HTN Flashcards
HTN prevalence
> 100 million people
African Americans > non-Hispanic Whites
Women > men, older than 60 years
Leading risk factor for morbidity and mortality in ppl
Systolic htn
Sustained systolic BP > 130 mm Hg
Diastolic htn
Sustained diastolic BP > 80 mm Hg
Isolated systolic hypertension
Systolic > 130 mm Hg and diastolic < 80 mm Hg
Isolated diastolic hypertension
Systolic < 130 mm Hg with diastolic > 80 mm Hg
Combined systolic and diastolichypertension
Systolic > 130 mm Hg and diastolic > 80 mm Hg
Elevated htn
120-129
<80
Stage 1 htn
130-139
80-89
stage 2 htn
> 140
90
Primary HTN (Essential) etiology
Specific etiology unclear
Primary HTN (Essential) contributing factors
SNS activity
Dysregulation of the renin-angiotensin-aldosterone system
Deficient production of endogenous vasodilators
Oxidative stress -> stiff vessels
RAAS controls…..
Extracellular fluid volume-> aldo release for na reabsprtion
Peripheral resistance-> maintain
Blood pressure
Dysregulated renin release leads to….
Elevated renin levels
Angiotensin II overproduction
Increased aldosterone
HTN
Angiotensin I cleaved into Angiotensin II by …..
chymase (human mast cell protease = bypass angiotensin cleaves to)
Acei don’t work on chymase = cant take acei
Angiotensin produced in…..
Production of angiotensin II in fat, blood vessels, heart, adrenals, and brain
Major regulators of vascular tone
Nitric oxide and endothelin
No – vasodilation
Endothelin = vasodilation or constriction
Atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), C-type natriuretic peptide (CNP), and urodilatin….
Blunts RAAS…
Oxidative stress causes
Impaired endothelial function
Disruption of NP release or receptor response-> HTN
Secondary htn prevalence
Secondary HTN
5% of population
Correctable cause
Age-dependent or drug-induced
Stop drug = htn goes away
herbals that cause htn
ephedra, ginseng, ma huang
% of children with htn w/ an underlying cause
birth -12yr = 70-85, most common etiologies = renal parenchymal disease
Resistant HTN
Above goal BP despite ≥3 antihypertensive drugs of different classes
Controlled resistant HTN
Need for ≥4 drugs to achieve control
Refractory HTN
Uncontrolled BP on ≥5 drugs
Drug intolerance or pseudo-resistant HTN (0.5% of pop)