hypertension Flashcards
1
Q
what is a normal blood pressure?
A
less than 120/80
2
Q
what is an elevated blood pressure?
A
120-129 and less than 80
3
Q
stage 1 hypertension is?
A
130-139 or 80-89
4
Q
hypertension stage 2 is?
A
140 or higher or 90 or higher
5
Q
hypertensive crisis is?
A
systolic: 180 or higher
and/or
120 and higher
meaning you usually have both but you could just have one
6
Q
A
7
Q
what is the most common primary diagnosis in the United States?
A
hypertension
8
Q
in individuals younger than 45 years old the prevalence of hypertension is higher in men or women?
A
men
9
Q
after 65 years old the prevalence of hypertension is higher in men or women?
A
women
10
Q
the prevalence of hypertension increases with ______.
A
age
11
Q
the prevalence of hypertension is higher in _____ _____ who suffer from diabetes.
A
aftrican americans
12
Q
what is isolated systolic hypertension?
A
an elevated systolic blood pressure accompanied by a normal diastolic blood pressure
13
Q
isolated systolic hypertension is commonly abbreviated?
A
ISH
14
Q
ISH is becoming mrore prevalent in all _____ ______ and is strongly assciated with what kind of events?
A
all age groups
cardiovascular and cerebrovascular events
15
Q
95% of hypertension cases are diagnosed as?
A
primary hypertension
16
Q
primary hypertension means what?
A
no known cause
17
Q
primary hypertension is also called?
A
essential hypertension
18
Q
what is secondary hypertension?
A
associated with an underlying primary disorder like renal disease
19
Q
hypertension is a complex disorder that affects the entire ______ system.
A
cardiovascular
20
Q
All types and stages of hypertension are associated with increased risk for target organ disease events such as?
A
myocardial infarction
kidney disease
stroke
21
Q
Risk factors for primary hypertension include (5)
A
age
obesity
smoking
stress
high alcohol intake
22
Q
secondary hypertension is caused by an underlying disease process that raises what two things?
A
peripheral vascular resistance or cardiac output
23
Q
what drugs can cause secondary hypertension?
A
oral contraceptives
corticosteroids
antihistamines
24
Q
what happens to the blood pressure in secondary hypertension is the cause is identified and removed before permanent structural changes occur?
A
blood pressure returns to normal
25
cardiac output is increased by any condition that increase the ____ \_\_\_\_ or _____ \_\_\_\_\_.
heart rate
or
stroke volume
26
peripheral resistance is increased by any factor that increases blood _____ or reduced _____ \_\_\_\_.
viscosity
vessel diameter
27
primary hypertension is the result of a complicated interaction between genetics and the environment that increases what two things
peripheral vascular resistance and blood volume
28
increased vascular volume is related to a decrese in renal exretion of \_\_\_\_\_, often referred to as a shift in the pressure natriuresis relationship
salt
29
what does pressure natriuresis relationship mean?
this means that for a given blood pressure, individuals with hypertension tend to secrete less salt in their urine
30
name pathophysiologic mechanisms that can cause primary hypertension (7).
SNS
RAAS
BNP
inflammation
endothelial dysfunction
obesity related hormones
insulin resistance
31
in patients with hypertension, the SNS can cause hypertension by two mechanisms?
increase production of catecholamines (ephinephrine or norepinephrine)
increased receptor reactivity involving the neurotransmitters (norepi or epi)
32
increased SNS activity = ______ heart rate and systemic \_\_\_\_\_\_\_.
increased
vasoconstriction
33
increased SNS causes what effects affecting blood pressure?
increased HR and PVR
increased insulin resistance
vascular remodeling
procoagulant effects
34
increased SNS activity increases insulin resistance which causes \_\_\_\_\_\_\_\_\_\_dysfunction, leading to what?
endothelial dysfunction
narrowing of the vessels and vasospasms causing hypertension
35
describe the RAAS system
Baroreceptors trigger the release of renin from the kidneys, and angiotensinogen from the liver, which combined make angiotensin 1 and then the ace enzyme from the lungs converts this into angiotensin II.
36
List the effects of angiotensin II (5 things)
constrict glomerular efferent arteriole
Posterior pituitary-ADH secretion-increased kidney water reabsorption
vascular smooth muscle - constriction
hypothalamus-stimulates thirst
adrenal cortex-adosterone secretion-increased sodium retention in the kidneys
37
in the brain angiotensin 2 enhances sympathetic neural outflow, altering the release of hormones that contribute to what four things?
endothelial dysfunction
insulin resistance
dyslipidemia
platelet aggregration
38
angiotensin 2 can cause _______ remodeling, which is a structural change in the vessel wall that results in permanent increases in peripheral resistance.
arterial
39
angiotensin 2 is associated with end organ damage due to hypertension such as (3 things)
atherosclerosis
renal disease
cardiac hypertrophy
40
why is angiotensin 2 a potent vasocontrictor?
because it destroys the potent vasodilator bradykinin
41
name the organs affected by angiotensin 2?
brain
heart
adrenals
kidney
and kidney efferent arterioles
42
angiotensin II can be further modified into?
angiotensin III and IV
43
describe the effects angiotensin II has on blood vessel structure and function leading to aterosclerosis?
increased thrombosis
increased platelet aggregation
increased smooth muscle cell growth and migration
increase growth
decreased apoptosis
increased endothelial dysfunction
44
Populations with high dietary ______ intake have long been shown to have an increased of hypertension.
sodium
45
sodium is retained when there is low dietary intake of which three electrolytes?
potassium
calcium
magnesium
46
Why does the sodium retention occur with decreased potassium, calcium, and magnesium intake?
Natriretic hormones modulate renal sodium excretion and require adequate potassium, calcium, and magnesium in order to function properly.
47
Natriuretic hormones include what?
atrial natriuretic peptide (ANP) or B type natriuretic peptide or BNP.
48
Natriuretic hormones does what functions?
increase natriuresis
decrease blood volume
decrease aldosterone secretion
vasodilate
decrease blood pressure
increase endothelial permeability
49
Dysfunction in the natriuretic hormone can cause what two things to happen?
increase in vascular tone
shift in the pressure natriuresis relationship
50
when there is inadequate natriuretic function, serum levels of ______ \_\_\_\_\_ rise in an attempt to compensate
natriuretic peptides
51
In hypertension, increased ANP and BNP are linked to an increased in what disease processes?
ventricular hypertrophy
atherosclerosis
heart failure
52
in addition to the shift in the pressure natruresis relationship why does the dysfunction in natriuretic hormones cause more rethention of sodium?
because of vasoconstriction decreasing blood flow to the kidneys causing ischemia causing inflamation causing dysfunction of the glomeruli and tubules and promote additional sodium retention.
53
how can you increase or enhance natriuretic peptide function with diet?
potassium
calcium
magnesium
54
what two molecules stimulate ANP and BNP?
renin and angiotensin II
55
what inhibites the NP system?
SNS system
56
inflammation place a role in ____ dysfunction of hypertension
vascular
57
endothelial injury and tissue ischemia can result in the release of ?
vasoactive inflammatory cytokines
58
endothelial injury and tissue ischemia release what cytokines in acute inflammatory injury?
histamine and protoglandins which vasodilate
59
with chronic inflammation vascular _____ and smooth muscle _____ occurs
remodeling
contraction
60
endothelial injury and dysfunction in primary hypertension are characterized by decreased production of ______ such as _____ \_\_\_\_ and increased production of ________ such as \_\_\_\_\_\_\_.
vasodilators such as nitrous oxide
vasoconstrictors such as intodetlin
61
obesity causes changes in \_\_\_\_\_\_. Name three.
adipokines
1. leptin
2. resistan
3. adipoq nectin
62
obesity does was to the SNS and RAAS
increases their activity
63
adipokine dysregulation causes what effects (6)
increased vascular tone and arterial stiffness (remodeling)
increased RAAS system
Increased liver inflammation
decreased metabolic rate
insulin resistance
decreased muscle perfusion
64
Patients with diabetes are treated with medications to improve insulin resistance, what can happen to the blood pressure?
decrease
65
insulin resistance is associated with ____ injury and affects the ____ function, causing ____ and _____ retention.
endothelial
renal
salt and water retention
66
insulin resistance is associated with overactivity of what two systems
SNS and RAAS
67
now for a summary name the factors leading to primary hypertension which will be cause by increased blood volume and increased peripheral resistance.
genetics
increased SNS
Increased RAAS (especially aldosterone)
endothelial dysfunction
dysfunction of natiruetic hormones
decreased dietary potassium, magnesium, and calcium
increased dietary sodium intake
insulin resistance
obesity
renal glomerular and tubular inflammation
68
what is complication hypertension?
hypertension that damages the walls of systemic blood vessels, leading to dysfunction of the organs perfused by the affected vessels.
69
another name for complicated hypertension is?
chronic hypertension
70
chronic hypertension affects which organs?
kidney
brain
heart
extremities
and eyes
71
a hypertensive crisis is also called
malignant hypertension
72
hypertensive crisis is when the the blood pressure is
systolic higher 180
diastolic higher than 120
73
hypertensive crisis can occur as an uncommon complication of _____ hypertension.
primary
74
other causes of hypertensive crisis would be?
pregnancy
cocaine or amphetamine use
reaction to certain medications
adrenal tumors
alcohol withdrawal syndrome
75
high arterial pressure renders the cerebral arteries incapable of doing what?
regulating blood flow to the cerebral capillary beds.
76
high hydrostatic pressures in the cerebral capillaries causes vascular fluid to ____ into the interstitial space
leak out
77
if hypertensive crisis blood pressure is not reduced, ______ edema and _____ dysfunction increase until death finally occurs
cerebral
cerebral
78
hypertensive crisis can also cause other symptoms such as (4)
heart failure
uremia
retinopathy
cerebrovascular accident
79
hypertensive crisis must be treated rapidly why?
to avoid serious complications
80
the early stages of hypertension have _____ clinical manifestations
none except elevated blood pressure
81
because early stages of hypertension does not have clinical manifestations other than elevated bp it is also called the
silent disease
82
most clinical manifestation of hypertensive disease are caused by complication affecting _____ \_\_\_\_\_.
target organs
83
Diagnosis of hypertension requires are high reading on how many occasions?
on at least two seperate occasions
84
describe how to take the blood pressure readings and special considerations when testing for hypertension?
average 2 readings at least two minutes apart with the individual seated, the arm supported at the level of the heart after five minutes at rest with no smoking or caffeine intake in the past 30 minutes.
85
why would some individuals benefit from a 24 hour ambulatory blood pressure monitoring?
better correlation with end organ damage and the ability to screen out for white coat hypertension and mask hypertension
to monitor for patients who fail to have a nocturnal decrease in blood pressure who may be at higher cardiovascular risk
86
evaluation of a hypertensive individual should include what?
complete medical history
assessment of lifestyle and other risk factors for hypertension and cardiovascular disease and secondary causes of hypertension.
87
what is mask hypertension?
when blood pressure is normal in the clinic setting but elevated everywhere else.
88
what is white coat syndrome?
where blood pressure is elevated in the clinic setting but not everywhere else
89
physical exam should include what for a hypertensive patient?
optic fundi
calculation of BMI
examination of heart and lungs
palpation of the abdomen
assessment of lower extremity pulses and edema
neurologic examination
90
diagonstic test of a hypertensive patient include?
CBC
urinalysis
BMP (glucose, sodium, potassium, calcium, magnesium, creatinine, cholesterol, and triglycerides)
EKG
91
Individuals who have elevated blood pressure are assumed to have ______ \_\_\_\_\_\_ unless their history, physical examination, or initial diagnostic screening indicates _______ hypertension.
primary hypertension
secondary hypertension
92
once the diagnosis is made for hypertension, a careful evaluation for other ______ risk factors and for ______ organ damage should be done.
cardiovascular risk factors
target organ damage
