EXAM #2: PATHOPHYSIOLOGY OF HTN

Question 1

According to the JNC7, what is normal blood pressure?

Answer 1

Less than 120/80 mmHg

Question 2

According to the JNC7, what is prehypertensive?

Answer 2

120-139/80-89 mmHg

Question 3

According to the JNC7, what is Stage 1 HTN?

Answer 3

140-159/90-99 mmHg

Question 4

According to the JNC7, what is Stage 2 HTN?

Answer 4

160+/100+ mmHg

Question 5

According to JNC8, what is the target BP for patient younger than 60?

Answer 5

Less than 150/90 mmHg

Question 6

According to JNC8, what is the target BP for an adult with DM or CKD?

Answer 6

Less than 140/90 mmHg

Question 7

What comorbid conditions are associated with HTN?

Answer 7

1) IHD
2) HF
3) A-fib
4) CVA

Question 8

How much does a 20 mmHg increase in BP increase risk?

Answer 8

It doubles it

Question 9

Describe the normal changes in blood pressure that occur with age?

Answer 9

• Systolic and diastolic increase with age until 50 y/o
• After 50, systolic increases and diastolic decreases

*This can cause “isolated systolic HTN (ISH)”

Question 10

Why is there an increase in systolic HTN with age?

Answer 10

• Decrease in vascular compliance b/c of a loss of “elastin”
• Elastin is replaced with collagen

Question 11

What are the implications of ISH in elderly individuals?

Answer 11

1) Sharp peaks in pulse pressure that are not attenuated by vascular compliance
2) Transmission of force to downstream vessels that can lead to damage

Question 12

What are the major mechanisms that underlie obesity related HTN?

Answer 12

1) Leptin induced activation of the SNS
2) Activation of the RAAS
3) Metabolic disturbances

Question 13

What causes HTN induced end-organ damage?

Answer 13

1) Damage induced by the pressure itself
2) Cardiac remodeling from increased afterload
3) Vascular remodeling

Question 14

Why does HTN lead to LVH?

Answer 14

• Increased afterload
• Ventricular hypertrophy ensues

*Note that remodeling is related to increased risk of MI, HF, and arrhythmia

Question 15

How does ANGII caused vascuclar remodeling?

Answer 15

Activation of downstream signaling cascades

Question 16

What is primary/essential HTN?

Answer 16

Product of genes/environment

Question 17

What is secondary HTN?

Answer 17

HTN as a manifestation of:

1) CKD
2) Renovascular Disease
3) Other

*Correcting the initial insult will correct the HTN

Question 18

How is central SNS activity increased in response to a drop in BP?

Answer 18

1) Activation of systemic baroreceptors

2) Increased SNS activity

Question 19

Outline the pathophysiology of renovascular HTN.

Answer 19

Decreased RBF activates the RAAS system

Question 20

What is the most common cause of secondary HTN that is resistant to therapy?

Answer 20

Obstructive sleep apnea (OSA)

Question 21

How does OSA cause HTN?

Answer 21

1) Hypercapnia stimulates SNS

2) Augmentation of the sensitivity of the chemoreceptor mechanism,

Question 22

What is pressure-natriuresis?

Answer 22

Ability of the kidney to respond to an increase in BP by excreting Na+ and decreasing ECF volume

Question 23

What is the equation for BP?

Answer 23

BP= COxTPR

Question 24

What causes essential HTN?

Answer 24

1) Augmented SNS discharge
2) Abberant responses to peripheral signals
3) Vascular dysfunction
4) Renal dysfunction

Question 25

What lifestyle modification has the greatest impact on HTN?

Answer 25

Weight reduction

Question 26

What are the basic steps/levels of HTN treatment?

Answer 26

1) Lifestyle modification
2) Pharmaceutical intervention
- RAAS specifically

Question 27

What is one device-based therapy for resistant HTN?

Answer 27

Carotid sinus stimulation

*Exploits the baroreceptor reflex