HTN and Arteriosclerosis Flashcards
Normal BP is considered:
- Systolic < 120 mmHg
- Diastolic < 80 mmHg
USPSTF recommends all individuals be screen for HTN at what age?
≥18 yo
Malignant HTN (> 200/120 mmHg) will lead to death within how long?
1-2 years
How many people with uncontrolled HTN will die due to stroke?
1/3
How many with uncontrolled HTN will die due to IHD or CHD?
50%
Angiotensin II is a powerful BLANK
vasoconstrictor
Angiotensin II is a powerful vasoconstrictor that stimulates the release of BLANK
Aldosterone –> increased blood volume and blood pressure
The pulmonary and renal endothelium release ACE which functions to do what?
Converts angiotensin I to angiotensin II
What does the liver secrete to facilitate RAAS?
Angiotensinogen
What results in the transformation of angiotensinogen to angiotensin I?
Renin
What are the important effects of angiotensin II resulting in an increase in BP?
- SANS activity
- Tubular NaCl reabsorption & H2O retention
- Adrenal gland stimulation to secrete aldosterone (leads to the above)
- Arteriolar vasoconstriction
- Pituitary gland stimulation leading to ADH secretion increasing H2O retention
H2O and Na retention stimulate which cells for negative feedback on the RAAS?
Juxtaglomerular cells
Primary HTN occurs in what percentage of cases?
95%
What characteristic of arteries is changed during aging that enhances risk for HTN development?
Increased stiffness and less compliance due to a decrease in elasticity
What are the disorders (categories) of secondary HTN?
ABCDEF
* Aldosterone
* Bad kidneys
* Catecholamines, coarctation of aorta, Cushing’s syndrome
* Drugs: methamphetamines, cocaine, NSAIDs, corticosteroids, oral contraceptives (high doses of estrogens)
* Erythropoietin & Endocrine disorders (hypothyroidism, hyperthyroidism, hyperparathyroidism)
* Food
What is the function of aldosterone? How can it increase the risk of secondary HTN?
- Na reabsorption from tubular urine back into bloodstream
- Increased blood volume increases BP
- K secretion into tubule
Idiopathic hyperaldosteronism or adenoma
What can cause HTN with hypokalemia?
Hyperaldosteronism
What is renovascular HTN?
HTN resulting from compromised arterial supply to the kidneys
* Decrease in stretch of juxtaglomerular apparatus leading to release of renin
Fibromuscular dysplasia (FMD) occurs most commonly in which gender?
females (90%)
Fibromuscular dysplasia (FMD) has multiple areas displaying what?
Stenosis then dilation (string of beads)
T/F: Fibromuscular dysplasia (FMD) is a non-inflammatory, non-atherosclerotic process that most commonly involves the renal arteries
True, renal arteries (75-80%) of time
How often are extracranial cerebrovascular arteries involved in fibromuscular dysplasia (FMD)?
75% of time
Hyperplasia of what structures leads to lumenal stenosis in fibromuscular dysplasia (FMD)?
- Tunica media
- Tunica intima
What are the (4) Ps of HTN-associated arteriosclerosis?
- Pink (hyaline deposition)
- Plasma proteins
- Pressure (HTN) & DM
- Pinpoint lumen or Packed lumen
What is the pathogenesis of HTN-associated arteriosclerosis?
- Leakage of plasma components across injured endothelial cells into vessel wall
- Increased ECM due to smooth muscle stimulation
- lumenal narrowing
An onion skin appearance of vessels is noted in what type of arteriosclerosis?
Hyperplastic ateriosclerosis (HTN associated)
Malignant HTN is associated with what type of necrosis?
Fibrinoid necrosis
What is hyaline arteriosclerosis?
A form of arterial thickening and hardening as a result of hypertension
What happens to the LV due to HTN?
Concentric LV hypertrophy
How does HTN lead to nephrosclerosis?
- Benign: hyaline deposition leading to media and intima thickening and narrowed lumen
- Results in ischemia and atrophy
- Renal function maintained
- Malignant: Fibrinoid necrosis and hyperplastic arteriosclerosis
- Renal function is not maintained
Papilledema is a sign of which type of HTN retinopathy?
Severe
Cotton-wool spots is a sign of what type of HTN retinopathy?
Moderate
Arteriovenous nicking is a sign of what type of HTN retinopathy?
Mild
Aortic dissection occurs when?
Blood separates the tunica media
What are some predisposing factors to aortic dissection?
- HTN, M, 40-60 yo (90%)
- Marfan syndrome or Ehlers Danlos
- Trauma
- Vasculitis
- Use of cocaine
- intima tear
Where does a Type A aortic dissection take place?
Affects ascending aorta
Where does a type B aortic dissection take place?
Begins beyond the subclavian artery
Pain from aortic dissection can radiate to?
Back
How do calcium salts appear on H&E?
Dark blue
T/F: In Monckeberg medial calcific sclerosis the lumen is significantly narrowed
False
