CVS Pathology Flashcards
What is the cause of primary hypertension?
cause is unknown
What are the non-modifiable risk factors of Primary (essential) hypertension?
Positive family history
Ethnicity
Advanced age
What are the modifiable risk factors of Primary (essential) hypertension?
Obesity Diabetes Smoking Excessive alcohol or caffeine intake Diet high in sodium Physical inactivity Psychological stress
What is the cause secondary hypertension?
caused by underlying problem LESS common such as: kidney disease Certain arterial conditions Some drugs Occasionally pregnancy
What are the risk factors for Secondary hypertension?
RECENT:
R = Renal (e.g., renal artery stenosis, glomerulonephritis),.
E = Endocrine (e.g., Cushing syndrome, hyperthyroidism, Conn syndrome).
C = Coarctation of aorta.
E = Estrogen (oral contraceptives).
N = Neurologic (raised intracranial pressure, psychostimulants use).
T = Treatment (e.g., glucocorticoids, NSAIDs).
95% of patients diagnosed with hypertension have which type of hypertension?
Essential (Primary) Hypertension
When taking a patient’s BP they must be resting for at least?
5 minutes
Essential (Primary) Hypertension is best understood by?
- Over activation of the sympathetic nervous system.
2. Over activation of the angiotensin-aldosterone systems.
Renin secretion is triggered by?
- Reduced renal perfusion pressure.
- Diminished intravascular volume.
- Circulating catecholamines.
- Increased sympathetic nervous system activity.
What medication reduces the effect of antihypertensive drugs?
NSAIDs
Since hypertension is often asymptomatic, what is necessary to prevent end-organ damage?
Regular screening!
Non-pharmacological measures should be pursued in any patient with a systolic BP and diastolic BP of?
systolic BP > 120 mm Hg
or
diastolic BP > 80 mm Hg!
Hypertensive crises are generally defined as?
> 180/120 mm Hg. (a severe increase in blood pressure that can lead to a stroke.)
Examples of what a hypertensive crisis can cause (end-organ damage)?
Damage to the brain (e.g., encephalopathy, stroke).
Eyes (e.g., retinopathy).
Cardiovascular system (e.g., ACS, pulmonary edema, aortic dissection).
Kidneys (e.g., acute renal failure).
What does hypertensive crisis management consist of?
rapidly identifying end-organ damage with patient history, physical examination, and focused testing, and determining whether the rapid lowering of the blood pressure with IV antihypertensives is required.
In the absence of end-organ damage, hypertensive crises should be managed with?
rapid follow-up and oral antihypertensives
Disclaimer: Reduce BP by max. ______ within the _____ hour to prevent _______________ and to ensure _____________.
25% - first hour - coronary insufficiency - adequate cerebral perfusion pressure.
Mean arterial pressure should not be lowered by more than 25% within the first hour, except in special cases. Reducing blood pressure too rapidly can lead to?
hypoperfusion and ischemia in certain organs
(e.g., brain, kidney, heart). KBH. كبة.
What are the eye complications of hypertensive crisis?
- A-V nicking
- Papilledema
- retinal hemorrhages
- Retinal exudates
- Copper/silver wires.
What are the effects of Angiotensin II?
- Systemic vasoconstriction
- Sodium and water retention
- Stimulation of aldosterone synthase
What are the clues of renovascular hypertension?
- new-onset HTN in very young or >50.
- Abdominal bruit on an exam.
- Proven Peripheral Artery Disease (PAD).
- Abrupt deterioration of renal function after initiation of ACE-I or ARB
What is the most common cause of hyperaldosteronism?
Adrenal Adenoma (Conn’s syndrome)
