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Body Systems > L10 Blood Pressure > Flashcards

L10 Blood Pressure Flashcards

1
Q

What is Poiseuille’s law?

A

Resistance is proportional to the length of a vessel and the inverse of the radius to the power four.

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2
Q

What is Laplace’s Law?

A

Pressure is proportional to the radius and innverse of the wall thickness. For a given vessel radius and internal pressure, a spherical vessel will have half the wall tension of a cylindrical vessel.

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3
Q

How is angiotensin II produced?

A

The sympathetic nervous system causes the liver to produce angiotensinogen. Angiotensinogen is converted to angiotensin I via renin, produced in the kidneys. ACE, produced by the lungs, converted angiotensin I to angiotensin II.

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4
Q

What is the role of natriuretic peptides?

A

Natriuretic peptide cause excretion of sodium in the urine.
ANP - Arterial Natriuretic peptide
BNP - Brain Natriuretic peptide.

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5
Q

Which natriuretic peptide can be used to investigate an MI?

A

BNP

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6
Q

What is the definition of hypertension?

A

Defined as SBP ≥ 140mmHg and/or DBP ≥ 90mmHg

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7
Q

What are the two types of hypertension?

A

Primary hypertension (90%):
Over-activation of physiological mechanisms:
- Age related decrease in sensitivity of baroreceptors
- Age related vascular calcification
- Idiopathic

Secondary hypertension:
As a result of another pathology e.g. reno-vasucular disease, real parenchymal disease, Conn’s syndrome, Cushing’s syndrome, coarctation of the aorta, tumours and pre-eclampsia.

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8
Q

How is hypertension classified?

A

Class I - Average of 135/85 and above
Class II - 150/95 and above
Class III - 180/110 and above

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9
Q

What are the complications of hypertension?

A
  • Left ventricular hypertrophy
  • Diastolic dysfunction - - There is an impaired ability for the heart to fill in diastole. In diastolic dysfunction, the heart cannot relax fast enough after each beat and fill with blood. This will mean the heart isn’t pumping anything.
  • Vascular remodelling
  • Hypertensive nephropathy - There is thickening of the renal arteriole narrowing of the lumen leading to ischaemia. There is tubular atrophy of interstitial fibrosis. There is damage to the glomeruli causing haemopreoteninuria as the mesh of capillaries is lost.
  • Hypertensive retinopathy
  • Pulmonary congestion leading to oedema
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10
Q

What investigations are done in the test of hypertension?

A
  • Look for secondary causes
  • Assess for organ damage

Tests:

  • Fundoscopy
  • FBC
  • kidney function - assess for haemoproteinuria, hypernatremia, urea
  • Lipid and glucose level and other CVD risk factors
  • ECG - large QRS complexes can signify ventricular hypertrophy
  • ECHO for atrial dilation
  • MRI for kidney tumours
  • Plasma renin-aldosterone: Conn’s syndrome
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11
Q

What are the causes of hypertension?

A
  • High salt diet
  • Obesity
  • Genetics
  • Alcohol
  • Atherosclerosis is the largest cause
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12
Q

What are lifestyle changes to treat hypertension?

A
  • Exercise and change the diet by reducing salt intact and alcohol. Can also suggest stop smoking to reduce atherosclerosis. With hypertension, stopping smoking will reduce the risk of heart failure. Losing weight means the blood pressure drops. Lipid control.
    Treat underlying secondary cause.
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13
Q

What pharmacological strategies are there to treat hypertension?

A

A - ACE inhibitors and Angiotensin Receptor Blockers

C - Calcium Channel Blocker

D - Diuretics

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14
Q

What are the two types of calcium channel blockers?

A 
Dihydropyridine (Amlodipine - only cause vasodilation) and non-dihydropyridine - this class can effect heart rate (negatively chronotropic)  and force of contraction (negatively inotropic).
All cause vasodilation. This leads to reduced peripheral resistance (and lower stroke volume in the case of non-dihydropyridines).
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15
Q

What are common diuretics?

A

Bendroflumethiazide and furosemide

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16
Q

Give an example of a beta blocker.

A

Bisproplol and Propanolol

17
Q

How does Chlopidogrel work?

A

The active metabolite of clopidogrel selectively inhibits the binding of adenosine diphosphate (ADP) to its platelet P2Y12 receptor and the subsequent ADP-mediated activation of the glycoprotein GPIIb/IIIa complex, thereby inhibiting platelet aggregation. This action is irreversible.

18
Q

How does Spironolactone work?

A

Spironolactone aldosterone antagonist. Mineralocorticoid receptor antagonist - are diuretic drugs that work primarily on the kidneys. They decrease sodium reabsorption which leads to increased water excretion by the kidneys.

19
Q

What steps are used to decide how to treat hypertension?

A

Type II Diabetes = A -> A + C or D -> A + C + D -> Spironolactone or alpha blocker or beta blocker

<55 years = A -> A + C or D -> A + C + D -> Spironolactone or alpha blocker or beta blocker

> 55 years or Black patient = C -> A + C or D -> A + C + D -> Spironolactone or alpha blocker or beta blocker

20
Q

Which drugs are used in specific cases of cardiovascular disease?

A

• Heart Failure → ACEi/A2RB or Beta-blocker
• Angina → Beta-blocker
• Diabetes → ACEi/A2RB
Proteinuria → ACEi/A2RB. These drugs protect the kidneys and so slow the progression to kidney failure.

21
Q

What are contraindications for cardiovascular drugs?

A
  • ACEi/A2RBs → Contraindications in pregnancy as they can lead to birth defects. Also in Bilateral Renal artery sclerosis as it can lead to kidney failure. This is as the ACEi cause vasoconstrictors and so can constrict the narrowed blood vessels too much leading to failure. This is uncommon but you must check kidney function first before prescribing this treatment. They can also lead to hyperkalaemia.
  • B blockers can be a problem in asthma as they cause bronchoconstriction. In 2nd/3rd degree Atrial-ventricular block, slow the heart rate more can cause problems. This can slow the heart rate to the point in stops.
  • CCBs → 2nd/3rd degree AVB (Non-dihydropyridine). Things that slow the heart rate cannot be given to people with an already slow heart rate.
  • Diuretics can lead to hypokalaemia and gout (thiazides)
22
Q

What is the side effect of calcium channel blockers?

A

Oedema

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