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Cardio Final Jeopardy > High/Low BP > Flashcards

High/Low BP Flashcards

0
Q

What is normal BP?

A

120/80

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1
Q

Define hypertension

A

Defined as a sustained elevation of systemic arterial BP and in the USA 1 in 3 adults diagnosed with it

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2
Q

What is prehypertension BP values?

A

120-129 systolic

80-89 diastolic

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3
Q

What is Stage 1 Hypertension BP values?

A

140-159 systolic

90-99 diastolic

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4
Q

What is Stage 2 Hypertension BP values?

A

160+ systolic

100+ diastolic

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5
Q

What is hypertension caused by?

A

Increase in CO, TPR, or both

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6
Q

Individuals with hypertensive disease may have either?

A

Combined systolic and diastolic hypertension OR

Isolated systolic hypertension

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7
Q

Most cases of combined systolic and diastolic hypertension have no known cause and are therefore diagnosed as?

A

Primary hypertension (idiopathic)

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8
Q

What percentage of hypertension is made up by secondary hypertension?

A

5 - 8% of all cases of hypertension is made up by secondary hypertension which can result from many diseases

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9
Q

What is isolated systolic hypertension?

A

This is elevated systolic BP PLUS normal diastolic BP below 90mmHg… so only the systolic BP value is elevated

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10
Q

What does high BP increase with regards to the heart, and relate this to ventricle pressure…..

A

High BP increases the workload of the heart. So when ventricles contract normally they force open the semilunar valves by generating higher pressure than in the major arteries. In hypertensive patients this means that the ventricles may have to generate up to 400mmHg for force to push the blood through a narrowed aortic valve. (Bad)

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11
Q

What is the role of hypertrophy with regards to after-load?

A

The heart may be able to compensate for an increase in after-load by enlarging (hypertrophy) which allows it to contract more forceful and maintain a normal SV despite an abnormal impediment to blood ejection

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12
Q

What are 10 factors associated with primary hypertension?

A
  1. Family history of
  2. Advancing age
  3. Gender - men younger than 55 and women older than 74
  4. Black race
  5. High dietary sodium intake
  6. Glucose intolerance
  7. Cigarette smoking (nicotine is a vasoconstriction agent)
  8. Obesity
  9. heavy alcohol consumption (greater than 3 a day. Moderate drinking of 2-4 per week shows lower BP than abstainers or alcoholoics)
  10. Low dietary intake of magnesium, calcium, and potassium
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13
Q

What does sodium, calcium, potassium, and magnesium have to do with hypertension?

A

High dietary sodium intake has long been linked to increased chance of hypertension, however, it is also shown that low levels of calcium, potassium, and magnesium are bad as without their intake sodium is retained

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14
Q

Is nicotine a vasoconstrictor?

A

Yes - nicotine is a vasconstrictor and this can elevate both systolic and diastolic BP acutely

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15
Q

What does obesity contribute to?

A

Obesity is recognized as an important risk factor for hypertension and contributes to many of the neurohumoral, metabolic, renal, and CV processes that cause hypertension, especially those factors that contribute to endothelial dysfunction and renal sodium retention

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16
Q

What does inflammation, endothelial dysfunction, and insulin resistance contribute to regarding blood volume and peripheral resistance?

A

These factors contribute to increases in peripheral resistance and blood volume

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17
Q

What regulates the affects of obesity?

A

Multiple pathophysiologic mechanisms mediate these affects including the SNS, the RAA system, adducin, and natriuretic peptides

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18
Q

In hypertensive pts. what can cause over activity of the SNS?

A

Increased production of catecholamines (epi and norepi) or from increased receptor reactivity involving these neurotransmitters

19
Q

What component of the RAA system is known to contribute to hypertrophy?

A

Angiotensin II is responsible for hypertrophy of the myocardium associated with hypertension

20
Q

Drugs that block ______ or ______ and _____ receptors are widely used in the treatment of hypertension and have been shown to improve ______ and _____ _____ in select populations

A 
angiotensin converting enzyme (ACE inhibitors)
angiotensin
aldosterone
cardiac
renal function
21
Q

What % of increase in risk for essential hypertension does a mutation in the gene for the protein adducin cause?

A

50 - 70% increase

22
Q

What does natriuretic hormone modulate?

A

Natriuretic hormone modulates renal sodium excretion and includes ANP (atrial natriuretic peptide), BNP (brain natriuretic peptide), CNP (C-type natriuretic petpite, and urodilanton

23
Q

What are the functions of natriuretic hormones be affected by?

A

Excessive sodium intake
Inadequate dietary potassium, calcium, and magnesium intake
Obesity

24
Q

How does salt retention increase BP?

A

Salt retention leads to water retention and therefore increased blood volume which contributes to increases in BP

25
Q

What renal injury can occur with increased salt retention?

A

Tissue ischemia and renal vasoconstriction

26
Q

What role does inflammation play in the kidney regarding the pathogenesis of hypertension?

A

In the kidney, decreased renal perfusion leads to tubular ischemia and preglomerular arteriopathy leading to decreased sodium filtration and increased sodium retention, thus shifting the pressure-natriuresis curve and contributing to sustained hypertension

27
Q

What is endothelial dysfunction in primary hypertension characterized by?

A

A decreased production of vasodilators such as NO, and an increased production of vasoconstrictors such as endothelin

28
Q

What is an important role insulin plays in vascular protection?

A

Increased endothelial cell production of NO

29
Q

What can diabetes and insulin resistance cause?

A

Changes in SNS and RAA activity, renal glomerular dysfunction, and contribute to target organ effects of hypertension

30
Q

What is secondary hypertension?

A

That which is caused by a systemic disease process that raises peripheral vascular resistance or CO

31
Q

What is isolated systolic hypertension?

A

Elevations in systolic BP caused by increases in CO, TPR, or both

32
Q

What does complicated hypertension cause?

A

Chronic hypertension can damage the walls of systemic blood vessels of target organs for hypertension including the brain, heart, kidneys, eyes, and extremities

33
Q

What are complications specific to the retina from hypertension and how can they be estimated?

A

Complications include retinal vascular sclerosis, exudation, and hemorrage. These changes in the vascular beds can be estimated by viewing the arterioles of the retina

34
Q

What are some cerebrovascular complications?

A

Similar as those of other arterial beds and include transient ischemia, stroke, cerebral thrombosis, aneurysm, and hemorrhage

35
Q

In the elderly, what has chronic hypertension been linked to?

A

A cognitive decline

36
Q

What are the early clinical manifestations of high BP?

A

There are none other than the elevated BP

37
Q

What are some further routine diagnostic tests beyond patient and family history for evaluating hypertension?

A

Hematocrit, urinalysis, biochemical blood profile (fasting glucose, sodium, potassium, calcium, creatinine, total cholesterol, high-density cholesterol, triglycerides) and an ECG

38
Q

What can pharmacological treatment of hypertension help to reduce?

A

The risk of end-organ damage, and prevent major diseases such as MI and stroke

39
Q

What type of diuretics have been shown to be most effective for lowering BP and preventing CV complications of hypertension?

A

Thiazide diuretics - and if two drugs needed recommended to use this with another antihypertensive such as beta blockers or ACE inhibitors

40
Q

What is hypotension?

A

Defined as systolic below 90mmHg or diastolic below 60mmHg

41
Q

What is orthostatic hypotension?

A

A decrease in BP upon standing

42
Q

What normally compensates for gravitational changes such as when standing in BP?

A

Normally compensated for by reflex arteriolar constriction, increased HR and factors such as valve closure in venous system and pumping action of leg muscles (skeletal and respiratory pumps)

43
Q

What normally happens with a postural change?

A

Volume shift triggers the baroreceptor reflex which increases SNS, increases HR, and constricts arterioles to maintain BP

44
Q

Symptoms of orthostatic hypotension include and what are they due to?

A

Dizziness, vision loss, syncope

These are due to insufficient vasomotor compensation and reduced blood flow to brain

45
Q

What is acute orthostatic hypotension associated with?

A

Prolonged immobility such as with long term illness
Drug reactions (like between antihypertensives and antidepressants)
Starvation
Exhaustion
Conditions assoc. with loss of blood volume
Venous pooling
Altered blood chemistry
(Elderly are particularly susceptible)

46
Q

What is orthostatic hypotension often secondary to?

A

Adrenal insufficiency
DM
Intracranial tumors

Cardio Final Jeopardy (5 decks)

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