CVD 3 Flashcards
normal SBP and DBP
SBP: < 120
DBP: < 80
elevated SBP and DBP
SBP: 120-129
DBP: < 80
stage 1 HTN SBP and DBP
SBP: 130-139
DBP: 80-89
stage 2 HTN SBP and DBP
SBP: > = 140
DBP: > = 90
HTN causes
increased cardiovascular __ and __
increased __
increased chronic __ disease and end stage __ disease
HTN causes
increased cardiovascular morbidity and mortality
increased cardiovasvular accidents (CVA, stroke)
increased chronic kidney disease and end stage kidney disease
blood pressure =
vascular resistance * cardiac output
vasoconstriction is caused by
catecholamines
angiotensin II
vasopressin
vasodilation is caused by
nitric oxide
ANP
RAAS system steps
- kidney senses low BP, secretes renin
- liver secretes angiotensignogen which becomes angiotensin
- acts on adrenal gland to increase aldosterone secretion –> increased sodium and water retention –> increased BP
- also decreased GFR and urine output via vasoconstriction
RAAS: when kidney senses low BP, it secretes
RAAS: when kidney senses low BP, it secretes renin
RAAS: renin causes liver to secrete __ which becomes __
RAAS: renin causes liver to secrete angiotensinogen which becomes angiotensin
RAAS: angiotensin acts on __ to increase __ secretion –> increases __ and __ retention –> increases __
RAAS: angiotensin acts on adrenal gland to increase aldosterone secretion –> increases sodium and water retention –> increases BP
RAAS: angiotensin also decreases __ and __ ouput via __
RAAS: angiotensin also decreases GFR and urine ouput via vasoconstriction
SNS system
- Cardiac Output via heart
- Catecholamines via Adrenal Medulla
- Kidney releases Renin
- Blood vessel and increased Vascular resistance
3 mechanisms of hypertension
BP
RAAS
SNS
risk factors for hypertension
- age
- obesity
- family Hx
- reduced nephron number
- excessive alcohol
- physical inactivity
- high SODIUM diet
primary = __ HTN
secondary = __ HTN
primary = essential HTN
secondary = identifiable HTN
primary HTN is __% of cases
primary HTN is 95% of cases
primary HTN has __ and __ causes
primary HTN has genetic and environmental causes
primary HTN has NO __
primary HTN has NO discrete causative entity
secondary HTN underlying etiological conditions
- hyperthyroidism
- Cushing’s
- renovascular disease
- obstructive sleep apnea
- hyperaldosteronism
- meds (NSAIDs, MAO-I, steroids, OCPs)
secondary HTN is considered in patients with
- severe HTN
- resistant HTN
- HTN before puberty
- presentation before age 30 in non-obese patient with no family Hx
- signs/symptoms suggesting etiological entity
severe HTN
SBP: > 170 mm Hg
DBP: > 110 mm Hg
resistant HTN
on 3 drugs, one of which is a diuretic
for each 1 gram increment in potassium excretion,
0.75 mm Hg decrease in SBP and 0.06 mm Hg decrease in DBP
how do we excrete more potassium and lower BP
consume more potassium
for each 1 gram increment in sodium excretion,
2.11 SBP increase, 0.78 DBP increase
more sodium =
high BP
best way to measure BP
- sitting back supported
- no talking
- correct cuff size
- arm bare and resting
- feet flat on floor
- quiet room
- no smoking, caffeine, exercise 30 mins before
- empty bladder
- relax for 5 min
gold standard of measuring BP
24 hour ambulatory pressure monitoring (24 H ABPM)
benefits of 24 H ABPM
shows BP patterns
shows nocturnal dipping
office BP is generally
higher than ABPM or at home
essential function of kidney
- excretion
- regulate EC volume by filtrating and reabsorbing sodium
- regulate plasma osmolarity
- regulate pH
- produce hormons for RBC production
- maintain bone health via vit D activation and phosphate excretion
- immune function
- drug metabolism
kidney regulates extracellular volume by __ and __ __
kidney regulates extracellular volume by filtrating and reabsorbing sodium
kidney produces hormones for
RBC production
kidneys regulate plasma __ through __
kidneys regulate plasma osmolarity through water handling
kidneys help maintain bone health through activation of __ and __ excretion
kidneys help maintain bone health through activation of vit D and phosphate excretion
creatinine is a byproduct of __ and is released into __ at a __ rate
creatinine is a byproduct of muscle breakdown and is released into blood at a steady rate
__ intake impacts creatinine levels
dietary meat intake impacts creatinine levels
creatinine if mostly filtered by
creatinine if mostly filtered by kidney
when kidney function declines, GFR __, and creatinine __
when kidney function declines, GFR declines, and creatinine increases in blood
limit of using creatinine to estimate GFR
blood creatinine is influenced by muscle mass and protein intake
AKI =
CKD =
AKI = acute kidney injury
CKD = chronic kidney disease
AKI
time course
compensation
GFR
natural history
AKI
time course: days-weeks
compensation: inable to regulate volume and solutes
GFR: 0
natural history: potentially reversible
CKD
time course
compensation
GFR
natural history
CKD
time course: 6 months-years
compensation: gradual adaptation allows for normal excretion until end stage
GFR: lowered, but okay
natural history: irreversible
proteinuria
high levels of protein in urine
proteinuria is independent of
estimated GFR
proteinuria associated with increased __, __, __, and __
proteinuria associated with increased all cause mortality, CV events and mortality, CKD progression, and end stage renal disease (ESRD)
