Hypertension - Quiz 4 Flashcards
what is the most common disease-related reason for visits for primary care providers
- hypertension
what is the number one attribute risk for death worldwide
- suboptimal BP
highest countries for DALYs by systolic blood pressure level
- china
- india
normal BP
<120/<80
elevated BP
- 120-129
- <80
stage 1 htn
- 130-139
- 80-89
stage 2 htn
- > 140
- >90
how many BP measurements should be used
- at least 2
when making clinical decisions based on at-home BP measurements, how many days should be used
- at least 3
systolic BP increases with
greater in which race
- age
- African Americans
factors included in framingham heart study
- systolic BP
- cholesterol/HDL
- diabetes
- cigarettes
- left ventricular hypertrophy
important systems in blood pressure regulation
- kidneys
- SNS
- RAAS
hemodynamic progression of hypertension
- early in life it’s cardiac output
- later in life its peripheral resistance
tubular model of the arterial system
- vascular stiffness contributes to systolic hypertension in the elderly
essential (primary) hypertension cause of hypertension in what percent of patients
- 90%
cardiovascular structures affected by HTN
- heart
- large and medium arteries
- small arteries and arterioles (microvasculature)
organs most at risk due to hypertension
- heart
- arteries
- brain
- kidney
pathogenesis of left ventricular hypertrophy
- increased afterload
- increased LV work
- hypertrophy of LV myocytes
- concentric LV hypertrophy with increased stiffness
left ventricular hypertrophy on the EKG
- taller R waves in leftward leads (I, AVL, V6)
- deeper S waves in rightward leads (V1, V3)
- downsloping ST depression
- T wave inversions
S wave in V1 and R wave in V5 (or V6) measurement in left ventricular hypertrophy
- > 35 mm
R wave in AVL measurement in left ventricular hypertrophy
> 11 mm
R wave in lead I measurement in left ventricular hypertrophy
> 15 mm
S wave in V3 and R in AVL measurement in left ventricular hypertrophy
> 20 mm (women)
> 28 mm (men)
HTN effects on large-medium arteries
- accelerated atherosclerosis
complications of accelerated atherosclerosis
- MI
- stroke/brain infarct
- aortic aneurysm
Chronic HTN effects on microvasculature - pathology
- thickened vessel wall
- stenotic lumen
pathogenesis of chronic HTN in small arteries
- adapt
- wall thickens with increased elastin and increased collagen
- benign arteriosclerosis
pathogenesis of chronic HTN in arteriole
- adapt +/- injury
- wall thickened with increased collagen and plasma proteins
- benign arteriolosclerosis
- hyaline arteriolosclerosis
complications of stenotic lumen
- ischemia to tissues downstream
organs affected by downstream ischemia
- kidney (renal failure) -> benign nephrosclerosis
- retina
pathology of severe, acute htn affects on microvasculature
- thickened vessel wall
- stenotic lumen
pathogenesis of severe, acute htn in small arteries and arterioles
- adapt
- endothelial injury
adaption of small arteries and arterioles in severe, acute htn
- wall thickens with increased layers of smooth muscle cells
= onion skinning
endothelial injury of small arteries and arterioles in severe, acute htn
- necrotic wall thickened with fibrinoid necrosis
- insudated plasma proteins
- +/- thrombus
SBP reduction of weight reduction
- 10 mmHg
SBP reduction of adoption of DASH diet
- 11 mmHg
most patients with hypertension should have BP measurements done where
- also outside of the clinic
there is a _____ between BP and cardiovascular risk
- continuous, graded relationship
what contributes to high BP
- increased cardiac output
- elevated peripheral resistance
- vascular stiffness
important end-organ manifestations of hypertension
- heart failure
- myocardial infarction
- stroke
- renal failure
biggest ways in lowering BP
- weight loss
- adoption of DASH diet
- dietary sodium restriction
- physical activity
- moderation of alcohol intake
