hypertension

Question 1

what is hypertension?

Answer 1

persistently elevated blood pressure (>140/90)

Question 2

BP=

Answer 2

cardiac output (CO) x peripheral resistance (PR)

Question 3

at rest, cardiac output is

Answer 3

STABLE but PR fluctuates for varying reasons

changes in PR occur from vasoconstriction and vasodilation

Question 4

changes in cardiac output affect the body

Answer 4

systemically

Question 5

systole=

Answer 5

PUMPING phase (around 120mmHg)

Question 6

diastole=

Answer 6

FILLING phase (around 80mmHg)

Question 7

4 control mechanisms of BP?

Answer 7

baroreceptors
vascular autoregulation
renin angiotensin-aldosterone system (RAAS)
fluid volume regulation

Question 8

baroreceptors?

Answer 8

located centerly in aorta and carotid arteries

• detect changes in PRESSURE
• feed info to NS
• HOMEOSTATIC mechanisms engage to return pressure to original state
• located in TUNICA EXTERNA/ADVENTITA
• SENSORY NEURON excited by stretch of vessel—> AP—> CNS—> stimulation of vascular smooth muscle—> constrict or dilate—> alter PR—>alter BP

Question 9

what is vascular autoregulation?

Answer 9

blood vessels constrict and dilate in response to many changes in the body (like pH, pO2)

Question 10

what is the renin-angiotensin-alodsterone system (RAAS)

Answer 10

homeostatic mechanism triggered by DECREASED BP

it INCREASES THE BP to NORMAL RANGE

Question 11

point form explain RAAS

Answer 11

-juxtaglomerular cells (kidneys) release RENIN, liver releases -
angiotensinogen —> angiotensin
-angiotensin I circulates until ACE is made by pulmonary capillaries
-ACE converts angiotensin I- II
-angiotensin II: stimulates thirst,constricts efferent arteriole to increase pressure, stimulates release of: aldosterone (from adrenal cortex), antidiuretic hormone (from posterior pituitary gland) BOTH promote H20 and Na retention—> INCREASE BP

Question 12

what is fluid volume regulation?

Answer 12

kidney: excretes and retains fluid to maintain BV and BP
- OPERATES together with RAAS
- RAAS only occurs when there is DECREASED BP

Question 13

when is BP highest?

Answer 13

in the morning! BP varies on circadian rhythm

Question 14

when is BP lowest?

Answer 14

between 2 and 5 am

Question 15

mild htn

Answer 15

140-159/ 90-99

Question 16

moderate htn

Answer 16

160-179/100-109

Question 17

SEVERE htn

Answer 17

> 180/>110

Question 18

what is primary hypertension

Answer 18

> 140/90, idiopathic (unknown cause)

• 1 or 4 control mechanisms is defective
• may be multifactoral
• most cases

Question 19

what is systolic hypertension

Answer 19

systolic >140, diastolic remains normal, less than 90
occurs mostly after age 50
peripheral resistance in vessels increases d/t some degree of atherosclerostic change, change in elasticity of vessels

Question 20

white coat hypertension

Answer 20

CLINICAL setting hypertension

Question 21

malignant hypertension

Answer 21

ACUTE EMERG, diastolic exceeds 120

Question 22

gestational hypertension

Answer 22

during pregnancy

most women return to normal after

Question 23

what is secondary hypertension

Answer 23

not second phase of primary, develops because of underlying problem
-etiology is identifiable, usually due to renal disease
kidneys receive blood to filter and perfuse renal tissue
-significant part of CO goes to kidney, if excretion/reabsorption not balanced, BP affected
-decreased renal perfusion—> RAAS activated

Question 24

what is renovascular hypertension

Answer 24

a FORM of secondary

-increased BP caused by kidneys responding to narrowed/blocked arteries supplying kidneys

Question 25

manifestations of hypertension?

Answer 25

“silent killer” because can be asymptomatic
-elevated BP, measure regularly to find this out!
later manifestations:
-fatigue, palpitations, morning headaches, blurred vision, dizziness
-can result in multi organ failure

Question 26

first thing for treatment of hypertension?

Answer 26

LIFESTYLE modifications

• DIET (DASH)
• EXERCISE
• WEIGHT CONTROL
• OTHERS—> less alcohol, waist circumference, sodium consumption, smoking, stress management

Question 27

first line of pharmacologic hypertension?

Answer 27

diuretics! monotherapy—> promotes diuresis (increase voiding, excrete fluid, decrease blood volume)

Question 28

if the first line doesnt work, then what?

Answer 28

calcium channel blockers (calcium aids contraction of muscle, by blocking decrease contraction and vessels cannot constrict)
angiotensin II receptor blocker (angiotensin II must bind to receptor to be activated, but this blocks it so vasodilation–> decreased BP
ACE inhibitor, angiotensin cannot convert to II, no vasoconstriction—> decreased BP