Hypertension Flashcards
Hypertension definition
Pressure on arterial walls exceeding a defined threshold
What does isolated hypertension mean?
Just one particular artery or vein/region, i.e. renovascular, portal
Normotension, according to the slide, is what range
<120 over <80
Pre-hypertension is what range
120-139 / 80-89
Stage I HTN range
140-159 / 90-99
Stage II HTN range
sys > 160 / dia > 100
Isolated systolic HTN range
sys >140 and dia < 90
When in the day is blood pressure normally higher?
Morning
What happens to the systolic vs diastolic value with age?
Systolic increases with age, diastolic decreases with age
At what age do women meet or surpass the systolic blood pressure of men? (before this age, women have lower BP than men)
60-70 years old
What percentage of all death is related to HTN?
13-15%
What does essential HTN mean?
no clear etiological factor, and describes 80-90% of all HTN patients. all others are “secondary” and have a clear cause
Two things that affect peripheral resistance (from slide)
Vessel wall function
Vessel wall structure
Two things that affect cardiac output (again just from slide, not the formula or whatever)
Intravascular volume
Contractility
How does increased NaCl intake lead to increased BP?
“In order to increase Na+ excretion, BP must increase some too”
Increases glomerular filtration, decreases renal tubule Na+ absorption
Also ANF
(one single mech not clear, but effects of high NaCl uptake are very clear)
What is the guideline for sodium intake in the average population?
2300 mg sodium (5.8g NaCl)
What is the guideline for sodium intake in the >51 y/o, diabetic, or hypertensive population?
1500 mg sodium (3.8g NaCl)
Main effects of Angiotensin:
vasoconstriction, stimulation of aldosterone secretion, stimulation of vessel wall smooth muscle proliferation
Main effects of aldosterone (relevant to this lecture anyway)
Stimulation of Na reabsorption
How do alterations in RAS relate to essential and secondary hypertension?
Essential hypertension: RAS is a consequence, not a cause
Secondary htn: may be from renin-secreting tumors, renovascular HTN, primary or secondary aldosteronism
In sustained HTN, what may happen to the baroreceptor set-point?
It may be altered, and symp activity is too high. Increased symp tone is related to obesity, sleeping disorders etc. May be more of a “permissive effect” than a cause of hypertension
What is arteriosclerosis?
Decreasing in elasticity of vessel walls
How do ion transport changes in smooth muscle cells lead to HTN?
Intracellular Ca2+ increases, causing increased contractile activity in arterioles and vasoconstriction
How does endothelin affect vascular compliance?
It’s a vasoconstrictor
HTN causes weakened vessel walls. What are 3 possible pathologies resulting from this?
- Cerebral vessel weakening -> hemorrhagic stroke
- Renal vessel weakening -> nephrosclerosis and renal failure
- Opthalmic vessel weakening -> retinopathy
HTN causes accelerated atherosclerosis. What are 3 major risks from this?
AMI, ischemic stroke, and aneurysms/dissections
HTN causes an increase in afterload. What are 2 major risks from this?
Heart failure and AMI due to increased myocardial O2 demand
What are two cerebral problems from hypertension that are not a form of stroke?
Hypertensive encephalopathy: loss of cerebral autoregulation, etc..
Hypertension-associated Dementia
What are 3 manifestations of hypertension in the heart?
LVH, CHF, and coronary artery disease
What is the most frequent cause of secondary hypertension?
Kidney disease
What part of the kidney is primarily affected by HTN?
Glomeruli primarily affected.
Tubular damage develops at a later stage
Combined glomerular and tubular damage makes the vessels leaky (?)
What is the threshold for microalbuminuria vs clinical albuminuria? (check this when suspecting kidney damage from HTN)
Micro: 30-300 mg/24 hours
Clinical: >300 mg/24 hours
What’s a good early, non-invasive diagnostic of peripheral vascular disease?
Dilated fundoscopic examination
What are the two kidney secondary hypertension entities?
Parenchymal and Renovascular
What are some endocrine causes of HTN?
Primary aldosteronism, Cushing’s syndrome, Pheochromocytoma, Hyperthyroidism, Acromegaly
What are some drugs that may cause secondary HTN?
Estrogen/androgen hormone supplements, NSAIDS, chronic alcohol intake, antidepressants, immunosupressive agents
How do you test kidney function in diagnostic laboratory test of HTN?
Urine sediment, albumin, potassium
Serum creatinin
How do you test endocrine function in diagnostic laboratory test of HTN?
Serum sodium, potassium, calcium, TSH
What are 3 ways to reduce intravascular volume by medication?
Diuretics
ACE inhibitors
Aldosterone antagonists
