HTN - VanRijn Flashcards
HTN is: \_\_\_\_ measurements of Bp with a diastolic pressure >\_\_\_\_\_ or Systolic > \_\_\_\_\_ or Resting Pulse Pressure (SBP-DBP) > \_\_\_\_
2 or more
D: > 90 mmHg
S: > 140 mmHg
RBP: > 65 mmHg
Primary Or Secondary HTN?
Lifestyle
Primary
Examples of Lifestyle that can affect HTN
Excess body weight; Smoking alcohol; excess sodium/too little K+
lack of exercise/sedentary lifestyle
Primary Or Secondary HTN?
Hyperlipidemia
Primary
Primary Or Secondary HTN?
Depression
primary
Primary Or Secondary HTN?
Age
primary
HTN (decreases or increases) with age
increases
If someone is over ____ years old and has a SBP > _____ then they are at a high CVD risk
50; 140
Primary Or Secondary HTN?
Sex
Primary
Men are more likely to have HTN in what age range
< 55
Women are more likely to have HTN in what age range
> 55
Primary Or Secondary HTN?
genes (family hx)
primary
Primary Or Secondary HTN?
Race (African Americans more common to have HTN)
Primary
Primary Or Secondary HTN?
Kidney Disease
Secondary
Primary Or Secondary HTN?
Renal Artery Constriction
Secondary
What are some examples of kidney issues that can cause SECONDARY HTN
Stenosis; Cysts; Glomerulonephritis
Primary Or Secondary HTN?
Tumors
Secondary
Primary Or Secondary HTN?
Pheochromocytoma
Seconary
what is Pheochromocytoma?
tumor on adrenal gland/ will cause increase in adrenanline
Primary Or Secondary HTN?
Endocrine disease
secondary
what are some endocrine diseases that lead to secondary HTN
Cushings Syndrome; Conn’s Syndrome
Why does cushing syndrome lead to HTN
excessive secretion of gluocorticoids –> increase in BP
why does Conn’s syndrome lead to HTN
Excessive production of aldosterone (aka hyperaldosteronism)
Primary Or Secondary HTN?
Coarctation of the aorta
Secondary
Primary Or Secondary HTN?
Pregnancy
Secondary
Primary Or Secondary HTN?
Medication Side Effects
Secondary
what are some common meds/side effects that will lead to secondary HTN
High estrogen oral contraceptives; Antidepressants (Clozapine, venlafaxine); Rebound HTN!
Diabetes and HTN:
_____ and _____ lead to vascular damages
Glucose; Fat
Diabetes & HTN:
___________ can lead to orthostatic HTN
autonomic neuropathy
Diabetes & HTN:
Diabetic Nephropathy can lead to HTN - what is the proposed idea to explain this?
- RAAS system is affected; there is increased oxidative stress; SNS (sodium retention sympathetic nervous system is affected)
Chronic HTN is damaging to ______ organs
end
“End Organs” are heavily enervated by _______
small vessels
What are some end organs that can be affected/damaged by Chronic HTN
Heart, Kidney, Brain, Eyes
Blood Pressure = ____ x _____
CO (cardiac Output); PVR (Peripheral Vascular Resistnace)
Goals of Pharmacotherapy of HTN:
Reduce what 3 things
- SYSTOLIC BP (diastolic not as predictive of mortality)
- Cardiac OUtput
- Vascular Resistance
The Baroreceptor Reflex:
Vascular resistance is primarily controlled by ______
SANS (Sympathetic autonomic …..)
Cardiac Output = what symbol?
Q
Cardiac output is also known as blood ______
flow
Cardiac output (or blood flow Q) is made up of what two things?
SV (stroke volume) x HR (heart rate)
Baroreceptors located by ________ are important in sensing BP by the _____ in the arteries to keep homeostasis
aortic arch; stretch
Chemoreceptors sense changes in what things?
pH; CO(2); O(2)
How does the body compensate when chemoreceptors notice low O2
it stimulates SNS/increase HR/cause vasoconstriction
How does the body compensate when chemoreceptors notice high O2
decrease HR
How does the body compensate when chemoreceptors notice low CO2
decrease HR (Low CO2 = High O2)
How does the body compensate when chemoreceptors notice high CO2
this means low O2 and then it stimulates SNS/increase HR/cause vasoconstriction
4 main targets for antihypertensive
- Heart
- Resistant arterioles
- Veins (SANS)
- Kidney
How does the body compensate when chemoreceptors notice low pH
stimulates SNS/increase HR/cause vasoconstriction
ANS:
Notable signalers of parasympathetic system
Muscarine and Nicotine
(Ach too)
aka
Cholinergic
ANS:
Notable signalers of Sympathetic system
Norepinephrine
Epinephrine
(Adrenergic Receptors)
ANS:
All ______ nerves release ______ onto _______ that are expressing ______ receptors
PREGANG neurons; release Ach; postgang; nicotinic receptors
this is for BOTH parasympathetic and sympathetic
Parasympathetic or Sympathetic ?
Postganglionic nerves release Ach onto muscarinic receptors
PARASYM
Parasympathetic or Sympathetic ?
Postganglionic nerves primarily release NE that will bind to adrenergic receptors
Sympathetic
There are postganglionic nerves in the kidney that release ______ to ______ receptors that will cause _________
release dopamine; to bind to dopamine (D1) receptors; which will cause vasodilation
Receptors/Signal Transduction in the ANS:
What are the possible options
Gs; Gi; Gq
Beta receptors use which pathway?
Gs or Gi or Gq
Gs
Alpha1 receptors use which pathway?
Gs or Gi or Gq
Gq
Activation of sympathetic nerves causes release of _________ from adrenals
epi/norepi
Activation of sympathetic nerves causes release of epi/norepi from ________
adrenals
Does the receptor do relaxation or contraction?
Alpha1
contraction (vasoconstriction)
Does the receptor do relaxation or contraction?
Beta2
relaxation (vasodilation)
Signal transduction through M3 receptor - causes vaso______ and is done via _____
vasoDILATION; via NO
Chronotropic Effects:
______ of contraction
and
________
Rate; SA Node cells
Ionotropic Effects:
_____ of contraction
and
__________
force; cardiomyocytes
What are the two primary ANS receptors that work in the heart?
M2 and B1
