A

Decrease BP

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16
Q

Which natural systems increase BP?

A

baroreceptor reflex- acutely
ADH
RAAS
Sympathetic stimulation

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17
Q

ANP is released in response to….

A

atrial stretch

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18
Q

What does ANP do?

A

Vasodilates afferent arteriole of kidney.
GFR thus gets more blood so less renin release.
Inhibit sodium reabsorption
Lose sodium in urine

19
Q

How do prostaglandins affect BP?

A

Vasodilate
Reduce sodium reabsorption
So increase BP
Buffer excessive constriction in RAAS or sympathetic systems.

20
Q

Dopamine is given to Parkinsons patients but how does it effect BP?

A

Vasodilator which increases renal blood flow and reduces NaCl reabsorption. Inhibits NHX and NA/K ATPase in PCT and TAL of kidney.
Lowers BP

21
Q

What proportion of people get high BP?

A

1/3

22
Q

What factors increase risk of primary HTN

A

Genetics

Enviromental

23
Q

What happens in renal disease to cause HTN?

A

Vasodilators lost in early stages but in the late stages the glomerular filtration fails and sodium is retained.

24
Q

What is Conn’s syndrome?

A

Aldosterone secreting adenoma

25
Q

What are the signs of Conn’s?

A

Hypertension

Hyperkalaemia

26
Q

What is Cushings?

A

Excess cortisol

27
Q

Why does bushings give HTN?

A

at high conc glucocorticoids like cortisone may act on aldosterone receptors in the kidney and cause Na+ retention .

28
Q

What tumour of the adrenal medulla secretes catecholamines?

A

Phaeochomocytoma

29
Q

Why treat HTN?

A 
Damages heart and vessels so if left untreated potential for:
MI
Stroke
Renal failure
Retinopathy
30
Q

High systolic BP associated with increased…. rate

A

mortality

31
Q

How does HTN lead to left ventricular hypertrophy and increased oxygen demand from heart tissue?

A

Increases after load so heart has to work harder to push against it

32
Q

What is a side effect of left ventricular hypertrophy?

A

Heart failure

33
Q

How can MI or ischaemia of myocardium occur in hypertensives?

A

Hypertension increases after load.
Heart has to work harder and so needs more O2.
Higher O2 demand is harder to meet so risk hypoxia.

34
Q

How can MI or ischaemia of myocardium occur in hypertensives?

A

Hypertension increases after load.
Heart has to work harder and so needs more O2.
Higher O2 demand is harder to meet so risk hypoxia.
The high BP damages arteries and increases risk of atherosclerosis.
Atherosclerosis increases risk of MI.

35
Q

Why do you get micro vascular haemorrhages in hypertension?

A

Artery walls damaged and become leaky or become anerysmic

36
Q

List non pharmacological HTN treatments

A

Diet
Exercise
Reduce Na+ intake
Reduce alcohol intake

Lifestyle changes should always be advised even in conjunction with pharmaceuticals because lifestyle limits the therapeutic effects of drugs.

37
Q

List non pharmacological HTN treatments

A

Diet
Exercise
Reduce Na+ intake
Reduce alcohol intake

38
Q

If you are treating HTN with tablets why do you always give life style advice with drug therapy for hyper tension and not just drugs?

A

Lifestyle changes should always be advised even in conjunction with pharmaceuticals because lifestyle limits the therapeutic effects of drugs.

39
Q

How do you treat HTN targeting the RAAS?

A

ACE inhibitors

AngII receptor antagonists

40
Q

L type calcium channel blockers may be used in hypertension, what is the mechanism of action?

A

Reduce Ca2+ entering vascular smooth muscle- vasodilate

41
Q

What is the side effect of vasodilating using alpha 1 blockers?

A

postural hypotension

42
Q

What is bendroflumethazide and how does it work?

A

thiazide diuretic reduces circulating volume to reduce BP.

43
Q

Give an example of an aldosterone antagonist and indicate if its a first line treatment for HTN?

A

Spirinolactone

Not first line

44
Q

What circumstance would you give a beta blocker for HTN?

A

If they have other indications like history of MI

Year 1 CVS (15 decks)

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