Hypertension (Lamping)

Question 1

True or false: someone with a blood pressure measured on 3 separate occassions of 132/92 would be considered prehypertensive and should be monitored for increased risk of developing hypertension.

Answer 1

False. The consistently elevated diastolic pressure above 90 would classify this individual as having stage 1 hypertension.

Question 2

True or false: women generally have higher blood pressure than men until menopause, at which point blood pressure tends to drop due to replacement hormone therapy.

Answer 2

False. The opposite is true actually - men tend to have higher blood pressure than women until women reach menopause, at which point average blood pressures tend to exceed men of the same age. Replacement hormone therapy actually causes an increase in BP.

Question 3

True or false: in older people, you tend to see a higher, more dramatic rise in systolic pressure whereas in younger people, diastolic pressure tends to increase more dramatically then decrease with age.

Answer 3

True.

Question 4

____ hypertension accounts for 90-95% of all hypertension and has an unknown etiology.

Answer 4

essential (primary)

Question 5

condition marked by a mutation in epithelial ENaC channels leading to increased Na+ retention and hypertension

Answer 5

Liddle syndrome

Question 6

condition marked by reduced Na+ retention and hypotension

Answer 6

Bartter and Gitelman syndromes

Question 7

True or false: most cases of essential hypertension are monogenic.

Answer 7

False. Only ~1% have been shown to be the result of a single gene mutation, while ~55% are thought to be polygenic (53 gene mutations identified)

Question 8

hypertension that results from a tumor secreting aldosterone would be known as what?

Answer 8

secondary hypertension

Question 9

which arteries are most important for regulating blood pressure?

Answer 9

arterioles <100 microns in diameter, residing in the peripheral tissues (e.g., skeletal muscle)

Question 10

the most important mechanism of short-term neural control of blood pressure

Answer 10

arterial baroreceptors

Question 11

Which of the following control mechanisms is most effective in bringing blood pressure back to normal after it has changed?

A. CNS ischemic response
B. Baroreceptors
C. Renal response
D. Chemoreceptors

Answer 11

C. This response takes longer (days instead of seconds) but is most effective in bringing blood pressure back to normal.

Question 12

True or false: most people with hypertension have normal levels of renin.

Answer 12

True. It is not known why this is.

Question 13

the ____ receptor for angiotensin II mediates pressor responses through vasoconstriction, mitogenesis, and aldosterone release.

Answer 13

AT1

Question 14

this is a potent vasodilator that also has an inflammatory effect whose metabolism is dependent on angiotensin converting enzyme (ACE)

Answer 14

bradykinin

Question 15

how does hypertension lead to loss of NO-dependent responses?

Answer 15

people with hypertension have increased levels of Ang II, which contributes to an increase in the formation of oxygen radicals. these radicals bind to NO, inactivating it and leading to a reduction in NO-dependent responses (decreased cGMP –> decreased relaxation)

Question 16

which of the following is NOT an endothelial derived vasoconstrictor?

A. Thromboxane
B. Endothelin
C. Prostacyclin
D. Angiotensin II

Answer 16

C. Prostacyclin (PGI2) is a vasodilator

Question 17

which of these is NOT a mechanism by which sodium is thought to increase vascular resistance, and hence raise blood pressure?

A. promotes increase in intracellular Ca++
B. increases basal tone of vascular smooth muscle
C. increases contractile response to NE and Ang II
D. increases endothelial permeability
E. increases vessel stiffness and fluid retention

Answer 17

D

Question 18

why are most patients being treated for hypertension on 2 or 3 different drugs?

Answer 18

combination therapy with different classes of antihypertensives have complimentary actions - this requires lower dosing with fewer side effects, leading to greater patient compliance

Question 19

Which of these is NOT a class of antihypertensives as discussed in lecture?

A. Vasodilators
B. Na+ channel blockers
C. Sympatholytics
D. RAS blockers
E. Diuretics

Answer 19

B. Ca++ channel blockers are the other class.

Question 20

class of drug that is used in the treatment of heart failure, and works by decreasing extracellular fluid (initially) and vascular resistance (long-term); major adverse effect is K+ depletion.

Answer 20

diuretics

Question 21

type of diuretic that works by blocking the Na+Cl- symporter, preventing the reabsorption of Na+ in the DCT

Answer 21

thiazide diuretics (chlorothiazide and HCTZ)

Question 22

the diuretic effect of thiazide diuretics is reduced by what class of drugs?

Answer 22

NSAIDs

Question 23

what condition afflicting post-menopausal women may be improved by use of thiazide diuretics?

Answer 23

osteoporosis; thiazide diuretics decrease Ca2+ excretion

Question 24

Which of these is NOT a side effect associated with thaizide diuretics?

A. reduces calcium excretion
B. increases potassium excretion
C. decreases uric acid excretion (may lead to gout)
D. cross-reacitivty with sulfonamides
E. deafness

Answer 24

E. Deafness is a serious adverse effect of loop diuretics.

Question 25

Which of these statements regarding loop diuretics is FALSE?

A. More effective than thiazides at reducing BP
B. Used in the treatment of edema
C. Block Na+/K+/2Cl- transporter
D. Site of action is loop of henle
E. Increase Ca2+ excretion

Answer 25

A. While loop diuretics are considered to be the most effective in the treatment of edema, they are not as good at reducing blood pressure, for reasons unknown.

Question 26

Name 3 loop diuretics

Answer 26

furosemide, bumetanide, torsemide

Question 27

name the class of diuretics:

• site of action: collecting duct
• mechanism of action: inhibits Na+ and H2O reabsorption, inhibits K+ excretion (may result in hyperkalemia)
• treatment: resistant HTN and CHF with HTN

Answer 27

aldosterone receptor blockers (spironolactone and eplerenone)

Question 28

class of drugs that include triamterene and amiloride, used in combination therapy and work by blocking Na+ channels in the late distal tubule and collecting duct

Answer 28

potassium sparing diuretics

Question 29

What are the 3 target levels of RAS inhibitors (ie, where do they work?)

Answer 29

1. beta blockers block renin release from the kidney
2. ace inhibitors prevent conversion of ang I –> ang II
3. AT-1 receptor blockers

Question 30

Which of these is NOT an action of angiotensin II?

A. Stimulate secretion of aldosterone and ADH
B. Stimulate thirst
C. Vasoconstriction of peripheral vessels
D. Increased sympathetic activity
E. Positive feedback on renin release

Answer 30

E. Angiotensin II actually inhibits, in a negative feedback fashion, the release of renin from the kidneys.

Question 31

term used for the phenomenon of loss of feedback inhibition of aldosterone over time, leading to increase in renin and increased salt and water retention

Answer 31

aldosterone escape

Question 32

class of drugs that is very effective for treatment of mild-moderate hypertension, whose adverse effects include dry cough, hyperkalemia, angioedema, and hypotension

Answer 32

ACE inhibitors (lisinopril, catalopril, enalapril)

Question 33

how do ace inhibitors cause hyperkalemia?

Answer 33

Suppression of angiotensin II leads to a decrease in aldosterone levels. Since aldosterone is responsible for increasing the excretion of potassium, ACE inhibitors can cause retention of potassium

Question 34

enalapril, lisinopril, fosinopril

Answer 34

ace inhibitors

Question 35

class of drugs used to treat hypertension and CHF, who work by causing vasodilation and increased Na+/H2O excretion, thereby reducing plasma volume; advantages include less incidence of cough

Answer 35

ARBs (angiotensin receptor blockers); losartan, valsartan

Question 36

the only drug approved for sale that mediates a direct inhibition of renin, leading to increased renin plasma levels but decreased renin activity

Answer 36

aliskiren

Question 37

this class of drugs blocks voltage gated ion channels and causes relaxation of the vascular smooth muscle and decreased MAP; may increase sympathetic activity so best used in combination with beta blockers

Answer 37

calcium channel blockers (verapamil and diltiazem)

Question 38

specific vascular smooth muscle selective agents that seem to be better for hypertension treatment

Answer 38

nifedipine, nicardipine, amlodipine (calcium channel blockers)

Question 39

class of drugs recommended for use in african americans with hypertension, specifically, dihyrdropyridines; adverse effects include headaches, gingivitis, and arrhythmia

Answer 39

calcium channel blockers

Question 40

nonselective beta blockers that are contraindicated in asthmatics, and may cause sleep disorders (nightmares, insomnia) as well as promote type II diabetes

Answer 40

metoprolol, atenolol

Question 41

the only nonselective alpha/beta blocker indicated for the treatment of heart failure

Answer 41

carvedilol

Question 42

drug that inhibits NE reuptake into storage terminal –> depletion of NE over time, and is best used in low dose combination with thiazide diuretics

Answer 42

reserpine

Question 43

agonists that stimulate brainstem alpha-2 adrenergic receptors to decrease sympathetic outflow, and whose adverse affects include dry mouth, sedation, depression and rebound HTN

Answer 43

clonidine (for resistant hypertenions) and alpha-methyldopa (for pregnancy-induced hypertension)

Question 44

drug with unclear mechanism that is thought to reduce intracellular calcium while decreasing peripheral resistance and is best used in combination with a beta blocker and diuretic; may have lupus-like side effect

Answer 44

hydralazine (vasodilator)

Question 45

K+ channel activator that preferentially acts on arterioles to relax vascular smooth muscle, and is used to treat resistant hypertension in combination with a diuretic and beta blocker; contraindicated in heart failure due to adverse effect of fluid retention

Answer 45

minoxidil (rogaine)

Question 46

drug used in surgery and hypertensive emergencies to promote hypotension, through the generation of NO and reduction of preload; adverse effects include rapid decrease in MAP and (rarely) cyanide accumulation

Answer 46

nitroprusside

Question 47

drug with preferential action on veins to decrease preload and is used in surgery and hypertensive emergencies; has short duration of action and may result in headache

Answer 47

nitroglycerin

Question 48

drug that is used in the treatment of pulmonary HTN and works by counteracting TXA2 (inhibits platelet aggregation) and vasodilation via cAMP; must be infused continuously due to very short half life

Answer 48

epoprostenol

Question 49

non-selective endothelin (ET) receptor blocker _____, and ETa receptor blocker ______ are used in the treatment of pulmonary HTN but may result in liver damage and birth defects

Answer 49

bosentan; ambrisentan

Question 50

new drug that is a direct stimulator of guanylyl cyclase, not effective in systemic HTN but good for pulmonary HTN when used with ET receptor blockers

Answer 50

riociguat