HYPERTENSION Flashcards
two determinants of arterial pressure
Cardiac output and peripheral resistance
Cardiac output is determined by
stroke volume and heart rate
Peripheral resistance is determined by
functional and anatomic changes in small arteries (lumen diameter 100–400 μm) and arterioles
the most common etiology of secondary hypertension
Primary renal disease
Which is correctly matched:
A. α1 Receptors -elicit vasoconstriction
B. α2 Receptors - act as negative feedback controllers, inhibiting further norepinephrine release
C. β1 receptors - stimulates the rate and strength of cardiac contraction and consequently increases cardiac outpu
D. β2 receptors - relaxes vascular smooth muscle and results in vasodilation
ALL are correct
TRUE OR FALSE: Acting primarily through angiotensin II type 1 receptors (AT1R) on cell membranes, angiotensin II is a potent pressor substance and is the primary trophic factor for the secretion of aldosterone by the adrenal zona glomerulosa
TRUE
* AT1R is believed to mediate most functions of angiotensin II, resulting in hypertension, cardiovascular remodeling, and endorgan damage.
TRUE OR FALSE: The AT2R induces vasodilation, sodium excretion, and inhibition of cell growth and matrix formation.
TRUE
* The AT2R may improve vascular remodeling by stimulating smooth muscle cell apoptosis and contributes to the regulation of glomerular filtration rate.
* AT1R blockade induces an increase in AT2R activity
TRUE OR FALSE: Among older individuals, systolic blood pressure and pulse pressure are more powerful predictors of cardiovascular disease than is diastolic blood pressure
TRUE
Patients with elevated office blood pressures but have normal ambulatory readings
White coat hypertension
normal office blood pressure and elevated out-of-office blood pressure
masked hypertension
*associated with a risk of cardiovascular disease and all-cause mortality twice that of normotensive individuals, with a risk range similar to that of patients with sustained hypertension.
Stage 1 Hypertension is defined as
130-139 mmgHg sytolic pressure or 80-89 mmHg diastolic pressure
Stage 2 Hypertension is defined as
> /= 140mmgHg systolic pressure or >90mmHg diastolic pressure
TRUE OR FALSE: Centrally located body fat is a more important determinant of blood pressure elevation than is peripheral body fat.
TRUE
A potentially curable form of hypertension due to an occlusive lesion of a renal artery
Renovascular hypertension
- Two groups of patients are at risk for this disorder:
- older arteriosclerotic patients who have a plaque obstructing the renal artery, frequently at its origin
- patients with fibromuscular dysplasia
TRUE OR FALSE: The lesions of fibromuscular dysplasia are frequently bilateral and tend to affect more distal portions of the renal artery.
TRUE
TRUE OR FALSE: Severe or refractory hypertension, recent loss of hypertension control or recent onset of moderately severe hypertension, carotid or femoral artery bruits, flash pulmonary edema, and unexplained deterioration of renal function or deterioration of renal function associated with an angiotensin-converting enzyme inhibitor (ACEI) should raise the possibility of renovascular hypertension
TRUE
“gold standard” for evaluation and identification of renal artery lesions.
Contrast arteriography
The most effective medical therapies for renovascular hypertension include
ACE inhibitor or an angiotensin II receptor blocker.
TRUE OR FALSE: Primary aldosteronism should be considered in all patients with refractory hypertension
TRUE
- The age at the time of diagnosis is generally the third through fifth decade.
- sodium retention, hypertension, hypokalemia, low PRA, cardiovascular disease, and kidney damage.
In patients with an elevated PA/PRA ratio, the diagnosis of primary aldosteronism can be confirmed by demonstrating failure to suppress PA to any one of four suppression tests:
Oral sodium loading
Saline infusion
Fludrocortisone
Captopril
The most accurate means of differentiating unilateral from bilateral forms of primary aldosteronism
Bilateral adrenal venous sampling
- Major difference in the aldosterone/cortisol ratio is indicative of unilateral disease
- An ipsilateral/contralateral aldosterone ratio >4, with symmetric ACTH-stimulated cortisol levels, is indicative of unilateral aldosterone production.
TRUE OR FALSE: The ratio of plasma aldosterone (PA) to PRA (PA/PRA) is a useful screening test that is obtained in ambulatory patients in the morning.
TRUE
- A ratio >30:1 in conjunction with a PA concentration >555 pmol/L (>20 ng/dL) reportedly has a sensitivity of 90% and a specificity of 91% for an aldosterone-producing adenoma
definitive treatment of pheochromocytoma
Surgical excision
- Clinical manifestations, including hypertension, are primarily related to increased circulating catecholamines
- Laboratory testing consists of measuring catecholamines in either urine or plasma, e.g., 24-h urine fractionated metanephrine excretion or plasma-free metanephrines under standardized conditions.
The most common congenital cardiovascular cause of hypertension
Coarctation of the aorta
* Physical findings include diminished and delayed femoral pulses and a systolic pressure gradient between the right arm and the legs
Basic laboratory test for the initial evaluation of hypertension
UA, Albumin excretion, BUN and Crea (compute for eGFR)
Na, K, Calcium and TSH
FBS, Total Cholesterol, HDL, and LDL, Triglycerides
CBC, ECG
Lowering systolic blood pressure by _____ and diastolic blood pressure by _____ confers relative risk reductions of 35–40% for stroke and 12–16% for CHD within 5 years of the initiation of treatment.
10–12 mmHg
5–6 mmHg
Recommended dietary salt restriction as part of the lifestyle modifications to manage hypertension
<6 grams per day
Modertation of consumption of alcohol is defined as how many drinks in men and women respectively?
</=2drinks/day in men and </=1drink/day in women
Possible exception to therapeutic target of <130/80mmHg
- Patients more than 80 years of age
- Patients previously untreated for hypertension who experience ischemic stroke or TIA and have BP <140/90
- Acute therapy of most hypertensive urgencies and emergencies
Blood pressure goal for patients with hypertension
<130/80mmHg
Which mechanism of action is correctly matched:
A. Thiazides - inhibit the Na+/Cl– pump in the distal convoluted tubule
B. Potassium-sparing diuretics, - inhibit ENaC in the distal nephron
C. Loop diuretics - target the Na+-K+-2Cl– cotransporter in the thick ascending limb of the loop of Henle
D. All of the above
ALL OF THE ABOVE
What is the SPRINT trial?
Intensive blood pressure control (systolic blood pressure <120 mmHg) reduced the risk of cardiovascular events and mortality by 25% compared with less intensive control (systolic blood pressure 135–139 mmHg).
Patients with blood pressures persistently >140/90 mmHg despite taking three or more antihypertensive agents, including a diuretic.
Resistant hypertension
- In the absence of a specific identifiable cause, mineralocorticoid receptor antagonists, especially spironolactone, have been demonstrated to be the most effective add-on drugs for the treatment of resistant hypertension.
In patients with a hypertensive urgency, except for those with acute aortic dissections or hemorrhagic strokes, blood pressure is generally gradually lowered over 24 h to ____% of the initial value
~25%
In patients with encephalopathy, the initial goal of therapy is to reduce mean arterial blood pressure by no more than ____% within minutes to 2 hours or to a blood pressure in the range of ___ mmHg.
25%, 160/100–110 mmHg
For the very elderly, defined as 80 years old and above, a therapeutic threshold of 150/90 mmHg to achieve a goal BP of less than 140/90 mmHg is recommended.
A therapeutic threshold of 140/90 mmHg to achieve a goal BP of less than 130/80 mmHg is recommended for most adults with hypertension.
