Hypertension

Question 1

what does systolic pressure show with hypertension?

Answer 1

-Systolic pressure more important than diastolic pressure
-In fact, elevated systolic blood pressure has consistently
been shown to be a better predictor of cardiovascular
events, including stroke and myocardial infarction

Question 2

what is hypertension associated with?

Answer 2

• IHD
• Heart failure
• Stroke

Question 3

what does hypertension do to CO ?

Answer 3

increases it

Question 4

what does hypertension do to SVR?

Answer 4

increases it

Question 5

factors for CO

Answer 5

1. Blood volume
   - Renal function
   - Sodium
   - Mineralocorticoids
   - Atriopeptin
2. Cardiac Factors
   - Heart rate
   - Contractility
   - Ventricular end diastolic volume

Question 6

factors in peripheral resistance

Answer 6

1. Humoral factors
   -Constrictors – angiotensin II, catecholamines,
   thromboxane, endothelin, leukotrienes
   -Dilators – prostaglandins, kinins, nitric oxide
2. Neural factors
   alpha-adrenergic – constrictors
   beta-adrenergic – dilators

Question 7

what are some treatable causes of hypertension

Answer 7

• Thyroid disease
• Renal stenosis
• Valvular disease
• Anxiety disorder
• Pheochromocytoma

Question 8

what causes the decreases arterial compliance in isolated systolic HTN

Answer 8

-Atherosclerosis
-Gradual loss of aortic distensibility
-Systolic pressure increase (140); diastolic pressure decreases (90)
-thickening of the aorta and media due to the
accumulation of collagenous fibers, as well as calcium
deposition
-Related to increased pulse pressures

Question 9

in isolated systolic HTN: elderly patients tend to have

Answer 9

-relatively low plasma volume and relatively low levels of renin and aldosterone

Question 10

in isolated systolic HTN: why is there salt sensitivity?

Answer 10

-Renal excretion of salt tends to be decreased in these patients, and this probably accounts for their relatively greater salt sensitivity compared with their younger counterparts

Question 11

in isolated systolic HTN: what else accounts for increase in PVR?

Answer 11

-Decreased calcium levels resulting from increased calciuria and poor dietary intake may also increase peripheral resistance, leading to hypertension

Question 12

what risk factors are ISH associated with?

Answer 12

-increased end-stage renal disease, cardiac disease, and stroke
-pulse pressures (SBP - DBP) are believed to have more
influence than does diastolic blood pressure on the
progression of CV disease
-associated with two to three times the risk of
cardiovascular events or mortality across ages and
genders
-ISH may also independently increase risk for
dementia

Question 13

therapy for ISH

Answer 13

1. long-acting calcium channel blockers
   2.thiazide diuretics
2. OR beta blockers in combination with thiazide
   diuretics.
   -long-acting dihydropyridine calcium channel
   blockers are safe to use in the elderly

Question 14

pathology of HTN

Answer 14

-Left ventricular hypertrophy
-HTN augments atherogenesis of small vessels
-Longstanding hypertension is associated with
changes in the renal arterioles
*chronic benign HTN – hyaline arteriolosclerosis
*malignant HTN – onionskinning; hyperplastic
arteriolosclerosis

Question 15

what are some of the renal affects of HTN

Answer 15

1. Hyaline arteriolosclerosis

2. Hyperplastic arteriolosclerosis

Question 16

Hyaline arteriolosclerosis

Answer 16

-elderly patients, diabetes
-leakage of plasma components, increased
extracellular matrix in smooth muscle layers
-homogeneous, pink, hyaline thickening of walls
of arterioles with narrowing of lumen
-seen in the kidney as benign nephrosclerosis

Question 17

Hyperplastic arteriolosclerosis

Answer 17

-more acute or severe elevations of blood pressure
-characteristic of malignant hypertension with diastolic
pressures > 110
-onionskin lesions, concentric laminated thickening of the
walls of the arterioles
-narrowing of lumen; thickened basement membrane
-may be associated with fibrinoid and acute necrosis -
necrotizing arteriolitis