Hypertension Flashcards

1
Q

How do you calculate blood pressure and cardiac output?

A
BP = cardiac output x total peripheral resistance
CO = stroke volume x heart rate
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2
Q

What are the current joint national committee levels for hypertension?

A

Normal: 120/80
Pre HTN: 120/80 - 139/89
HTN 1: 140/90 - 160/100
HTN 2: >160/100

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3
Q

What has control over blood pressure regardless of how high cardiac output and total peripheral resistance are?

A

Renal Excretion

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4
Q

How does the carotid sinus regulate blood pressure?

A
  • High blood pressure stretches the carotid sinus.
  • The stretch in the vessel wall sends a signal up CN IX to the nucleus tractus solitaries in the brainstem medulla
  • sympathetic stimulation is inhibited and parasympathetic stimulation occurs
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5
Q

How does the aortic arch regulate blood pressure?

A
  • High blood pressure stretches the carotid sinus.
  • The stretch in the vessel wall sends a signal up CN X to the nucleus tractus solitaries in the brainstem medulla
  • sympathetic stimulation is inhibited and parasympathetic stimulation occurs
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6
Q

How is essential hypertension diagnosed?

A

It is diagnosed by exclusion. When all other etiologies are ruled out you are left with primary or essential hypertension.

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7
Q

What are the 4 theoretical mechanisms explaining how hyperinsulinemia may cause essential HTN?

A
  1. Stimulates Renal absorption increasing volume
  2. Increases SANS activity increasing circulating catecholamines
  3. Mitogen that stimulates vascular smooth muscle hypertrophy
  4. Alters membrane transport increasing intracellular calcium and vascular tone

-a mitogen is a chemical substance (like insulin) that encourages mitosis

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8
Q

What is the theory behind leptin contributing to essential hypertension?

A

Leptin activates the SANS

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9
Q

What is the difference in the proposed cause of essential hypertension in younger patients vs. older patients? What would the treatments then be?

A

Younger: due to elevated CO
-Tx: beta blockers

Older: due to elevated TPR
-Tx: vasodilators

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10
Q

Top two most common causes of Renovascular HTN (a type of secondary HTN) and treatments for each.

A

Men: atherosclerosis
-Tx: stent

Women: fibromuscular dysplasia
-Tx: angioplastic balloon

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11
Q

Treatment for a unilateral Renal artery stenosis leading to Renovascular HTN.

A

ACE-Is

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12
Q

What is the mechanism that leads to secondary HTN in a patient with aortic coarctation?

A
  1. Coarctation causes low renal blood flow (RBF)
  2. Kidneys respond to low RBF with Renin-Ag-Ald system
  3. Atherosclerosis also occurs proximal to the stenosis and baroceptor’s neural regulation is less sensitive
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13
Q

Radiography clue to aortic coarctation and treatment.

A

Dx: notched ribs on chest X-ray

Tx: angioplasty

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14
Q

Tx. for pheochromocytoma.

A

Phenoxybenzamine

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15
Q

Etiology and diagnosis of primary vs. secondary aldosteronism.

A

Primary
Cause: aldosterone-secreting adenoma in adrenal glands
Dx: high aldosterone levels and low renin levels

Secondary
Cause: renin-secreting tumor
Dx: high renin levels, high Ag II levels, low aldosterone levels

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16
Q

What changes to the heart can occur with chronic HTN that is a huge indicator for morbidity?

A

Left Ventricular Hypertrophy

17
Q

What is noticed on ophthalmoscopy exam that would indicate need for neurosurgery consult?

A

Papilledema