Hypertension Flashcards
Maintenance of a normal blood pressure is dependent on the balance between the _________ and ________
cardiac output and peripheral vascular resistance.
Most patients with essential hypertension have a normal (CO or PR?) but a raised (CO or PR?)
CO
PR
Hypertension
__________________ is thought to induce structural changes with _______ of the arteriolar vessel walls possibly mediated by _______, leading to an irreversible rise in ________
Prolonged smooth muscle constriction
thickening
angiotensin
peripheral resistance.
Hypertension affects up to ___ % of the population of the world
20
(Blacks or Whites?) particularly suffer the ravages of hypertension and are more likely than (Blacks or Whites?) to experience serious complications
Blacks
Whites
Hypertension is Defined as a blood pressure level below which ___________
the patient can benefit from its reduction
Hypertension is Usually taken as a sustained diastolic BP>___mmHg or systolic BP>____mmHg, or ____.
90
160
both
According to WHO
OPTIMAL =SP<____; DP<___
NORMAL= SP<____ ; DP<____
HIGH NORMAL= SP__-___ ; DP__-___
120; 80
130;85
130-139; 85-89
Hypertension
Grade 1- SP__-___ and/or DP__-___
Grade 2 -SP__-___ and/or DP__-___
Grade 3-SP__-___ and/or DP__-___
Isolata ed SHT-SP__-___ and/or DP__-___
Grade4-SP__-___ and/or DP__-___
140-159; 90-99
160-179; 100-109
Greater or equal to 180; greater or equal to 110
Greater or equal to 140; less than 90
Greater than 210; greater than 120
PREVALANCE of hypertension
__-__% in unacculturated societies such as _____ Indians,_______ and ____ people in Nigeria
___% in Black Americans.
(Male or female?) > (Male or female?) below 50yrs
(Male or female?) > (Male or female?) after 50 yrs
0-2; Yanomami; Papua New Guinea; koma
40
Male; female; female; male
PREVALENCE IN NIGERIA
•_____%(greater than or equal to 140/90)
• approximately ___%(greater than or equal to 160/95).
NCD Committee, Hypertension Project.
• Prevalance ___ in M; ___% in F (160/95)
Urban/rural gradient
• In rural areas,lowest in ______.
17-20
10
11.1; 11.2
Savannah
RATE OF PROGRESSION
BENIGN HT
•(Acute or Chronic?) hypertension occuring over _____ which may be either ______ or ______
• The clinical presentation is ( benign or malignant?) but may eventually have serious effects (eg ______, brain, blood vessels)
Chronic ; many years
mild or moderate.
Benign ; organ damage
RATE OF PROGRESSION
MALIGNANT HT
• A (slowly or rapidly?) increasing BP over a period of _____ or ________
• The BP is usually very ___ and (slowly or rapidly?) increasing (eg diastolic >___mmHg)
• The clinical effects are serious, damaging many organs
Rapidly
few months or 1 or 2 years
high; rapidly
120
_____ HT is common in young HTensives
Malignant
ESSENTIAL HT
•Seen in ___-__% of cases
•A diagnosis of ____, i.e. _______
90-95; exclusion; no cause is found
ESSENTIAL HT
A number of aetiological factors may be implicated including
•_____ predisposition ( ________ inheritance)
• -racial, (black or whites?) >(black or whites?)
•___ homeostasis: increased _____
• Stress-nervous reactivity
• Lackofexercise.
genetic; polygenic
Black; whites
Na; salt intake
SECONDARY HT
• Occurs in __-___%
• It is a ______ of other disease
5-10; complication
Causes of secondary HT
• - RENAL: ____, ____,____,_____ stenosis, renal _______, ______ tumour, and very importantly __________
• NEUROGENIC: ______, raised ___, sleep apnoea, acute ____
AGN; CGN; CRF; renal artery; vasculitis; renin producing; diabetic nephropathy
psychogenic; ICP; stress
Causes of secondary HT
•- DRUGS: eg ______ and _____
• - ENDOCRINE, ______, ____ syndrome, phaechromocytomas, exogenous hormones, acromegaly, hyper______, ______ induced
• - CVS, ______ of the aorta, increased CO, increased intravascular volume, _____
steroids and contraceptives
aldosterone; cushing; thyroidism
pregnancy
coarctation; PAN
NORMAL REGULATION OF BP
• Depends on the ______ and ——-
CO and PR
Normal regulation of BP
CO is influenced by the ____ which is in turn dependent on the body’s _____
• Total PR is determined at the level of _____ and it depends on the ______ which is dependent on the arteriolar wall and the effects on the ____ and ——- factors that either constricts or dilate the arterioles (endothelin, NO, cathecolamines, angiothensin)
Blood volume
sodium
arterioles
caliber of the lumen
neural and hormonal
The kidneys play an important role in the control of BP thru its influence on the ______ and ————
PR & sodium homeostasis
Kidney’s role in maintaining BP
By:
• The ______ System
Renin-Angiotensin
The renin angiotensin system
Renal artery _____/_____ restriction/
reduction in _____ Leads to reduced ___ and stimulation of ____ from the JGA
stenosis
dietary salt
CO
GFR
RENIN
Renin is a protease that acts on ______ (an ________)
• It splits it into a _____ (_____) which is in turn converted into ____ by ____ ( a protein found on the ___________ )
angiotensinogen
alpha globulin
decapeptide
Ang I
Ang II
ACE
surface of endothelial cells
Ang II is a powerful vaso______ that also acts centrally and stimulates _____ release from the ______.
constrictor
aldosterone
adrenal gland
The net effect of the RAAS is __________ and ________
an increase in total body fluid volume and increased PR
GFR INDEPENDENT NATRIURETIC FACTOR
• ATRIAL NATRIURETIC FACTOR (ANF)
• A hormone secreted by the specialized cells of the ______ in response to _____ that accompanies ____________.
cardiac atria; distension; expansion of the blood volume
ANF binds to specific receptors in the ______
• Causes increased urinary ________
kidneys; sodium excretion