Hypertension Flashcards
What is the mechanism by which oral contraceptives increase blood pressure
Na retention, increase angiotensinogen, catecholamine facilitation
How does alcohol increase blood pressure?
Activates the sympathetic branch, increases cortisol, Ca++
How do amphetamines increase blood pressure
By increasing TPR
How do NSAIDs increase blood pressure?
Na+ retention, renal vasoconstriction, interferes with Beta-blockers, diuretics, ACE blockers, Ag receptor blockers
How do corticosteroids increase blood pressure?
Iatrogenic Cushing’s syndrome
How does cocaine increase blood pressure?
Systemic vasoconstriction, increase TPR
How does marijuana increase blood pressure?
By increasing systolic blood pressure
All forms of HTN are treated with what?
Beta-adrenergic blockers, ACE inhibitors, Ca++ channel blockers, and diuretics
How does clonidine reduce blood pressure?
Clonidine is an alpha 2 agonist and it thus decreases sympathetic tone
How does ANP affect blood pressure?
Lowers it (causes sodium loss)
How is the Na-H exchanger affected in primary HTN?
In 50% of people with primary HTN, the exchanger’s activity is enhanced
Define metabolic syndrome
The combination of insulin resistance, hyperlipidemia, obesity, and hyper-insulinemia
How does reduced renal function affect mineralocorticoid secretion?
Increases, resulting in more Na+ and water retention, thus causing hypertension
Which populations show more salt sensitivity?
Hypertensive black people show more salt sensitivity (73%) than hypertensive white people (55%) and less salt resistance (27% VS 45%)
What happens in malignant hypertension?
widespread fibrinous necrosis of the media and intimal fibrosis in arterioles, causing narrowing, leading to progressive retinopathy , HF, and renal failure
What happens in hypertensive encephalopathy
Confusion, disordered consciousness, seizures - due to arteriolar spasms and cerebral edema
Why do elderly patients with essential hypertension see a rise in blood pressure upon standing?
Due to a hyper-reactive sympathetic response
How do systolic and diastolic pressure change with age?
Systolic generally increases with age. Diastolic increases with age until 50-60 years of age and then falls, so pulse pressure increases.
Why would overly aggressive treatment of diastolic HTN in older patients with CAD or CHF result in MI?
Because adequate perfusion of the coronaries is dependent upon diastolic pressure
What tests are ordered to identify cardiovascular risk factors?
Cholesterol (total, HDL), triglycerides, fasting blood glucose
What tests are ordered to identify target organ injury?
Chest x-ray, ECG, UA, serum creatinine or BUN, uric acid, urine microalbumin
What tests are ordered to screen for secondary HTN?
serum creatinine, potassium, calcium, UA
What is part of the basic testing for primary hypertension?
Fasting blood glucose, complete blood count, lipid profile, serum creatinine with eGFR, serum sodium, potassium, and calcium, TSH, UA, ECG
What is part of the optional testing for primary HTN
Echocardiogram, uric acid, urinary albumin to creatinine ratio
