Hypertension Flashcards
High+blood+pressure is anything
above+140/90+
mm/Hg
classification,of,hypertension.
Primary(Essential)Hypertension
Secondary hypertension
Primary(Essential)Hypertension
Unknown causes
Secondary hypertension
has an underlying cause (could be due to specific drugs or another disease)
caused&by&other&conditions&
that&affect&the&kidneys,&arteries,&heart&or&
endocrine&system
Secondary HTN is ——common than primary HTN.
less
To diagnose HTN, best time to measure blood pressure is———— successively for——- days
early in the morning
3
The WHO/ISH blood pressure classification includes 3 grades of hypertension
Grade1,2,3
Grade 1
Systolic:
Diastolic:
140-159
90-99
Grade 2
Systolic:
Diastolic:
160-179
100-109
Grade 3
Systolic:
Diastolic:
> 180
> 110
Risk Factors of high hypertension
- Age
- weight
- Tobacco
- too much salt(sodium)
- too little potassium
- Excercise
- family history
- race
- too little vit D
- stress
- alcohol
Primary Hypertension onset typically in ?
The fifth or sixth decades of life
If hypertension in both parent,’risk of
hypertension in off spring is increased by
250%
Patho physiology Theories of HTN
increased
peripheral vascular resistance or
systemic vascular resistance.
• Almost—— genes’have’been’identified’to’be’
related’to’hypertension
10
mutations’affect’blood’pressure’by’
altering’——— ,Leading’to’———
renal’salt’handling (specifically RAAS)
decreased’salt’excretion(salt’retention)’by’the’kidney
The autonomic nervous system plays a central
role in maintaining the cardiovascular homeostasis via
pressure,
volume and
chemoreceptor signals.
Sympathetic nervous system overactivity,
increases blood pressure and contributes to
the development and maintenance of
hypertension.
Sympathetic = vasoconstriction
Autonomic imbalance
increased sympathetic tone accompanied by reduced paraympathetic tone
Sympathetic = vasoconstriction Parasympathetic = vasodilation
Endothelial dysfunction
Imbalance between Nitric Oxide and endothelin
——- and ——-are secreted by
the endothelium, are the major regulators of
vascular tone and blood pressure.
Nitric oxide and endothelin
- Nitric Oxide = vasodilator
- Endothelin = vasoconstrictor
In patients with essential hypertension, the
balance between the vasodilators and the
vasoconstrictors is upset, which leads to
changes in the endothelium and sets up a
“vicious cycle” that contributes to the
maintenance of high blood pressure
High endothelin and low Nitric Oxide—> High peripheral vascular resistance
In patients with hypertension,endothelial activation happens by
endothelial activation and damage
endothelial activation and damage lead to
changes in
vascular tone,
vascular reactivity, and
coagulation and fibrinolytic pathways
beginning of atherosclerosis.
Secondary hypertension
- Renal / renovascular disease
- Endocrine disease
- Coarctation of the aorta
- iatrogenic
Renal/renovascular disease
atherosclerosis,
Fibromuscluar dysplasia
Endocrine disease
Pheochromocytoma Cushing syndrome Conn s syndrome Acromegaly Hypothyroidism
Coarctation of the aorta
Genetic condition that causes narrowing of the aorta
Iatrogenic
- Hormonal/oral contraceptive
* NSAIDs
Renal artery stenosis can be treated by
- removing and replacing this segment
- putting a balloon to dilate the artery
Normal thickness of the ventricle walls:
LV thickness =
RV thickness =
- 2 - 1.5cm
0. 5cm
Consequences of heart disease in hypertension
- Conduction,system,diseases,,
- Angina,or,Myocardial,infarction
- Cardiac,arrhythmias,(AF),
- Congestive,Heart,Failure
