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Pathophysiology > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Describe systolic arterial blood pressure.

A

The pressure of the arteries during systole (contraction of the heart)

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2
Q

Describe diastolic arterial blood pressure.

A

The pressure of the arteries during diastole (rest/filling of the heart)

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3
Q

Describe the Mean Arterial Pressure (MAP)

A

Represents the average pressure throughout the cardiac cycle
MAP = 2/3 diastole + 1/3 systole
(66% of the time the heart is in rest and 33% of the time the heart is in contraction

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4
Q

Define hypertension

A

High blood pressure

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5
Q

Explain the difference between essential and secondary hypertension

A

Essential - cause is unknown (90% of cases)

Secondary - comorbid diseases or drug causing elevated BP (10% of cases)

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6
Q

What is the mathematical formula for blood pressure?

A

BP = total peripheral resistance (TPR) X cardiac output (CO)

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7
Q

What is the formula for cardiac output?

A

heart rate X stroke volume

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8
Q

What is TPR?

A

The amount of resistance in the periphery or the blood vessels.

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9
Q

When TPR increases this is called?

A

Vasoconstriction

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10
Q

What happens when TPR increases? (vasoconstriction)

A

BP increases

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11
Q

Define: cardiac output

Remember cardiac output = heart rate X stroke volume

A

How much the heart is pumping

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12
Q

Define: heart rate

A

How fast the heart is pumping

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13
Q

Define: stroke volume

A

How much blood the heart is pumping

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14
Q

There are 5 Mechanisms of BP Regulation: List them.

A
  1. Renal (RAAS)
  2. Electrolytes (Na, K, Ca)
  3. Neuronal
  4. Vascular
  5. Hormonal
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15
Q

Describe the Renal Mechanism (RAAS)

A
  1. Juxtaglomerular cells (which are baroreceptors) sense a decrease in blood pressure.
  2. Renin is secreted which converts angiotensinogen that is circulating in the blood into angiotensin I.
  3. Angiotensin I is then converted into Angiotensin II by a converting enzyme.
  4. Angiotensin II then affects all areas including adrenal cortex, kidneys, intestines, CNS, peripheral nervous system, vascular smooth muscle and the heart.
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16
Q

Explain how adrenal cortex is affected by angiotensin II.

A

There is an increase in aldosterone synthesis which increases sodium/water reabsorption which increases the blood volume and increases the TPR and increases BP.

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17
Q

Explain how the kidneys and intestines are affected by angiotensin II.

A

There is an increase in sodium/water reabsorption which increases the blood volume and increases the TPR and increases BP.

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18
Q

Explain how CNS is affected by angiotensin II.

A

Causes a release of Vasopressin (an antidiuretic hormone) which causes water (urine) to stay in the body and increase blood volume which increases the TPR and increases BP

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19
Q

Explain how the PNS is affected by angiotensin II.

A

It causes sympathetic discharge (fight or flight system) which increases the TPR and increases BP.

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20
Q

Explain how vascular smooth muscle is affected by angiotensin II.

A

Causes vasoconstriction which increases the TPR and increases BP.

21
Q

Explain how the heart is affected by angiotensin II.

A

Causes increased contractility (the heart pumps harder) which increases CO and increases BP.

22
Q

What does RAAS stand for?

A

Renin Angiotensin Aldosterone System

23
Q

Explain the Electrolyte Mechanism.

A

Wherever sodium goes, water follows. Patients with higher sodium levels, have increased water retention which increases blood volume which increases TPR which increases BP.

Lower Ca and Lower K levels can increases TPR which would also cause increased BP.

24
Q

The Neuronal Mechanism has 3 parts to it: Explain extrinsic reflexes.

A

Outside circulatory system through hypothalamus (ex. pain or cold temp: You want to increase BP to warm someone up or get rid of pain)

25
Q

The Neuronal Mechanism has 3 parts to it: Explain intrinsic reflexes.

A

Within the circulatory system (baroreceptor/chemoreceptors)

26
Q

What is a baroreceptor?

A

Senses a change in pressure

27
Q

What is a chemoreceptor?

A

Senses a change in chemical balance.

28
Q

The Neuronal Mechanism has 3 parts to it: Explain higher center reflexes.

A

Mood and emotions can also have an affect on BP

ex. If you are nervous you can have a higher heart rate which will increase your blood pressure

29
Q

Explain the Vascular Mechanism.

A

Endothelium secretes factors that promote vasodilation or vasoconstriction.

30
Q

Explain vasoconstriction and list the drugs that can cause this.

A

Vasoconstriction is when blood vessels get smaller in diameter. This can be caused by drugs such as: angiotensin II, vasopressin, endothelia.

31
Q

Explain vasodilation and list the drugs that can cause this.

A

Vasodilation is when blood vessels get bigger in diameter. This can be caused by drugs such as: Prostacyclin, nitric oxide, bradykinin.

32
Q

Vasoconstriction increases and vasodilation decreases _________ _______.

A

Vascular resistance

33
Q

An increase in vascular resistance promotes _____.

A

Hypertrophy

34
Q

The Hormonal Mechanism has 2 parts to it: Explain Natriuretic hormones

A

Natriuretic hormones inhibits Na/K ATPase which blocks active Na out of vascular smooth muscle cells. The end result is increased vascular tone (vasoconstriction)

35
Q

The Hormonal Mechanism has 2 parts to it: Explain Hyperinsulinemia

A

It means you have too much insulin and it increases renal Sodium retention. This acts a growth hormone leading vascular smooth muscle cells to grow (hypertrophy). It increases Ca in vascular smooth muscles leading to constrictions which increases BP
It also increases sympathetic nerve activity.

36
Q

What is a normal BP?

A

120/80

37
Q

List some risk factors for hypertension?

A
  • Age: >55 for men, >65 for women
  • Hyperinsulinemia
  • Microaluminuria
  • Family history of hypertension
  • Race
  • Obesity
  • Dyslipidemia
  • Hyperuricemia (GOUT)
  • Lifestyle: alcohol, diet, exercise, smoking, etc.
38
Q

Describe the symptoms of hypertension.

A
  • Usually none (silent killer)

- Sometimes headaches, blurred vision can happen from really high blood pressure

39
Q

Untreated hypertension can have consequences in 5 areas: Discuss the brain

A

You could have a stroke occur from either a vessel bursting or a clot occurring.

40
Q

Untreated hypertension can have consequences in 5 areas: Discuss the kidneys

A

You could get a renal disease

41
Q

Untreated hypertension can have consequences in 5 areas: Discuss the eyes

A

Retinopathy
-You have very small blood vessels in the eye so if you have hypertension then the capillaries can rupture and you can go blind

42
Q

Untreated hypertension can have consequences in 5 areas: Discuss the heart

A

Left ventricular dysfunction or heart failure. You could also get coronary artery disease (stable angina or ACS)

43
Q

Untreated hypertension can have consequences in 5 areas: Discuss the vessels

A

You could get peripheral artery disease

44
Q

What types of lifestyle modifications could be made to reduce BP

A
  • weight reduction
  • better diet
  • dietary sodium restriction
  • increase physical activity
  • decrease alcohol intake
45
Q

How can blood pressure be defined?

A

As the pressure against the artery wall

46
Q

What is white coat hypertension?

A

When a patient is nervous to see a doctor so their BP is elevated more than normal and the reading for BP therefore is not accurate.

47
Q

What types of medications can be used to lower BP

A
  • A drug that blocks angiotensin II being formed
  • A diuretic (promotes water loss)
  • A drug that stops renin production
  • A drug that stops blood vessels from constricting. (Drugs that can stop vasospasm ?)
  • Nitric Oxides - cause vasodilation
  • Beta blockers - decrease oxygen demand by lowering heart rate
48
Q

How do beta blockers work?

A

They decrease the heart rate which decreases oxygen demand which decreases oxygen supply. This works to lower blood pressure.

49
Q

Describe the 5 stages of blood pressure

A 
Normal: S- 120 D-80
Pre HT: S:120-139 D: 80-89
Stage 1 HT: S:140-159 D:90-99
Stage 2 HT: S:160-179 D: 100-109
Hypertensive crisis: S: >180 D:>110

Pathophysiology (15 decks)

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