HTN - STOELTING CH 9 Flashcards
_ _ widening is a risk factor for CV morbidity and is considered as an index of vascular remodeling and “Stiffness”
pulse pressure widening
Patho of primary HTN table 9.2 (3 main factors)
ANS
-acute control of CO, VR, and blood volume
-HTN assoc w dysregulation of baroreceptors and chemoreceptors (periph + central)
RAAS
-dysregulated = increased renin production > ang II overproduction > increased aldosterone > HTN
Endogenous vasodilators/ vasoconstricor balance
-normally endothelial vasoactive substances (NO), ANP + BNP released from myocardium > vasodilation, if dysregulated not happening + overactivity of neprilysin (ARNIs take care of this)
Pharm causes of secondary HTN (list a few):
-certain abx (ketoconazole)
-COX2i, NSAIDs
-herbs: ephedra, ginseng, ma fuang?
-illicits: amphetamine, cocaine
-immunosuppressives: cyclosporine, tacrolimus
-psych: bupropione, carbamazepine, lithium, MAOI, SSRI, TCA
-HRT: androgens, po contraceptives, estrogen
-steroids
-sympathomimetics: diet pills, decongestants
Causes of secondary HTN by age:
Kids: Renal parenchymal dz, coarction of aorta
Teens: coarction of aorta
YA: thyroid issues, fibromuscular dysplasia, renal dz
Middle age: hyperaldo, thyroid issue, OSA, Cushing, Pheochromocytoma
Old age: atherosclerotic renal artery stenosis, renal fail, hypothyroidism
Chronic HTN leads to:
-remodeling of small and large arteries
-endothelial dysfunction
-possible organ damage
Disseminated vasculopathy plays major role in: (6)
ischemic heart dz
LVH
CHF
cerebrovasc dz + CVA
PVD + aortic aneurysm
neuropathy
Resistant HTN =
above goal BP despite 3+ meds of different classes given at MAX dose
usually: LA CCB, ACEi, ARB, diuretics
Controlled resistant HTN =
controlled BP requiring 4+ HTN meds
refractory HTN =
uncontrolled HTN on 5+ meds
pseudoresistant HTN
