Hypertension Flashcards
What is the arbitrary definition of prehypertension?
- SBP 120-139
- DBP 80-89
What does fibromuscular dysplasia cause in young, female pts?
renal artery stenosis
Name 7 environmental factors that contribute to essential HTN.
- high dietary Na intake
- excess caloric intake
- EtOH
- stress
- sedentary lifestyle
- smoking
- low K+ or Ca++ intake
What is the prognosis for untreated malignant HTN?
renal failure in less than 1 year
What is the major determinant of ECF volume?
total Na content
What is renovascular HTN?
abnormal signal to release renin
What is non-malignant HTN?
HTN in the absence of hypertensive neuroretinopathy
What are the fundoscopic findings that indicate HTN-induced arteriolitis?
- flame shaped (striate) hemorrhages
- cotton wool spots (soft exudates)
- papilledema
What is the long term physiologic effect of a diuretic?
decreased peripheral vascular resistance (PVR)
What is secondary hyperaldosteronism?
increased renin secretion
What is naturesis?
renal Na excretion
What causes renal artery stenosis in older pts, esp male smokers?
atherosclerosis
Maligant HTN is characterized by necrotizing arteriolitis in the _____, _____, _____, and _____.
kidneys, retinas, heart, and CNS
What lifestyle modifications can reduce BP?
- weight reduction
- DASH diet
- dietary Na+ reduction
- physical activity
- moderation of EtOH
What is the arbitrary definition of HTN?
- SBP>140
- DBP>90
What is pheochromocytoma?
a benign tumor of the adrenal medulla causing excess catecholamines
Name some various factors contributing to secondary HTN.
- Cushings/Chronic steroid therapy
- pheochromocytoma
- 1a hyperaldosteronism
- coarctation of the aorta
- sleep apnea
- drug induced
- thyroid/parathyroid disease
What is the tx for renal artery stenosis in those with fibromuscular dysplasia?
percutaneous balloon dilatation
What are the ABCDs of HTN treatment?
- A = ACEis and ARBs
- B = beta blockers
- C = Ca++ channel blockers
- D = diuretics
How is renin stimulated to be released?
- activation of beta-sympathetic nerves
- stimulation of renal baroreceptors
- activation of the macula densa chemoreceptor
What is the renal Na excretion called?
naturesis
What is primary/essential HTN?
an unknown, single reversible cause of HTN
Increased TPR primarily occurs at the level of the _____.
precapillary arterioles
Name 2 signs of primary hyperaldosteronism.
- hypokalemic metabolic acidosis
- resistant HTN
- ****NO edema
What is the BP goal for diabetics or pts with CKD?
- less than 130 SBP
- less than 80 DBP
What usually causes renal artery stenosis in female pts younger than 30yo?
fibromuscular dysplasia
What is the acute physiologic effect of a diuretic?
decreased ECF and plasma volume with reduced CO
What is primary hyperaldsteronism?
defect of the adrenal cortex (adenoma, hyperplasia)- secretion independent of extra-adrenal stimuli
What is a hypertensive crisis?
when asymptomatic HTN pts take a turn into symptomatic, acutely elevated BP
This is HTN in the absence of hypertensive neuroretinopathy .
non-malignant HTN
What is the first line treatment for essential HTN?
thiazide diuretics
Physiologically, HTN can only result from _____ and/or _____.
increase in CO; increase in total peripheral resistance
The Frank-Starling mechanism suggest that an increase in ECF volume due to renal Na and water retention should result in increased ____, ____, and _____.
blood volume, venous return, and stroke volume
What does TPR stand for?
total peripheral resistance
Secondary HTN is rare. When would you check for it?
- in very young pts (>30yo)
- in pts with restistant HTN that are already on at least 4 drugs
- What do the following fundoscopic findings indicate? flame shaped (striate) hemorrhages
- cotton wool spots (soft exudates)
- papilledema
HTN-induced arteriolitis of malignant HTN
What is malignant HTN?
- marked elevation of BP
- hypertensive vasculopathy
- hypertensive neuroretinopathy
People who are normotensive at age 50 have a ____% lifetime risk of developing HTN.
90
