Hypertension

Question 1

RAAS system

Answer 1

Responds when BP serum sodium levels, or blood fluid levels are low by increasing BP

Question 2

Angiotensinogen

Answer 2

Hormone in the blood that is released by the liver when BP is low

Question 3

Renin

Answer 3

Enzyme released by the kidneys in response to angiotensinogen in the blood (decreased blood flow in the kidneys)

Question 4

Angiotensin I

Answer 4

Created by reaction of angiotensinogen and renin, goes to the lungs and causes lungs to release ACE

Question 5

ACE (angiotensin converting exyme)

Answer 5

Released by the lungs

Question 6

Angiotensin II

Answer 6

ACE converts angiotensin I into angiotensin II and angiotensin II goes to the adrenal glands; also causes arterial vasoconstriction at the kidney level which increases BP

Question 7

Aldosterone

Answer 7

Made when angiotensin II goes to the adrenal glands; increases sodium reabsorption which increases fluid and BP; decreases potassium thru urine excretion of K

Question 8

Arginine vasopressin (ADH)

Answer 8

causes vasoconstrictor and water retention

Question 9

Stress and BP

Answer 9

stress elevates angiotensin II–sets off RAAS

Question 10

Arterial baroreceptors

Answer 10

in carotid sinus, aorta, L ventricle; sense BP and alter it by increasing HR; impacts vasodilation/constriction

Question 11

Vasoautoregulation

Answer 11

helps keep consistent BP levels by altering resistance in BVs (based on MAP—mean arterial pressure)

Question 12

Normal BP

Answer 12

Systolic under 120 AND diastolic under 80

Question 13

Elevated BP

Answer 13

Systolic 120-129 AND diastolic under 80

Question 14

HTN Stage 1

Answer 14

Systolic 130-139 OR diastolic 80-89

Question 15

HTN Stage 2

Answer 15

Systolic 140+ OR diastolic 90+

Question 16

HTN Stage 3

Answer 16

Systolic 180+ AND/OR diastolic 120+

Question 17

What is BP known as

Answer 17

The silent killer

Question 18

Primary HTN “essential HTN”

Answer 18

occurs w/o known cause; absence of underlying disease process; occurs because of interaction between genetics and environment, several neurohormonal effects

Question 19

Factors involved in primary HTN

Answer 19

Overactive SNS due to obesity, insulin resistance; RAAS, inflammatory interleukins circulating, endothelial dysfunction, natriuretic peptides

Question 20

Insulin resistance effect on BP

Answer 20

causes structural changes like permanent increase in peripheral vascular resistance

Question 21

Natriuretic peptides

Answer 21

Cause renal sodium excretion (water retention); increased BP and fluid volume in peptides that are malfunctioning

Question 22

Secondary HTN and causes

Answer 22

HTN with a known cause of underlying disease/dx like renal disease, adrenomedullary tumors (pheochromocytoma) which stimulate epinephrine, adrenocortical tumors which constantly secrete aldosterone and release angiotensin, and drugs (oral contraceptives, corticosteroids, antihistamines, cocaine, amphetamines)

Question 23

S/S of HTN

Answer 23

None

Question 24

When do you need to check BP immediately

Answer 24

End of organ damage

Question 25

Long term outcomes of BP

Answer 25

Increased L vent work, inc risk of heart attack, L vent hypertrophy bc of excess cardiac demand, accelerated atherosclerosis, inc risk of aortic aneurysm, end-stage renal disease (inc SNS, RAAS, dec blood flow), higher risk of stroke aneurysm, and hemorrhage, retinopathy, retinal sclerosis, inc retinal eye pressure, inc tissue death, gangrene, intermittent claudication

Question 26

Hypertensive crisis

Answer 26

complication of acute, uncontrolled BP; rapidly progressive HTN with systolic over 180 and/or diastolic over 120; often primary HTN; 2 types

Question 27

Hypertensive urgency

Answer 27

no s/s of end organ damage caused by anxiety, pain, abrupt withdrawal of meds; treated with oral agents to gradually decrease BP with time

Question 28

Hypertensive emergency

Answer 28

Leads to end organ damage; pt is symptomatic (headache, blurry vision); due to stroke, brain hemorrhage, chest pain, acute coronary; tx with IV meds in minutes to hours (even tho may cause future probs)

Question 29

Angiotensin II is a….

Answer 29

Powerful vasoconstrictor