Hypertension Patho

Question 1

Does goal BP = ideal BP?

Answer 1

No

Question 2

BP = ….

Answer 2

CO * PVR

CO - Cardiac output (SV * HR)
SV - stroke volume
HR - heart rate
PVR - peripheral vascular resistance

Question 3

PVR Factors

Answer 3

• vascular tone

- resistance arteriole diameter

Question 4

Cardiac Output Factors

Answer 4

• Blood volume - renal Na+/H2O absorption

- Symp. NS - cardiac HR and contractility

Question 5

Blood Volume

Answer 5

• Regulates CO
• long term regulation controlled by kidneys
• Hypertension clinics are run by nephrologists
• Dehydration: decreases ECF, decreases BP, decreases Na+/H2O excretion
• Too much salt: opposite effects

Question 6

Glomerulus

Answer 6

• controls blood volume by regulating Na+/H2O exretion
• Macula densa cells - regulations Na+/H2O excretion
• Juxtaglomerular cells - regulate aldosterone which effects Na+/H2O retention
• Ascending loop of Henle and distal tubule are CRITICAL segments for Na+/H2O absorption, therefore critical for BV
• Ascending loop - large amounts of sodium, distal tubule - modest amounts of sodium
• More dietary Na+ increases your BP

Question 7

Arteriolar Diameter

Answer 7

• Regulates PVR
• resistance vessels
• Contriction/dilation regulates peripheral bascular resistance
• Increase in endogenous vasoconstrictors increases BP
• Decrease in endogenous vasodilators increases BP

Question 8

Endogenous Vasoconstrictors

Answer 8

• NE
• Epi
• Angiotensin II
• Thomboxane A2
• Endothelin-1
• Serotonin

Question 9

Endogenous Vasodilators

Answer 9

• Prostacyclin
• Bradykinin
• NO
• EDHF

Question 10

Renin-Angiotensin-Aldosterone System

Answer 10

• *OFTEN ACTIVATED IN HTN PATIENTS**
• Liver - releases angiotensinogen into blood vessels
• Renin from the kidney interacts with it and make Angiotensin I
• ACE from lungs interacts with Angiotensin I and makes Angiotensin II
• Angiotensin II acts on AT Receptors and causes vasoconstrictions and the release of aldosterone
• Aldosterone then causes sodium retention (increases BP overall)

Question 11

Which hypertensive drugs are less effective in black patients?

Answer 11

• ARBs

- ACE-Is

Question 12

SNS

Answer 12

-Activation increases BP by increasing HR and contractility force

Question 13

Are body systems highly integrated??

Answer 13

YES

• Dramatic increases in vasodilation activates the SNS
• Dramatic increases in vasoconstriction increases Na+/H2O excretion

Question 14

Secondary HTN

Answer 14

• Needs workup for secondary causes when newly diagnosed for HT
• Renal artery stenosis, adrenal disease, medication
• Treating secondary causes fixes the hypertension

Question 15

Promoting Na/H2O Excretion

Answer 15

• Possible HTN drug target
• Block Na+ absorption in renal excretion
• Diuretics

Question 16

Blocking Vasoconstriction/Stimulating Vasodilation

Answer 16

• Possible HTN drug target
• Blocks calcium channels on anterior, smooth muscle
• Block Ang II synthesis/signaling
• Block alpha-1 receptors
• Stimulate NO release/signaling

Question 17

Block SNS

Answer 17

• Possible HTN drug target
• Block Alpha1/Beta1 receptors (one or both)
• Blocks sympathetic outflow in CNS