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Cardiac Anatomy and Physiology > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What are the types of hypertension?

A

-primary/essential
-secondary
-whitecoat
-malignant
-masked

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2
Q

define hypertension

A

The chronic elevation of arterial blood pressure and can exist in either the pulmonary or systemic vascular system

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3
Q

What two mechanisms is BP usually regulated by?

A

-nervous system with afferent and efferent pathways
-humoral using the kidneys and adrenal glands

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4
Q

What 4 systems are directly responsible for influencing BP?

A

-cardiac-generates pressure
-blood vessels-systemic resistance
-kidneys-intravascular volume
-nervous and humoral -regulating the function s of the other three systems

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5
Q

​What does RAAS mean?

A

renin-angiotension-aldosterone-system

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6
Q

Describe the role of Renin in blood pressure regulation

A

-produced near the renal blood vessels that enter the glomerulus- the juxta glomerular apparatus
-main stimulus to renin production is a reduced blood flow or volume- sensed as a lowered renal perfusion pressure

-renin converts angiotensinogen (produced by liver) to a physiologically inactive polypeptide- angiotensin1 changed in the lungs to angiotensin2

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7
Q

Describe the role of angiotensin II in the control of BP

A

-its a powerful vasoconstrictor
-stimulates brain to activate the thirst sensation, enhances contractility of the heart
-promotes supranenal glands to produce more aldosterone
-this substance causes sodium and water retention, increasing circulating plasma volume and raising BP

-increase in aldosterone reduces renin production

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8
Q

What’s the standard hypertension figure?

A

140/90 mmHg

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9
Q

Describe primary/essential hypertension

A

-no known cause
-multifactorial and could be linked to genetics, environment, nutrition
-foetal factors, low birth weight caused by the environment e.g in the placenta or mothers nutrition
-no known therapy has been identified to treat or cure essential hypertension

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10
Q

Describe secondary hypertension

A

-high BP directly attributed to a cause.

-can be caused by, renal diseases,cushing disease, aldosteronism, phaeochromocytoma, catecholamine secreting tumours usually in the adrenal medulla, pregnancy, hyper or hypo thyroidism

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11
Q

What are some indications of secondary hypertension?

A

-age- before 20 or after 50
-severity- more severe than essential hypertension
-onset- more sudden
-signs/symptoms
-family history

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12
Q

What is white coat hypertension?

A

-anxiety can easily influence BP by greater than 30mmHg SBP
-cant be influenced by reassurance or familiarisation
-can occur in normotensive and hypertensive patients
-fight or flight reaction increases BP by 50-60mmHg

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13
Q

What is malignant hypertension?

A

DBP>120mmHg
-leads to kidney damage, retinal haemorrhage, optic nerve swelling
-patients can present with renal or heart failure

-considered a medical emergency, without effective treatment <20% patients survive a year

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14
Q

What is masked hypertension?

A

normal BP on presenting in clinic but elevated measurements out of the clinic

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15
Q

Whats the equation for BP?

A

BP= CO x Peripheral resistance

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16
Q

What are the four main factors effecting BP?

A

-blood volume
-peripheral resistance
-elasticity
-viscosity

17
Q

how does blood volume influence BP?

A

if circulating volume increases, more pressure is exerted against arterial walls.

18
Q

How does peripheral resistance influence BP?

A

arteries and arterioles are surrounded by smooth muscle hat contracts and relaxes to change the diameter of the lumen , hence resistance and poisselles law.

19
Q

How does elasticity influence BP?

A

as the pressure within arteries increases, the diameter of vessels increases to accommodate the pressure change

20
Q

How does viscosity influence BP?

A

-effects the ease with which blood flows through small vessels, the percentage of haematocrit in the blood determines its viscosity

21
Q

Name some local regulators that lower BP

A

nitric oxide
-hydrogen ions
-adenosine

22
Q

Name some local regulators that increase BP

A

oxygen
endothelin

23
Q

What major organs does hypertension effect?

A

-heart
-blood vessels
-kidney
-retina

24
Q

How does hypertensive retinopathy occur?

A

existing high BP causes changes to the microvasculature e.g rupture of the small retina vessels
-can cause visual impairment

25
Q

Where is the only place systemic arteries can be visualised?

A

retina

26
Q

what is nephrosclerosis?

A

-leading cause of renal failure
-damage to organs vasculature, vessel walls become thickened with an infiltrate causing reduced vascular supply, ischemia and atrophy of tubules and glomeruli

-the renal systems ability to regulate blood volume is compromised= hypertension

27
Q

How does hypertension affect the heart?

A

hypertrophy
-heart becomes stiff, reduced ability to fill
-raised filling pressures and congestion
-can lead to congestive heart failure
-hypertension increases the strain on blood vessels causing physical damage as well as accelerated processes associated with atherosclerosis

28
Q

What are some examples of end organ damage risks?

A

heart-hypertophy
cerebrovascular-stroke
-aorta-dissection
-kidney-renal failure
-retina-haemorhages

29
Q

How can we treat hypertension?

A

pharmacological:
-diuretics
-beta blockers
-calcium channel blockers
-ACE/ARBS
-direct acting vasodilators
-centrally acting agents
lifestyle:
-tobaccos
-weight
-exercise
-diet
-alcohol

30
Q

What do you do for each of these BPs?

> 220/120​

> 200/110​

> 160/100​

> 140/90​

A

1-treat immediately
2-confirm measurements over 1-2 weeks and then treat
3-confirm measurements over 3-4 weeks and then treat if complications identified or offer lifestyle advice , monitor and treat if elevated
4-confirm measurement over 6-8 weeks treat if complications arise, or offer lifestyle advice, monitor for 6-8 weeks , if elevated assess risk and treat if needed

Cardiac Anatomy and Physiology (5 decks)

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