HTN Flashcards
S2Q1
HTN:
most what since what
ASCVD - pathology, 1=1=1
high BP = what = what = (3)
elevated SBP vs. DBP (1.2)
- mostly undiagnosed since asymptomatic
- high BP = atherogenesis = CV events = CVA, MI, heart failure
- elevated SBP > DBP = stroke
- elevated DBP > SBP = MI, heart attack
atherosclerotic CV disease
- heart or vessel that would take its root
- form & deposit cholesterol into arterial walls = calcified = bulging of arteries
HTN: Occurs with
1 - what, (3)
2 - associated
3 - associated
4
dyslipidemia
- abnormal lipid level, high bad low good cholesterol
- high triglyceride
- resistance to insulin-stimulated glucose uptake
glucose uptake: DM
hyperinsulinemia: associated c glucose uptake
obesity
HTN: Factors
(3)
arteries - what, branches (2.1)
fibrosis - 1=1=1=2
SaO2
coronary arterial hypertrophy
dec myocardial vascularity
narrowing of epicardial arteries
- main supply of heart
- left circulation: left coronary artery = left ant descending & left circumflex
- right circulation: right coronary artery
perivascular fibrosis
- Htn = inflammation = fibrosis (scarring & non-contractile)
HTN:
SBP, DBP - sound, ventricular what
clues - 2 age, usual organ (3)
SBP
- 1st sound heard after releasing cuff
- ventricular emptying & contract
DBP
- last sound appreciated not heard, korotkoff disappears
- ventricular filling & relax
CLUES
- HPN at <20y
- diastolic HPN at >50y
- brain heart kidney
HTN: Arterial Pressure
factor 1 - formula, SV what, HR & BP relationship, if dehydrated then what, homeostasis what
factor 2 - what
arterial pressure depends on:
cardiac output
- (SV)(HR)
- SV: amount of blood in each pump
- HR DP BP
- if dec SV = inc HR
- less blood taken (dehydrated) = less venous return = dec SV = dec CO = hypotension
- homeostasis: if parameter changes others will adjust
peripheral resistance
- all forces in arterial walls
HTN: MAP
what, where, formula
if ischemic stroke, otherwise
borderline BP
MAP
- average pressure throughout cardiac cycle in aorta
- 1/3 (SBP+2DBP)
- if ischemic stroke = just maintain BP don’t lower otherwise infarct & to protect ischemic penumbra
borderline BP: 120-138/80-89
HTN: BP Guidelines
(7)
optimal, normal, high normal, grade 1 (mild), grade 2 (mod), grade 3 (severe), isolated systolic Htn
<120
120-129
130-139
140-159
160-179
>180
140
<80
80-84
85-90
90-99
100-109
110
90
HTN: Principal Mechanism
volume - what, purpose, extracellular x BP, Na purpose (2), kidney as what + why
intravascular volume
- amount of fluid inside vessels
- primary determinant of long-term arterial BP
- extracellular volume DP BP
- Na: determinant of extracellular vol; attracts water = Htn
- kidney as target of Htn since if NaCl intake exceed capacity to expel Na = inc vol & CO
HTN: Principal Mechanism
ANS - main purpose (3)
catecholamine - purpose, (3), rhythm, tonic phasic reflex
ANS
- maintain homeostasis of volume, BP, chemoreceptor signals
ENDOGENOUS CATECHOLAMINES
- fight or flight response
- dopamine norepinephrine epinephrine
- circadian rhythm: dec HR BP in sleep but catecholamine surge = inc again when wake up
- tonic CV regulation: contract
- phasic: sometimes excrete sometimes don’t
- adrenergic reflex: manage short-term BP
HTN: Principal Mechanism
norepinephrine - synthesized by, released to (2), either (2) via (1)
epinephrine - synthesized by, released into what by what
NOREPINEPHRINE
- synthesized by adrenergic neurons
- released to synaptic cleft or receptor sites on tissues
- either metabolized or taken up into neuron via active reuptake process
EPINEPHRINE
- synthesized by adrenal medulla
- released into circulation via adrenal stimulation
HTN: Principal Mechanism
baroreceptor - what, where (2), age, purpose (1=1)
rate of firing x BP
- baro: pressure
- stretch-sensitive receptor at aortic arch & carotid sinus
- deteriorate in elderly
- rapid buffering = dec sympathetic outflow
- rate of firing DP BP
HTN: RAA System
renin - what, synthesized as, main purpose, stimulated by (3), synthesized where (2)
macula densa mechanism - if what + where then what
baroreceptors - if what + where then what
RENIN
- aspartyl protease synthesized as enzymatically inactive precursor
- inc fluids
- stimulated via beta adrenoreceptors, nervous, stress
- synthesized in kidney portion of renal afferent arteriole (juxtaglomerular cells) & group of sensory cells at distal end of loop of henle (macula densa)
- macula densa mechanism: if dec NaCl transport into thick ascending limb of henle = stimulate JG cells = renin = fluid
- baroreceptors: if dec pressure/stretch at renal afferent arteriole (less fluid enters kidney) = stimulate JG cells
HTN: RAA System
renal arteriole - purpose (2), circulates where
tubular system - purpose
inhibition (3)
RENAL AFFERENT ARTERIOLE
- where blood enters kidney
- cleans; excess water or Na = urine
- circulates in capillary tuft
TUBULAR SYSTEM
- forms urine
RAA SYSTEM INHIBITION
- inc NaCl, stretch/pressure in arteriole, beta receptor blockade
HTN: RAA System
angiotensin - how made (3G), what, stimulus (2), inc BP via (4)
- angiotensinogen peptide –> angiotensin I –> go from kidney to lungs (ACE) = angiotensin II
- potent vasoconstrictor
- stimulus: low Na & arteriole pressure
inc BP:
- inc SNS activity, Ca
- inc vasopressin & aldosterone
HTN: RAA System
aldosterone - what, main purpose (2), stimulate (2=1=1), can lead to (4),
enhanced extracellular & what = what
- potent mineralcorticoid
- Na & water retention
- stimulate cardiac fibrosis & (L) ventricle hypertrophy = fibrosis = no contract/pump
- can lead to: cardiac hypertrophy, CHF, glomerular hyperfiltration, albuminuria
- enhances extracellular matrix & collagen in myocardium = muscle cell replaced by non-contractile
HTN: Vascular Mechanism
resistance x radius, Htn d/t what, what as main determinant of BP
remodeling - what (2) not what (1), lumen diameter (2), hypertrophic (3), eutrophic, factors (3)
- resistance IVP 4th power of radius
- Htn = d/t dec in lumen size of small arteries
- arterioles as main determinant of BP
REMODELING
- changes in component & geometry of vessels not volume
- lumen diameter: elasticity & compliance
- hypertrophic remodeling: inc cell number, cell size, intercellular matrix
- eutrophic remodeling: no change in component just become rigid
- factors: apoptosis, fibrosis, inflammation
HTN: Exercise
dec, inc, dilate, constrict
SBP DBP during
- dec parasympathetic, inc sympathetic
- inc venous return
- dilate arterioles, vasoconstrict nonworking areas
- exercise: <180mmHg SBP, no change in DBP
HTN: Classification by Etiology
primary - other name, d/t (2), age, race, risk (7), pathology (2), sx (3)
ESSENTIAL/PRIMARY
- elevated s cause
- d/t aging, genetics
- epi: 25-50y, black>white
- risk: smoking, alcohol, obese, metabolic disease, low K, salt, sleep apnea
- patho: overactive SNS & RAA
- sx: asymptomatic, nonspecific headache
HTN: Classification by Etiology
renal parenchymal - associated, pathology (4)
renal artery - pathology (1=1), sx
hypothyroidism - 1=1
hyperthyroidism - 2=1
RENAL PARENCHYMAL HTN
- ESRD
- patho: inc intracellular volume, renin, Na, sympathetic activity
RENAL ARTERY STENOSIS
- narrowed artery = overstimulate RAA
- abdominal bruit
HYPOTHYROIDISM
- catecholamine = diastolic Htn
HYPERTHYROIDISM
- inc CO dec PVR = systolic Htn
HTN: Classification by Etiology
primary hyperaldosteronism - 1=2=1
pheo - 1=1=3
cushing - 2=1
monogenic - what
coarctation - what
obstructive sleep apnea - (2)
PRIMARY HYPERALDOSTERONISM
- inc aldosterone = inc Na & BP = low K
PHEOCHROMOCYTOMA
- adrenal tumor = catecholamine = labile Htn, tachycardia, sweating
CUSHING
- inc fat & growth hormone = inc CO
MONOGENIC HTN
- steroid defect
COARCTATION OF AORTA
- most common congenital CV disease that cause Htn
OBSTRUCTIVE SLEEP APNEA
- snore, stop breathing
HTN: Classification by Etiology
drugs (5.4)
alcohol
nicotine
PPA
steroid
non-steroid
hormone replacement therapy (birth control, estrogen)
herbal
appetite suppressant
anti-depressant, anti-psychotic
HTN: Classification by Tx
hypertensive emergency - BP & do what, sx (5), encephalopathy what + sx (2), eclampsia do what
- 220/140 = bring down immediately
signs/sx
- chest pain, abdominal pain
- weakness, changed sensorium, slurred speech
acute target organ damage
- encephalopathy: waiting for stroke; cognitive, memory
- eclampsia: terminate or delivery
- aortic dissection, MI, heart failure
HTN: Classification by Etiology
hypertensive urgency - BP + do what
HCVD - for, complications (4)
white coat
HYPERTENSIVE URGENCY
- 180/100 = gradual bring down, send pt home
- no acute target organ damage
HCVD
- for chronic untreated Htn
- complications: gr. 4 retinopathy, kidney failure, cardiomegaly, PVD
WHITE COAT HTN
- hospital only
HTN:
cardiovascular continuum (6)
risk factor (DM, Htn)
vascular
tissue (stroke, MI)
pathological remodeling
organ
death
HTN: Pathologic Consequences
heart - heart disease as what, hypertrophy, diastolic dysfunction, CHF
brain - Htn as what, (1>1), condition, age
HEART
- heart disease: most common cause of Htn death
- (L) ventricle hypertrophy: thicker muscle
- diastolic dysfunction: not rest even during diastole
- CHF: abnormal diastolic
BRAIN
- Htn as most common cause of stroke
- infarction > hemorrhage
- encephalopathy
- >65y
HTN: Pathologic Consequences
kidney - main problem, disease as what, Htn lead to (4)
atherosclerotic - sx, ABI
— lead: HASE
KIDNEY
- excessive RAA
- primary renal disease: most common cause for secondary Htn
- Htn = hypoperfusion, atrophy, sclerosis, ESRD
ATHEROSCLEROTIC PAD
- sx: intermittent claudication (pain when walking distal to site then relieved by rest)
- ABI = <0.90 (1 as normal)
HTN: Mx
BMI, diet (5), exercise duration, alcohol (beer wine MF)
BP should always be at what level except if (3)
- BMI: 18.5-24.9
- diet: low fat dairy, DASH, Ca Mg K
- exercise: 30 mins/day
- alcohol: 24oz beer, 8oz wine, 2/day (men) 1/day (women)
BP always <130/80, except:
- previous stroke
- acute care in Htn emergency/urgency
- >80y
HTN: Mx
beta blocker - example, 1=1
Ca - example (3), does what
ACE inhibitor, angiotensin, alpha, central - example (1.1.1.2)
diuretics - does what (2)
BETA BLOCKERS
- olol
- block SNS = dec CO
Ca CHANNEL BLOCKERS
- pine, diltiazem, verapamil
- prevent Ca release otherwise vasoconstrict
ACE INHIBITOR
- pril
ANGIOTENSIN RECEPTOR BLOCKER
- tan
ALPHA BLOCKER
- sin
- peripheral
CENTRAL BLOCKER
- dine, zine
- brain
DIURETICS
- mide, thiazides, chlorthalidone,
- excess water & Na
<120
120-129
130-139
140-159
160
AND AND OR OR OR
<80
<80
80-89
90-99
>100
JNC8
normal, pre, pre, 1, 2
ACC
normal, elevated, 1, 2, 2
