HTN

Question 1

What happens to vessels over time and how does the body compensate?

Answer 1

Lose elasticity and become narrow

Body creates collateral vessels

Question 2

What is affected by atherosclerosis of the aorta?

Answer 2

LV afterload

Question 3

Which vessels and what parts of the vessels does atherosclerosis affect?

Answer 3

Intima of large and medium arteries

Question 4

Which vessels does arteriosclerosis affect?

Answer 4

Small arteries

Question 5

What are the results of atherosclerosis?

Answer 5

Narrowing of lumen
Obstruction
Aneurysm
Ulceration
Rupture

Question 6

What can obstruction of the vessel lead to?

Answer 6

Ischemia (lack of blood flow) -> hypoxic tissue -> infarction (death)

Question 7

What is the biggest cause of an aneurysm (weakening of the vessel wall)?

Answer 7

Turbulent blood flow

Question 8

How does an ulceration form in an artery?

Answer 8

Ulceration gets scarred over (granulation tissue) - tough material

Question 9

What is the reaction to injury theory?

Answer 9

Injury increases aggregation of platelets & monocytes

Smooth muscle forms a matrix of collagen & elastic fibers - causes tightening of vessels

Question 10

What is an arteriogram/angiogram?

Answer 10

Sending a camera through femoral or radial artery to view the vessels

Question 11

What circumstances will you see because of diseased and sclerosed arteries?

Answer 11

Will find low blood flow in the legs, decreased hair growth, discolored extremities, intermittent claudication, ulcers, weak pedal pulses

Question 12

What are the two atherosclerotic lesions?

Answer 12

Fatty streaks

Fibrous plaques

Question 13

What are characteristics of fatty streaks?

Answer 13

Yellow and smooth
Protrude into lumen
Composed of lipids & elongated smooth muscle cells

Question 14

How can fatty streaks be decreased?

Answer 14

Diet, exercise, medication

Question 15

What are characteristics of fibrous plaques?

Answer 15

White to whitish-yellow in color
Protrude into lumen
Composed of smooth muscle cells, collagen fibers, plasma components, and lipids
Found mostly in abdominal aorta, coronary, popliteal, and internal carotid arteries
IRREVERSIBLE

Question 16

How can fibrous plaques be decreased?

Answer 16

Stent

Carotid endarterectomy

Question 17

Why is age a risk factor for vascular disease?

Answer 17

Vessels lose elasticity

Question 18

Why is sex a risk factor for vascular disease?

Answer 18

Estrogen is cardioprotective

Men are at a higher risk until women hit menopause

Question 19

Why is a diet high in fat a risk factor for vascular disease?

Answer 19

Fat solidifies and causes fibrous plaques within the body

Question 20

Why is HTN a risk factor for vascular disease?

Answer 20

Due to turbulent blood flow damaging the vessels

Question 21

Why is diabetes a risk factor for vascular disease?

Answer 21

Sugar sticking to the walls in the blood vessels

Problem with the microcirculation in the eyes, distal peripheries, and kidneys

Question 22

Why is smoking a risk factor for vascular disease?

Answer 22

Directly affects intima of vessels and changes it

Nicotinic acid changes vasculature

Question 23

Why is obesity a risk factor for vascular disease?

Answer 23

Tend to have worse lifestyle (eating/exercising) practices

Question 24

Why is stress a risk factor for vascular disease?

Answer 24

Increases turbulent blood flow

Question 25

What are the BP guidelines for anyone <60?

Answer 25

SBP <140 | DBP <90

Question 26

What are the BP guidelines for anyone >60

Answer 26

SBP <150 | DBP <90

Question 27

What are the BP guidelines for anyone with diabetes/no CKD?

Answer 27

SBP <140 | DBP <90

Question 28

What are the BP guidelines for anyone with CKD?

Answer 28

SBP <140 | DBP <90

Question 29

What is essential or primary HTN?

Answer 29

No identifiable medical cause | Possibly due to norepinephrine (vasoconstriction), epinephrine (vasoconstriction), response of kidneys in the body

Question 30

What are clinical manifestations of HTN?

Answer 30

``` May only be change in B/P Change in retina Coronary artery disease (CAD) or Angina Left Ventricular hypertrophy Change in kidneys CVA or TIA ```

Question 31

How does HTN affect the kidneys?

Answer 31

Glomerulus (filtration system) becomes less effective | *Need to do a UA

Question 32

What is secondary HTN?

Answer 32

HTN secondary to something else

Question 33

What can cause secondary HTN?

Answer 33

``` Diabetes High salt Stress Smoking Cancer Adrenal disease Corticosteroids CKD ```

Question 34

What are the 4 first-line treatments of HTN?

Answer 34

Thiazide diuretics CCBs ACE inhibitors ARB

Question 35

What are second- and third-line alternative treatments for HTN?

Answer 35

Higher doses or combinations of ACEIs, ARBs, thiazide-type diuretics, and CCBs

Question 36

What are later-line alternatives for treating HTN?

Answer 36

Beta-blockers (-olol) Alpha-blockers (ex. doxazosin) Alpha1/beta-blockers (-ilol - Coreg) Vasodilating beta-blockers (ex. nebivolol) Central alpha2-adrenergic agonists (ex. clonidine) Direct vasodilators (ex. hydralazine) Loop diuretics (ex. furosemide - Lasix) Aldosterone antagonists (ex. spironolactone) Peripherally acting adrenergic antagonists (ex. reserpine)

Question 37

What is a concern for Lasix?

Answer 37

Hypokalemia and excessive urination

Question 38

Which two classes of HTN meds should not be used simultaneously?

Answer 38

ACE inhibitors and ARBs

Question 39

Which class of HTN meds should black people use?

Answer 39

CCBs and thiazides instead of ACE inhibitors

Question 40

Which 2 classes of meds are recommended for patients with CKD regardless of ethnic background?

Answer 40

ACE inhibitors or ARBs

Question 41

Which 2 HTN meds are renal protective?

Answer 41

ACE inhibitors and ARBs