hypertension Flashcards

1
Q

describe the hypertension blood pressure profile before and after 50

A
  • Systolic and diastolic blood pressure increase together until about age 50
  • DIASTOLIC PRESSURE DECREASES while SYSTOLIC PRESSURE CONTINUES the UPWARD trend

–> due to the aging process impairing cardiac fucntion, reducing diastolic pressure and altering vascular function causing the systolic pressure to INCREASE

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2
Q

describe the effects of longer term hypertension on the heart

A
  • Hypertension leads to cardiac remodeling due to chronically elevated blood pressure resulting in VENTRICULAR HYPERTROPHY due to heart responding to HIGH AFTERLOAD

–> Hypertrophy increases risk for cardiovascular incidents (MI, HF and sudden cardiac death)

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3
Q

Describe the long term effects of hypertension on vasculature

A
  • Vasculature remodeling occurs with high blood pressure
  • Atherosclerosis = vascular remodeling and plaque formation

–> occurs through reactive process related to sheer stress on vessels along with hormonal factors

–> angiotension II mediates vascular remodeling

  • INFLAMMATION

–> hypertension activates T-cell mediated response and further exacerbate end-organ damage

–> inflammation alters oxidative capacity in immune cells resulting in reactive oxygen stress (can influence vascular tone and protein expression)

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4
Q

describe the regulation of blood pressure (SHORT TERM)

A
  • BAROREFLEXES

–> sense changes in blood pressure and send feedback to CNS to modulate sympathetic and parasympathetic outflow

–> modulate HR and Total peripheral resistance

  • CHEMORECEPTORS

–> detect changes in chemical constituents of blood (oxygen, Carbon dioxide, and pH))

–> fall ina rterial oxygen saturation, increase in carbon dioxide saturation or decrease in pH STIMULATES a VASOCONSTRICTION and BRADYCARDIA

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5
Q

Describe ANGII role in long term regulation of BP

A
  • Potent vasoactive substance
  • DIRECT VASOCONSTRICTION and moderate sodium reabsorption
  • Also stimulates ALDOSTERONE secretion from adrenal gland

aldosterone promotes even greater sodium reabsorption from kidney

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6
Q

describe the synthesis of ANGII

A
  • Production of ANGII begings with release of angiotensinogen from liver

–> circulates in blood stream until it reaches the kidney

–> in the kidney, RENIN released from juxtaglomerular cells (response to sympathetic nerve stimulation) cleaves aniotensinogen into ANGI

–> ANGI circulates blood stream where it is futher cleaved into ANGII

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7
Q

Describe kidneys role in long term control of BP

A
  • BLOOD VOLUME is a major factor in OVERAL ARTERIAL BLOOD PRESSURE (shifts blood volume vary directly with blood pressure through modulation of venous return)
  • Under conditions of low arterial pressure, renal mechanisms CONSERVE WATER and SALT
  • HIGH pressure, through an increase in resitance, will INCREASE SODIUM EXCRETION (water follows sodium –> called pressure-natriuresis) leading to REDUCTION in BLOOD VOLUME/pressure
  • DYSFUNCTION in renal sodium/water handling WILL RESULT IN ABNORMAL BLOOD PRESSURES
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8
Q

describe the effect on aging in the vasculature

A
  • in normal individuals, vessel wall easily accommodates pulsatile fluid flow due to lots of elastin in walls
  • In older patients the vessel walls (aorta) become noncompliant

–> Vessel wall does not change with each ventricular ejection due to lots of collagen in wall

–> causes charp peaks of pusle pressure leading to differences transmitting downstream from aorta

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9
Q

describe the pathogenesis of essential hypertension

A
  • CENTRAL FACTORS:

–> augemented symapthetic discharge

–> aberrant responses to peripheral signals

  • VASCULAR DYSFUNCTION

–> exaggerated response to vasoconstrictors

–> depressed response to vasodilators

–> remodeling

  • RENAL DYSFUNCTION = sodium and water handling defects
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10
Q

carotid sinus stimulation tx

A
  • Used in resitant hypertension
  • -> Is a pacemaker under the skin, gives stimulation to the carotid sinus to get an effect of dramatic decrease in blood pressure that is sustained over time.
  • -> Uses the baroreflex to simulate a high blood pressure to use bodies normal technique at lowering blood pressure
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11
Q
A
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