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Cardiovascular 2 > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What are the complications of hypertension damaging endothelial cells?

A

MI

Stroke

Aneurysm

Atherosclerosis

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2
Q

What is the most common cause of hypertension - what do we refer to this hypertension as?

A

90% of hypertension is idiopathic

  • referred to as primary hypertension.
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3
Q

What are risk factors of primary hypertension?

A

Old age

Obesity

Salt heavy diets

Sedentary lifestyle

Family History

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4
Q

How can the kidneys cause secondary hypertension?

A

Low perfusion due to atherosclerosis, aortic disection or vasculitis leads to overactivation of RAAS.

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5
Q

Hypertensive crisis

A

A hypertensive crisis is a severe increase in blood pressure that can lead to a stroke and damage to blood vessels.

Systolic pressure of above 180mmHg

Diastolic pressure of above 120 mmHg

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6
Q

What are the symptoms of primary hypertension?

A

Not asscoaited with any symptoms hence referred to as the silent killer.

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7
Q

What are the mechanisms for regulating blood pressure?

A

Short term mechanisms: Regulate blood vessel diameter, heart rate and contractility.

Long term mechanisms: Regulate blood volume.

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8
Q

Short-term mechanisms respond to what?

A

Small changes in the environment, e.g sitting to standing / starting running.

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9
Q

Blood pressure =

A

Blood pressure = cardiac output x peripheral resistance

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10
Q

Explain the short term mechanisms that control blood pressure:

A
  1. Nervous system - Vasomotor centre of the brain sends efferent motor fibres that innervate smooth muscle of blood vessels. Sympathetic = vasoconstriction and parasympathetic = vasodilation.
  2. Chemicals - adrenaline and noradrenaline.
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11
Q

Where is the vasomotor centre of the brain?

A

Medulla

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12
Q

Function of barroreceptors?

A

Stretch receptors that detect rise in BP.

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13
Q

Where are barroreceptors found?

A

Carotid body

Aortic arch

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14
Q

Barroreceptors in the aortic arch are innervated by…

A

Vagus nerve

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15
Q

Barroreceptors in the carotid sinus are innvervated by…

A

Glossopharyngeal nerve

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16
Q

Summary of effect of barroreceptors:

A
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17
Q

Vagus is parasympathetic or sympathetic?

A

Vagus nerve gives parasympathetic control of the heart, lungs, and digestive tract.

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18
Q

Sympathetic activation causes release of what hormone and neurotransmitter that affects heart rate?

A

Adrenaline and Noradrenaline

(note these are both hormones and neurotransmitters)

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19
Q

Where are chemoreceptors located?

A

Aortic body

Carotid body

Peripherally

Cardio/respiratory centre of the medulla

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20
Q

Chemoreceptive cells respond to changes in what 3 different things?

A

pCO2

pO2

pH levels

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21
Q

Summary of chemoreceptors:

A
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22
Q

CNS Ischemic response

A
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23
Q

Cushing Reaction:

A
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24
Q

Effects of angiotensin ii

A
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25
Q

Pressure Naturesis

A

pressure-natriuresis mechanism, whereby increases in renal perfusion pressure lead to decreases in sodium reabsorption in the PCT and increases in sodium excretion.

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26
Q

Nitric oxide is a

A

Vasodilator

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27
Q

Kinins are vaso…

A

Vasodilators

28
Q

Tromboxane A2 is a vaso

A

Vasoconstrictor

29
Q

Endothelin-1 is a vaso…

A

Vasoconstrictor

30
Q

Atrial-natriuretic peptide is a vaso…

A

Vasodilator

31
Q

Epinephrine in skeletal muscle and the liver is a vaso…

A

Vasodilator

32
Q

Epinephrine not in skeletal muscle and the liver is a vaso…

A

Vasoconstrictor

33
Q

VIP (vasoactive intestinal polypeptide is a vaso…

A

Vasodilator

34
Q

Essential hypertension aka

A

Primary / Idiopathic hypertension

35
Q

Classification of Hypertension:

A
36
Q

Hypertension syndrome relates to genes that are involved with what?

A

Sodium transport channel

37
Q

How does arterial stiffness which increase with age affect hypertension?

A
  • Ageing = intimal thickening of arteries/ calcification
  • Decreased compliance (vascular elasticity)
  • Endothelial dysfunction = Arterial stiffness
  • Increased Systemic Vascular Resistance
  • Isolated systolic hypertension common in elderly
38
Q

Hypertension is almost unknown in populations with consumption of less than 50mmol of salt a day!

A

Hypertension is almost unknown in populations with consumption of less than 50mmol of salt a day!

39
Q

How does renal vasoconstriction damage the kidney?

A

Tubular ischemia and interstitial inflammation.

40
Q

Secondary hypertension

A

Secondary hypertension (about 10% of people) is the result of a known underlying cause such as Conn’s adenoma, renovascular disease, or phaeochromocytoma.

41
Q

When is secondary hypertension suspected more strongly?

A

Secondary hypertension may be suspected more strongly if the patient is less than 40 years old and/or has hypertension that is resistant to treatment.

42
Q

How is hypertension investigated?

A
  • NICE suggests to GPs that they carry out the following on patients with confirmed hypertension.
  • 12-lead ECG • Urine dipstick.
  • measurement of urine albumin: creatinine ratio.
  • Plasma glucose, electrolytes, creatinine.
  • Estimated glomerular filtration rate— to exclude adrenal disease, chronic kidney disease, and diabetes.
43
Q

Common causes of secondary hypertension:

A
  • Renal disorders – by far the most common
  • Vascular disorders
  • Endocrine disorders
  • Some drugs and other substances
  • Connective tissue disorders
  • Retroperitoneal fibrosis
  • Obstructive sleep apnoea
44
Q

What renal can cause hypertension?

A
  • Chronic pyelonephritis — usually detected unexpectedly on ultrasonography when investigating hypertension.
  • Diabetic nephropathy — indicated by microalbuminuria or proteinuria.
  • Glomerulonephritis — often indicated by microscopic haematuria.
  • Polycystic kidney disease — suggested by an abdominal or flank mass, microscopic haematuria, or family history.
  • Obstructive uropathy — the person may have an abdominal or flank mass.
  • Renal cell carcinoma — classically the person may have haematuria, loin pain and a loin mass, but increasingly asymptomatic renal cell carcinoma is being picked up on ultrasonography or CT scan.
45
Q

What vascular disorders can cause secondary hypertension?

A

Renal artery stenosis - increased plasma renin levels

Coarctation of the aorta

46
Q

Coarctation of the aorta

A

A congenital condition whereby the aorta is narrow, usually in the area where the ductus arteriosus (ligamentum arteriosum after regression) inserts.

  • means the left ventricle has to work harder.
47
Q

In coarctation of the aorta, hypertension affects where specifically?

A

The upper limb - note there can be a significant difference in blood pressure between arms.

48
Q

What endocrine disorders can cause hypertension?

A

Conn’s syndrome

Cushing’s syndrome

Acromegaly

Hypothyroidism

Hyperthyroidism

49
Q

Conn’s syndrome aka

A

Primary hyperaldosteronism

50
Q

Conn’s syndrome

A

Conn’s syndrome is a rare health problem that occurs when the adrenal glands make too much aldosterone. This problem is also known as primary hyperaldosteronism. Aldosterone is a hormone that controls salt and potassium levels in the blood. Too much leads to high blood pressure.

51
Q

What are the signs and symptoms of Conn’s syndrome?

A

Signs:

  • Hypokalaemia
  • Alkalosis (elevated bicarbonate level)
  • Plasma sodium level greater than 140 mmol/L

Symptoms:

  • Tetany
  • Muscle weakness
  • Nocturia
  • Polyuria.
52
Q

What is a concern in Conn’s syndrome?

A

Adrenal adenoma - investigate with CT/MRI

53
Q

Phaeochromocytoma

A

Pheochromocytoma is a rare tumor of adrenal gland tissue. It results in the release of too much epinephrine and norepinephrine, hormones that control heart rate, metabolism, and blood pressure.

54
Q

Phaeochromocytoma is a rare tumor of which part of adrenal gland tissue?

A

Adrenal Medulla

55
Q

How does Phaeochromocytoma present?

A

People can present with intermittently high or labile blood pressure, or postural hypotension, headaches, sweating attacks, palpitations, or unexplained fever and abdominal pains.

  • can appear as if people are having panic attacks.
56
Q

Cushing’s syndrome

A

Excess cortisol

57
Q

Hypothyroidism affects blood pressure how?

A

Increases diastolic blood pressure.

58
Q

Hyperthyroidism affects blood pressure how?

A

Increases systolic blood pressure.

59
Q

Understand that some drugs are associated with an increase in BP:

A
  • Alcohol — misuse of alcohol may be the most common individual secondary cause of hypertension. Features include variable hypertension that is resistant to commonly used drugs and that disappears within a week or two of complete abstinence.
  • Ciclosporin.
  • Cocaine and other substances of abuse.
  • Combined oral contraceptive.
  • Corticosteroids.
  • Erythropoietin.
  • Leflunomide – a Disease-Modifying Anti-Rheumatic Drug (DMARD) – used for rheumatoid arthritis and other types of autoimmune disease.
  • Liquorice — present in some herbal medicines.
  • Nonsteroidal anti-inflammatory drugs.
  • Sympathomimetics — may be found in over-the-counter cough and cold remedies (for example ephedrine, phenylpropanolamine).
  • Venlafaxine – an antidepressant
60
Q

What connective tissue disorders can cause hypertension?

A
  • Scleroderma
  • Systemic Lupus Erythematosus
  • Polyarteritis nodosa
61
Q

Scleroderma

A

Scleroderma is a group of autoimmune diseases that may result in changes to the skin, blood vessels, muscles, and internal organs. The disease can be either localized to the skin or involve other organs in addition to the skin.

62
Q

Systemic Lupus Erythematosus

A

An autoimmune disease in which the body’s immune system mistakenly attacks healthy tissue in many parts of the body. Symptoms vary between people and may be mild to severe.

63
Q

Polyarteritis nodosa

A

A rare disease that results from blood vessel inflammation (vasculitis) causing injury to organ systems. The areas most commonly affected by PAN include the nerves, intestinal tract, heart, and joints.

64
Q

See treatment and management of hypertension in therapeutics.

A

See treatment and management of hypertension in therapeutics.

65
Q

Hypertension in the Pathogenesis of Vascular Dementia.

A
66
Q

Labelling of a normal retinal image:

A

Cardiovascular 2 (20 decks)

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