hypertension Flashcards
these pressure differences produce the gradient allowing for systemic movement of blood
the pressure difference between the right and the left side of the heart
_____ is produced by the force of the left ventricular contraction overcoming the resistance of the aorta
arterial blood pressure
know the distribution of pressure within the systemic circulation (e.g. from greatest to least pressure in mmHg)
the greatest pressure in the aorta, then it goes to the arteries then arterioles then the capillaries (pressure is greater on arteriole side of capillaries and gets lower on venule side). Then it goes to the venules, to the muscular veins then the central veins and finally the right atrium where the pressure is now 0mmHg
_______+ __________ are the two determinants for arterial pressure
cardiac output and peripheral resistance
what two determinants affect cardiac output
heart rate and stroke volume
______ is related to myocardial contractility and to the size of the vascular component
stroke volume
______ is the most common aetiology of secondary hypertension
primary renal disease
______ is the peak pressure during cardiac systole
systolic bp
______ is the lowest pressure during cardiac diastole
diastolic bp
what is the primary factor influencing systolic blood pressure
stroke volume
what is the major determinant for diastolic pressure
systemic vascular resistance (SVR)
________ is the average arterial pressure throughout one cardiac cycle
mean arterial pressure
______ requires intra-arterial catheter; usually in radial artery and this is the most accurate measurement of BP
direct BP
______ requires intra-arterial catheter; usually in radial artery and this is the most accurate measurement of BP
direct BP
_____ includes using a manual or automated method (e.g. BP cuff and stethoscope), requires careful techniques; auscultation of korotkoff sounds
indirect measurement of BP
what are the 4 ways BP is regulated?
-lifestyle
-neural, humoral and renal factors
-suprachiasmatic nuclei
-circadian rhythm
list the short term regulation of BP
- activation of the systemic nervous system to produce NE & epinephrine
- activation of the vasomotor centre by activation of baroreceptors which activates alpha and beta receptors
what receptors are found in smooth muscle of arterioles and are post synaptic that lead to vasoconstriction
alpha 1
what receptors are pre synaptic
alpha 2
what receptors are found in vascular smooth muscle that lead to vasodilation and bronchodilation when activated
beta 2
what receptors are found in the heart and increase muscle contraction when activated
beta 1
are alpha or beta receptors epinephrine mediated
beta
are alpha or beta receptors norepinephrine mediated
alpha
liat examples of long term regulation of systemic BP
- increase in ECF leads to increase in CO and SVR which increases BP
- increase in serum sodium levels increases osmolality which increases ADH secretion
- angiotensin II increases SVR which increases BP
- ANP causes increase secretion of H2O and Na from an increase in GFR
- RAAS
know how the RAAS is an important regulator of BP
due to its vasoconstrictive properties of angiotensin II and its Na retaining properties of aldosterone.
renin secretes angiotensinogen which leads to inactive angiotensin I. ACE converts angiotensin I to angiotensin II. angiotensin II is a vasoconstrictor and it produces aldosterone. ACE also inactivates the vasodilator bradykinin
what is a normal systolic and diastolic BP
systolic <120 diastolic <80
what is an elevated systolic and diastolic BP
systolic 120-129 diastolic <80
what systolic and diastolic BP’s are associated with stage I hypertension
systolic 130-139 diastolic 80-89
what systolic and diastolic BP’s are associated with stage II hypertension
systolic greater than or equal to 140-149 diastolic >90
_____ occurs when you have abnormally high BP that’s not the result of a medical condition
primary/essential hypertension
what are some non modifiable factors for primary hypertension
-family history/genetics
-age
-gender
what are some modifiable risk factors for primary hypertension
-sedentary lifestyle
-metabolic disorders
-dietary factos
-obesity
what are some outcomes of primary hypertension
- increased myocardial work leads to heart failure
- gomerlular damage leads to kidney failure
- affects microcirculation in eyes
- increased pressure in cerebral vasculature leads to hemorrhage
when does atherosclerosis start to occur
after first decade of life
know the pathogenesis of atherosclerosis
- after vascular injury, monocytes bind to epithelium and become activated microphages
- macrophages take up oxidized LDL becoming foam cells
-T cells release cytokines which also activate macrophages - cytokines cause smooth muscle cells to proliferate. under growth factors the smooth muscle cells then move to the subendothelial space where they produce collagen and take up LDL, adding to the production of foam cells
what are some treatment interventions for primary hypertension
- dietary changes/lifestyle modifications
- drug therapy
_______ is hypertension attributed to an indentifiable pathology or condition. maybe related to pregnancy, obesity, endocrine disorders, etc
secondary hypertension
what are some conditions that may cause hypertension
- sleep apnea
- primary renal disease
- glomerulonephritis
-polycystic kidney disease - renal artery stenosis
- hyperthyroidism
- cushing disease
- hypertensive nephrosclerosis
what are some drugs/other substances that may cause hypertension
- NSAIDS
- oral contraceptives
- excessive alcohol
- salt
- stimulants (cocaine)
- SSRIs
- corticosteroids
______ is a birth defect in which part of the aorta is narrower than usual. occurs distal to subclavian artery. BP is high in upper body and lower in the legs
coarction of aorta
know what occurs in salt mediated hypertension
- G proteins (G12-13) activates myosin light chain kinase
- Rho/Rho kinase = inhibited myosin light chain phosphorylase
- ouabain release = decrease in Na+K+ ATPase = increase in intracellular Ca2+ = increase in smooth muscle tone = vasoconstriction
how should secondary hypertension be treated
treat the disease causing the hypertension first!
for e.g. hyperthyroidism - treat thyroid first
