Hypertension

Question 1

What two factors affect blood pressure?

Answer 1

Volume of blood (cardiac output), and compliance of arteries (systemic vascular resistance)

Question 2

What are some neural cardiovascular reflexes that help with RAPID compensation of blood pressure?

Answer 2

Baroreceptor reflexes, chemoreceptor reflexes and brain (CNS) ischemic response (like in increased ICP, etc)

Question 3

What are some hormonal responses to blood pressure changes that take effect for intermediate/short term responses?

Answer 3

Catecholamines, RAAS, vasopressin

Question 4

What blood pressure regulating system is responsible for long term BP management?

Answer 4

Renal body fluid control system

Question 5

What is natriuresis?

Answer 5

Getting rid of sodium

Question 6

How do the kidneys control high blood pressure/extra cellular fluid volume (ECFV)?

Answer 6

They excrete excess fluid and sodium in the urine. Diuresis and natriuresis.

Question 7

How do the kidneys compensate for low blood pressure/low ECFV?

Answer 7

The kidneys excrete less fluid and sodium than ingested.

Question 8

What happens to BP with age?

Answer 8

Systolic and diastolic bp increase with age due to blood vessel stiffening and narrowing. Systolic more so than diastolic.

Question 9

What happens to BP when someone is male and aging?

Answer 9

BP’s tend to have higher BP with increased age.

Question 10

When we exercise, how does this affect BP?

Answer 10

BP increases transiently with physical or psychological stress

Question 11

Does gravity have an effect on BP?

Answer 11

Yes, BP can vary in relation to vertical distance from heart.

Question 12

Does the time of day have an effect on BP?

Answer 12

Yes - the circadian variations account for your lowest BP happening at night between 2-5 am. The highest is shortly after waking.

Question 13

What’s a goal BP for someone with diabetes?

Answer 13

Less than 130/80

Question 14

What’s a goal BP for someone that has kidney disease?

Answer 14

<140/90

Question 15

What’s a goal BP for someone that’s over 80 years old?

Answer 15

<150/90

Question 16

What is primary or “essential” hypertension?

Answer 16

No clear identifiable cause. Happens in one’s 50’s or 60’s and is the most common cause of htn (90-95% of people have it). Risk factors are: kidney function changes, RAAS activity, SNS hyperactivity, and intracellular sodium and calcium levels.

Question 17

What can increase the arterial by?

Answer 17

Shifting the renal output curve toward a higher pressure or increasing the intake of salt and water.

Question 18

What are some non-modifiable risk factors for htn?

Answer 18

Family hx, advanced age (>45 in men, >55 in women), men more often than women, and race (south asian and african american)

Question 19

What are some modifiable risk factors for htn?

Answer 19

High salt diet, abdominal obesity (sns activation by leptin, increased blood vessel length), sedentary lifestyle, poor dietary habits (high fat, low fibre, and potassium intake), impaired glucose intolerance or diabetes, and stress (activation of SNS and ADH and cortisol), cigarette smoking, and ETOH.

Question 20

What is secondary htn?

Answer 20

It’s htn caused by a known condition that increases BP or other exogenous conditions. Can be corrected or cured through surgery other other med conditions. Ex: hyperaldosteronism or renovascular dx, Acute and chronic kidney disorders, hyperthyroid, cushings, pheochromocytoma.

Question 21

What is hyperaldosteronism?

Answer 21

A condition that makes too much aldosterone - causing sodium and water retension. Ex: adrenal adenoma, idiopathic adrenal hyperplasia, Acute and chronic kidney disorders, hyperthyroid, cushings, pheochromocytoma.

Question 22

What’s a symptom of hyperaldosteronism besides low potassium?

Answer 22

Hypokalemia

Question 23

What is renovascular dx?

Answer 23

Renal artery stenosis due to athersclerosis. Fibromuscular dysplasia (non inflammatory vascular dx). Reduced renal blood flow activates the RAAS which causes angiotensin II to activate aldosterone. Also affects K+ levels.

Question 24

What might you find on a physical assessment of someone with renovascular disease?

Answer 24

A bruit because of the renal artery obstruction.

Question 25

Why does Cushing’s disease affect htn?

Answer 25

High cortisol increases sensitivity of alpha 1 receptors to catecholamines. High ACTH stimulates aldosterone release.

Question 26

Why does hyperthyroidism (like grave’s, thyroid adenoma or nodular goitre) affect htn?

Answer 26

High thyroid hormone upregulates B1 receptors in the heart. Which affects pacemaker and cardiac cells and makes them more responsive to epi and nor epi.

Question 27

Why does pheochromocytoma affect htn?

Answer 27

It’s a tumor of the adrenal medulla, it releases catecholamines.

Question 28

Other states that cause htn are…

Answer 28

Coarctation of the aorta, pregnancy, and obstructive sleep apnea.

Question 29

What are some exogenous factors that cause a rise in BP?

Answer 29

Nsaids, decongestants, erythropoietin, antihistamines, oral contraceptives, stimulants, and licorice.

Question 30

What is isolated systolic htn?

Answer 30

When the systolic BP alone is elevated at >140 and the diastolic is normal or below 90. It’s because there’s a loss of elasticity and decreased compliance of the aorta that occurs with age due to atherosclerosis.

Question 31

What’s a hypertensive crisis?

Answer 31

Diastolic BP >120, which causes organ damage like stroke, or acute heart failure. S&S are: epitaxis, headache, blurred vision, confusion, tinnitus, or angina. Can cause cerebral edema. The significance of elevated BP is that you can’t overcome the afterload and that can cause heart failure.

Question 32

What key pathophysiological issue causes organ damage?

Answer 32

Athersclerosis

Question 33

How does atherosclerosis affect the heart?

Answer 33

Angina, or ACS. High blood pressure also increased myocardial work load. The left ventricle will hypertrophy and cause heart failure. It also increases the oxygen demand of the heart - causing angina.

Question 34

How does atherosclerosis affect the brain?

Answer 34

It causes CVD and ischemic strokes. The high BP can also cause hemorrhagic strokes and cerebral aneurysm and vascular dementia.

Question 35

How does atherosclerosis affect the kidneys?

Answer 35

Chronic kidney disease, high blood pressure can also affect glomerular damage and protein loss in urine.

Question 36

How does atherosclerosis affect the eyes?

Answer 36

Small vessels are damaged causing decreased blood flow and that can cause retinal detachmet, aneurysm, hemorrhage and blindness.