hypertension Flashcards
hypertension:
* Persistantly elevated blood pressure
* Sustained Diastolic >— mmsHg or sustained Systolic >—mms Hg significant (WHO)
* American Heart Association more than —
* Stage 1 - S — D— - ambulatory daytime average —
* Stage 2 - S— , D — - amb average —
* Severe s>– d>—
* Hypertension (HT) is a leading risk factor for —
90
140
130/80
140-159
90-99
135-85
160-179
100-109
150/95
189
110
premature death
hypertesnion sites:
* Systemic hypertension
* Portal hypertension (— system)
* Pulmonary hypertension (— )
* Intracranial hypertension (high pressure in— , – )
portal venous
lungs
brain , CSF
complications of hypertension:
* It is a Risk Factor for:
Cardiac disease
Stroke
Atherosclerosis
Renal disease
* Complications of Hypertension
– Increase with — – higher in — -Americans
* Very— – spectrum of —
* — – — essential
age
African american
common
severity
asymptomatic
screening
Bp = — x —
- cardiac output :
* Blood Volume
— , — , —
* Cardiac factors
— , —
Peripheral Resistance
* Humoral
—
– Angiotensin, Catecholamine’s,
Thromboxane, Leukotrienes, Endothelin
—
– Prostaglandins, Kinins, NO
* Neural
Constrictors
– —
Dilators
– —
-cardiac output x peripheral resistance
-Sodium, Mineralocorticoids, Atrial
Natriuretic peptide
- rate , contractility
constrictors
dilators
alpha adrenegnic
beta adrenegnic
hypertension essential ( 90-95%) and secondary:
* General Risk Factors – – , — , — ,— ,— and —
* Most cases have no specific identifiable “— ” thus
95% are regarded —
* — Na+ excretion central to EHT and leads to salt/water — and — blood volume and cardiac output
BMI , dietary salt , ethanol , smoking , inactivity , genetics
cause
essential hypertension (EHT )
decreased
retention
raised
ESSENTIAL HYPERTENSION
(90-95% OF ALL HYPERTENSION)
* Unusual in – usually >—
* Factors
—
Defective — by kidney - salt/water
retention and raised blood volume and cardiac output - followed by — renal excretion BUT new — state of altered— balance achieved - — blood volume
Vasoconstriction e.g. —- over activity increase —- and —
— Factors – salt intake , smoking,
stress, obesity etc.
young >40
genetic
sodium excretion
increased
steady
sodium
increased
sympthatic
vasomotor tone and resistance
environmental
RENIN-ANGIOTENSIN SYSTEM (RATS)
* Influences both — and —
* Renin (from JGA in kidney) converts — (–) [—] —> — , which is then
converted —> — by a—
* ATII (Ang II)
Acts on arteriolar smooth muscle - —
Stimulates secretion of —
peripheral resistance and sodium homeostasis
plasma angiotensin ( AT ) at liver
AT I
AR II
angiotensin converting enzyme ACE
vasoconstriction
adrenal mineralcortiocoid aldotesteron
RENIN-ANGIOTENSIN SYSTEM (RATS)
* ACE converts – into— the active — etc.
* ACE 2 enzyme – — enzyme found in lung epithelium, endothelium, heart, GI tract- converts— into —
* Ang 1-7 is — , raises — , it is a — to –
* COVID virus attaches to — and reduces its function
Ang i
ang ii
vasoconstrictor
trans membrane
Ang ii to ang 1-7
vasodilator
NO
counter balance
ANG II
ace 2
secondary hypertension ( 5%)
* Renal
Any renal disease but especially renal artery stenosis,
Glomerulonephritis, Vasculitis, Tumour
* Adrenal
Cortisol, Aldosterone, Catecholamine’s
* Other endocrine
* Pituitary-acromegaly GH
—
* Cardiovascular
Coarctation of aorta
* Others
Alcohol, Drugs (cocaine)
* Neurologic
— Intracranial pressure – (— response)
- crushing disease - pituitary adenoma : — stimulates adrenal gland to produce –
preggo
increased
crushing response
ACTH
cortisol
adrenal hypertension:
* — Excess
Primary — —- syndrome,—,—
* — Excess
Pheochromocytoma rare tumour of—
Classically — hypertension
aldosterone
primary aldosteronism
conns syndrom
hyperplasia and adenoma
catecholamine excess
medulla
paroxysmal
endocrine - others:
* – hypo / hyper function
* Pituitary tumour producing — hormone –
* — Disease – — tumour –> — Bilateral adrenal hyperplasia
* Pre-eclampsia: — induced hypertension occurs via – which stimulates — production
thyroid
growth
acromegaly
crushing
pituitary
ACTH
pregnancy
placenta ischameia
placental renin
management of hypertension- exclude 2ndary hypertension if practical:
Impractical to investigate everyone but should consider
secondary HT if:
* Patient < — years
* — hypertension
* Evidence of any of the conditions outlined in causes of – hypertension
- investigations:
* Urinalysis - —
* Blood tests - — u/e
* —
* — - ventricular hypertrophy heart
40
severe
2ndary
protein blood
glucose lipids
fundoscopy
ECG
consequences of hypertension:
* — Injury
* Larger and medium arteries
Smooth muscle — in —
— and loss of — e.g.
- Aortic —/—
- — of cerebral berry aneurysms
* Accelerated—
vascular
hypertrophy in media
fibrosis ad loss of elastic tissue
dissection.haemorrahge
rupture
atherosclerosis
- effects of hypertension small arteries and arterioles:
- Hyaline Arteriolosclerosis pink
(light microscopy) — of
vessel wall
Luminal — especially in –
– impairment - malignant hypertension complications:
- Diastolic BP > — mmHg
- The process is often
accompanied by — & — due
to damage to — - Medical emergency
- Can precipitate:
Acute renal failure
Encephalopathy
Raised Intracranial
Pressure -
Papilloedema
pls check photos in slide 24,25
thickening
narrowing
kidney
chronic renal
120
thrombosis
hameolytic anemia
small blood vessels
consequences of hypertension:
* Systemic HT →
Cardiac (— )—
If sustained the heart may
undergo — and progressively – i.e. there is insufficient— to
perfuse tissues adequately
– cardiac failure
check pic in slide 27
left ventricular hypertrophy
dilatation
fail
stroke volume
hypertensive renal disease:
* Nephrosclerosis - scarred –
* Large renal reserve
Ultimately renal —
loss especially if other
causes of small vessels
disease are present e.g.—
Small — kidneys
Poor — switches
on renin angiotensin
system
scarred kidney
nephron
diabetes mellitus
scarred
perfusion
hypertensive cerebrovascular disease:
Stroke
* Small Vessel Disease
—
— (lacunar)
* Large vessel Disease
—- – hypertension
causes progressive— and increases risk of — of berry aneurysms
—
- Clinical Consequences of HCD
include consequences of stroke especially disability & “vascular” –
haemorrhage
infraction
aneurysm
enlargement
rapture
dissection
dementia
summary:
Very – - easily — :
— effects with other risk factors for
cardiovascular disease may lower threshold for using
pharmacological treatment
Rarely — - – first line
approach in all forms of hypertension
- different sites of hypetertion are:
Pulmonary Hypertension
Intracranial Hypertension
Portal Hypertension
very common easily diagnosed
synergitsic
curable
lifestyle modification
