Hypertension Intro

Question 1

define elevated BP

Answer 1

120-129/less than 80

Question 2

stage 1 HTN numbers

Answer 2

130-139/80-89

Question 3

stage 2 HTN numbers

Answer 3

more than 140/more than 90

Question 4

does systolic BP increase or decrease with age?

Answer 4

increases

Question 5

how does diastolic blood pressure change with age?

Answer 5

plateaus around age 55

Question 6

since systolic rises with age and diastolic plateaus…what does this mean for BP in elderly?

Answer 6

can have isolated systolic HBP

Question 7

what are the three key contributors to blood pressure

Answer 7

sympathetic NS
RAAS
Kidneys

Question 8

in young patients what is the main driving force behind HBP?

Answer 8

high CO

Question 9

in older patients what is the main contributor to HBP?

Answer 9

increased peripheral resistance

Question 10

vascular stiffness of the arterial system has what effect on the blood pressure?

Answer 10

mainly causes an increase in the systolic BP because large vessels cannot adjust to large pressure coming out of ventricle now

Question 11

two main causes of secondary hypertension

Answer 11

chronic kidney disease

primary aldosteronism

Question 12

organs at high risk from HT (4)

Answer 12

brain
heart
arteries
kidneys

Question 13

what is the main cause of left ventricular hypertrophy in HT?

Answer 13

increased afterload due to HBP

Question 14

what two changes do you see microscopically with ventricular hypertrophy of the myocytes?

Answer 14

larger nuclei and more cytoplasm

Question 15

what is the main thing LVH leads to on an EKG?

Answer 15

HIGHER VOLTAGES IN THE QRS complexes

Question 16

the leftward leads with LVH have higher positive or negative voltages in QRS?

Answer 16

higher positive R waves

Question 17

the rightward leads with LVH have higher positive or negative voltages in QRS?

Answer 17

higher negative S waves

Question 18

what is another EKG abnormality seen with LVH?

Answer 18

ST depression and T wave inversions in the lateral leads of the EKG

Question 19

what two leads to look at usually for LVH voltage changes?

Answer 19

V1 and V5/6

Question 20

what is the cutoff for voltage of the R/S waves in leads for LVH?

Answer 20

needs to be greater than 35 mm or 7 big boxes

Question 21

what is the main effect of HBP on the large/medium arteries?

Answer 21

accelerated atherosclerosis

Question 22

what pathologic changes does HBP cause in small arteries/arterioles?

Answer 22

thickened vessel wall…stenotic lumen

Question 23

what increases in the small arteries that cause thickened vessel walls with HBP?

Answer 23

elastin and collagen

Question 24

what increases in arterioles that cause thickened vessel walls with HBP?

Answer 24

increased collagen and plasma proteins

Question 25

what is the chronic thickening of small arteries called with HBP?

Answer 25

benign arteriosclerosis

Question 26

what is the chronic thickening of arterioles called with HBP? Two names

Answer 26

benign arteriolosclerosis

hyaline arteriolosclerosis

Question 27

whats is the difference between benign arteriolosclerosis and hyaline arteriolosclerosis?

Answer 27

hyaline has plasma proteins involved and leads to a pink amorphous look on microscope

Question 28

malignant arteriosclerosis and arteriolosclerosis changes in small arteries and arterioles respectively?

Answer 28

increased layers of smooth muscles…called onion skinning

endothelial cell injury can lead to fibrinoid necrosis and thrombus formation

Question 29

what are the five lifestyle modifications that can decrease HBP?

Answer 29

weight reduction
DASH diet
Exercise
sodium reduction
moderation of alcohol