Hypertension Flashcards by Iseoluwa Ojo

Maintenance of a normal blood pressure is dependent on the balance between the _________ and ________

cardiac output and peripheral vascular resistance.

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Most patients with essential hypertension have a normal (CO or PR?) but a raised (CO or PR?)

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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.

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Hypertension affects up to ___ % of the population of the world

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(Blacks or Whites?) particularly suffer the ravages of hypertension and are more likely than (Blacks or Whites?) to experience serious complications

Blacks

Whites

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Hypertension is Defined as a blood pressure level below which ___________

the patient can benefit from its reduction

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Hypertension is Usually taken as a sustained diastolic BP>___mmHg or systolic BP>____mmHg, or ____.

160

both

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According to WHO

OPTIMAL =SP<____; DP<___

NORMAL= SP<____ ; DP<____

HIGH NORMAL= SP__-___ ; DP__-___

120; 80

130;85

130-139; 85-89

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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

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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

Male; female; female; male

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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

11.1; 11.2

Savannah

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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

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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

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_____ HT is common in young HTensives

Malignant

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ESSENTIAL HT

•Seen in ___-__% of cases
•A diagnosis of ____, i.e. _______

90-95; exclusion; no cause is found

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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

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SECONDARY HT

• Occurs in __-___%
• It is a ______ of other disease

5-10; complication

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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

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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

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NORMAL REGULATION OF BP
• Depends on the ______ and ——-

CO and PR

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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

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The kidneys play an important role in the control of BP thru its influence on the ______ and ————

PR & sodium homeostasis

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Kidney’s role in maintaining BP

By:
• The ______ System

Renin-Angiotensin

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The renin angiotensin system

Renal artery _____/_____ restriction/
reduction in _____ Leads to reduced ___ and stimulation of ____ from the JGA

stenosis
dietary salt
CO
GFR
RENIN

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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

ANF (antagonizes or aids?) the RAS(Renin-Ang)

Antagonizes

GFR INDEPENDENT NATRIURETIC FACTOR • Na+ HOMEOSTASIS • Important for the control of BP • Increase in Na in the body is accompanied by an ______ and (expansion on constriction?)of the _____ • This acts on the _____ resulting in an increased _____ of salt and water

Increase in water; expansion; blood volume kidney; excretion

EFFECT OF ORAL CONTRACEPTIVES ON BP • Acts by activating the ____ pathway • Most OCPs contain ________ • They stimulate the liver to produce the ________ which is _______ • Why do some women develop HBP with OCP and others do not?

RA ; progesterone-estrogens; renin substrate ; angiotensinogen

EFFECT OF ORAL CONTRACEPTIVES ON BP • Increased _______ to _____ • Presence of (mild or severe?) renal disease • Familial factors((positive or negative ?) family history >50%) • Age>_____years • _______ content of the contraceptive • Obesity

vascular sensitivity to AngII; mild ; positive 35; Oestrogen

The oral contraceptives are thus thought to be simply __________________

unmasking women with essential hypertension

PHAEOCHROMOCYTOMA • Increased secretion of ______ and ______ • Which results in ___________ and ——— • Diagnosed by ______________________

epinephrine and norepinephrine peripheral vasoconstriction and cardiac stimulation increased urinary secretion of adrenalin, noradrenalin and their metabolites

Accelerated/malignant HT • –Seen in about ___% of hypertensives • Usually ________ on _____ HT.

5; super imposed; preexisting

Malignant HT The clinical syndrome is characterized by: •Severe hypertension (i.e., systolic pressure over ____ Hg, diastolic pressure over ____ Hg) • If untreated leads to death in ___ years. •

200 mm; 120 mm; 1 or 2

Malignant HT •Causes ____ failure and • Retinopathy: _______ ,_____ and presence or absence of ______ • Brain – _____ microaneurysms, Intraparenchymal haemorrhages, hypertensive _________.

renal; Retinal haemorrhages and exudates ; papilloedema Charcot Bouchard; encephalopathy

EFFECT OF HT on the HEART Hypertensive heart disease: • Systemic= ___ sided; pulmonary=___- sided

left; right

EFFECT OF HT on the HEART Hypertensive heart disease: Systemic: diagnostic criteria – • (i) ______ • (ii) A ______ or ________ of hypertension.

Left ventricular hypertrophy; history or pathologic evidence

EFFECT OF HT on the HEART Hypertensive heart disease: Systemic: diagnostic criteria – LVH(_______) – usually _____ in the absence of any cardiovascular pathology that might have induced it and This Left ventricular hypertrophy is an adaptive response to _______ which can lead to myocardial _____, cardiac ____, _______ failure and sudden _____.

Left ventricular hypertrophy; concentric pressure over load; dysfunction; dilation; congestive heart ; death

Hypertensive heart disease: • Increased work load causes concentric LV hypertrophy • characterized by an increase in the left ventricular free wall ______ • Ventricular free wall is measured ___ cm (below or above?) the AV orifice

thickness; 2.5; below

In hypertensive heart disease, The heart (can or can not?) cope with excessive work load • This leads to ______ and _____, eventually •

can not; hypertrophy and dilatation

The best assessment of cardiomegaly is ____ and not _____

weight; ventricular thickness

In hypertensive heart disease, ANGINA PECTORIS may occur because ____ and ______ is decreased with decreased coronary bld flow

CO and bld flow

artherosclerosis is a complication of hypertension T/F

coronary vessels are rarely affected in artherosclerosis. T/F

F(commonly)

Morphology of Heart •______ hypertrophy without _____ of the ventricle • Increase LV wall ______ • Cardiomegally with increased heart weight leads to impaired _______ which leads to _______ enlargement with presence or absence of atrial fibrillation , •

Circumferential dilatation; thickness diastolic filling Left atrial

Morphology of the heart Microscopically: _____ myocyte diameter that is later _____ with interstitial fibrosis. •(presence or absence ?) of hyperplasia. • Other possible complications include: • ischemic heart disease from the potentiating effect of HT on coronary artherosclerosis, comgestive heart failure and sudden cardiac death as above.

Increase ; irregular; absence

Vascular pathology • Affects _____________ sized vessels:

both small & large

Vascular pathology Two main forms of small blood vessels diseases: 1. Hyaline arteriolosclerosis: • Encountered generally in ____ and _____ but more generalized and more severe in _____. • Vascular lesions consists of __genous, _____ color , hyaline thickening of the walls of arterioles and with _____ of the lumen.

elderly and diabetics; hypertensives homo; pink; narrowing;

Hyaline arteriolosclerosis Pathogenesis •Presumably the chronic hemodynamic stress of hypertension accentuates endothelial injury → ________ and ________ deposition with narrowing and • Consequent ischaemia and organ shrinkage as in ______________. • The hyaline appearance of the protein gives it its name

leakage of plasma proteins and hyaline benign nephrosclerosis

Hyperplastic Arteriolosclerosis • Related to more (acute or chronic ?) and (mild or severe?) elevations of BP, • Therefore characteristic of _____ HT (diastolic press > 110 mmHg)

Acute ; severe; malignant

Hyperplastic Arteriolosclerosis • Proliferation of _____ manifests as ______,_______,______ thickening of the walls of arterioles with progressive narrowing of lumina • This proliferation is thought to be a response to _______ derived from _____ • There is also loss of endothelial integrity often accompanied by deposits of ____ material (______ necrosis) and • Acute necrosis of the vessels walls – ____________ • All tissues throughout the body may be affected but the favoured site is the _____.

smooth muscle ; onion –skin, concentric , laminated growth factors; platelets fibrinoid; fibrinoid necrosis necrotizing arterolitis.; kidney

Pulmonary HT • Pulmonary vasculature 1. Primary pulmonary hypertension 2. Secondary causes: •_________ disease, • Pneumoconiosis; • Recurrent _________ • Marked obesity and •_______ sickness.

Chronic obstructive pulmonary pulmonary thrombo-embolism Chronic altitude

Secondary causes of pulmonary hypertension: It can be acute or chronic: • Acute-massive pulm. thromboembolism → marked ____________ Chronic → ______,_______ and potentially failure (__________) + pulmonary vascular sclerosis

Rt ventricular dilation without hypertrophy right vent. Hypertrophy, dilatation ; Cor pulmonale

BRAIN • The most important effects of hypertension on the brain include: 1. Massive ___________, with the presence or absence of ______ 2.______ infarcts and ____ hemorrhages, 3. Hypertensive _______. Atherosclerosis and diabetes are frequently associated diseases

hypertensive intracerebral hemorrhage; berry aneurysms Lacunar; slit encephalopathy

BRAIN-2 • Hypertension affects the (shallow or deep ?) penetrating arteries and arterioles that supply the: * _______,______,__________ • These cerebral vessels develop arteriolar sclerosis and may become occluded -_____________

Deep; Basal ganglia, hemispheric white matter & the brainstem. Transient ischemic atrophy

Effect of Hypertension on the brain Ischaemic strokes ____%; hemorrhagic -____%; subarachnoid hemorrhage - ___ %

75-80; 15; 5

Effect of Hypertension on the brain • Development of single or multiple, small, cavitary infarcts-_____ , or lacunar state (________) • Less than _____ wide, & occur in the ________, thalamus, internal capsule, deep white matter, caudate nucleus, and pons, in descending order of frequency. • Lacunes can either be ______ or cause _____. • Widening of the perivascular spaces around affected vessels - (_______).

lacunes; état lacunaire 15 mm lenticular nucleus clinically silent ; severe neurologic impairment; état criblé

BRAIN-3 Slit hemorrhages • Rupture of the (small or large?) -caliber penetrating vessels and the development of small hemorrhages. Which resorbs, slitlike cavity (slit hemorrhage) surrounded by ______ discoloration; • Hypertensive _________ • Clinicopathologic syndrome arising in a hypertensive patient characterized by diffuse cerebral dysfunction, including headaches, confusion, vomiting, and convulsions, sometimes leading to coma. • Edematous brain with or without __________ or _______ . Petechiae and fibrinoid necrosis of arterioles in the gray and white matter may be seen microscopically.

Small ; brownish; Encephalopathy transtentorial or tonsillar herniation.

BRAIN-4 Vascular (multi-infarct) dementia – • Multiple, bilateral, gray matter (cortex, thalamus, basal ganglia) and white matter (centrum semiovale) infarcts caused by multifocal vascular disease, consisting largely of • (1) cerebral _______, • (2) vessel thrombosis or embolization from ______ vessels or from the ______ , or • (3) cerebral _______ from chronic hypertension.

atherosclerosis; carotid; heart; arteriolar sclerosis

Effect of hypertension on the brain Binswanger disease • Pattern of injury preferentially involves (small or large?) areas of the ____________ with myelin and axon loss,

Large subcortical white matter

EYE RETINAL VASCULAR DISEASE • A- ‘Non Malignant’ Hypertensive retinopathy 1.________ arteriolar wall -generalized arteriolar (narrowing or widening?) 2.____ and ___ wiring. Vessels may appear (narrowed or widened?) , and the color of the blood column may change from ___ to _____ and to _______ depending on the degree of ________ 3. Arteriovenous _____: Retinal arterioles and veins share a common _______. Therefore, in pronounced retinal arteriolosclerosis, the arteriole may ______ at points where ______ 4. Venous ____ distal to arteriolar-venous crossing may precipitate ____ of the _______ branches.

Thickened; narrowing Copper & Silver; narrowed; bright red to copper and to silver ; vascular wall thickness nipping; adventitial sheath; compress the vein ; both vessels cross stasis; occlusions; retinal vein

EYE-2 • B Malignant Hypertensive Retinopathy, • Vessels in the ____ and ——— may be damaged. •it is characterized by – _____,______, and presence or absence of _______

retina and choroid hemorrhages, hard exudates; Optic disc oedema

EYE-2 • B Malignant Hypertensive Retinopathy, • Elschnig's spots -Damage to ______ vessels may produce ____________

choroidal; focal choroidal infarcts

EYE-2 • B Malignant Hypertensive Retinopathy, • Retinal detachment -Damage to the ______, the ______ layer of the choroidal vasculature, may, in turn, damage the _________________ epithelium and permit exudate to accumulate in the potential space between the _______ and the ________

choriocapillaris; internal overlying retinal pigment neurosensory retina and the retinal pigment epithelium.

EYE-3 • Occlusion of retinal arterioles may produce infarcts of the nerve fiber layer of the retina • Axoplasmic transport in the nerve fiber layer is interrupted at the point of axonal damage, and accumulation of _______ at the swollen ends of damaged axons creates the__________ (_____bodies).Collections of those bodies populate the nerve fiber layer infarct, seen ophthalmoscopically as "__________".

mitochondria histologic illusion of cells cytoid cotton-wool spots

Renal Changes • Benign Nephrosclerosis: Sclerosis of ______ and ________ with resultant parenchymal ischaemia. • Morphology – ___________ and ______ • (N) or ______ kidneys + fine ________.

renal arterioles and small arteries Hyaline arteriolosclerosis & fibroelastic hyperplasia. ; shrunken; granularity

Malignant nephrosclerosis – occurs in 1-5% of hypertensives. Morphology – 1. “______” appearance. 2._______ necrosis of arterioles; 3. Hyperplastic _____ 4. Necrotizing _____ • BP usually >____ mmHg diastolic →

flea bitten Fibrinoid arteriolitis glomerulitis 130

_______________ - ACC ________________ - AHA JNC-______________

American College of Cardiology American Heart Association Joint national committee

Causes of secondary HT; - #_________!

RNDEC Renal Neurogenic Drugs Endocrine CVS

EYES Fundoscopic examination: _______ spots (___ _____) Retinal hemorrhages (i.e.,_____-shaped hemorrhages) Microaneurysms ____________(results from exudation into the macula) Arteriovenous ______: _______ shape on fundoscopic exam Associated with advanced hypertensive retinopathy. Marked swelling and prominence of the ______ with ______ borders due to papilledema and optic ____ (end-stage disease)

Cotton-wool ; hard exudates flame Macular star; nicking optic disk; indistinct; atrophy

Left ventricular free wall thickness (Normal : ___-___cm) Normal weight of heart: Males – ___-____ g, Females – ____-____ g)

1.3 – 1.5 300 to 350 250 to 300

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Hypertension Flashcards

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