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CVS > L10 - Blood Pressure Control > Flashcards

L10 - Blood Pressure Control Flashcards

1
Q

What is hypertension?

A

A sustained increase in blood pressure

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2
Q

What is the ideal range of blood pressure?

A

90/60mmHg - 120/80mmHg

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3
Q

Numerically Devine

a) stage 1 hypertension
b) stage 2
c) severe hypertension

A

a) greater than or equal to 140/90mmHg OR greater than or equal to 135/85mmHg ABPM average
b) greater than or equal to 160/100mmHg OR greater than or equal to 150/95mmHg ABPM average
c) greater than or equal to either 180 systolic or 110 diastolic

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4
Q

Primary hypertension is when the cause of the hypertension is unknown/can’t be narrowed down to a single factor, what percentage of hypertension cases does primary hypertension account for?

A

95%

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5
Q

Give some examples of secondary hypertension causes

A

Cushing syndrome/hyperaldosteronism/chronic renal disease/renovascular disease

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6
Q

What can high blood pressure lead to?

A

MI/heart failure/stroke/renal failure/retinopathy

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7
Q

High blood pressure is the 3rd biggest risk factors for premature death in England after what?

A

Smoking and poor diet

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8
Q

Hypertension exerts problems via two main ways one being an increased afterload on the heart as a result of increased peripheral resistance, what’s the other?

A

Vascular (arterial) damage

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9
Q

If hypertension is diagnosed what 5 areas of the body should be clinically checked regularly by your GP

A 
Eyes
Brain
Heart
Arteries
Kidneys ((e.g. protein in urine)
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10
Q

MABP =?

A

CO X TPR

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11
Q

CO = SV X ?

A

HR

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12
Q

What is the short term regulation of BP?

A

The baroceptor reflex

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13
Q

Long term regulation of BP is under the control of neurohumoral responses such as…..

A

The renin/angiotensin system
Sympathetic NS
ADH
Atrial natriuretic peptide (ANP)

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14
Q

Low blood pressure stimulates the release of renin mainly at the level of the kidneys, what cells release renin?

A

Juxtaglomerular cells

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15
Q

Describe the three factors affecting renin release from juxtoglomerular cells

A

Low plasma sodium
Sympathetic stimulation of juxtoglomerular cells
Decreased renal perfusion

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16
Q

Explain how the sympathetic nervous system has an impact on long term BP regulation

A

High levels of sympathetic stimulation
Causes vasoconstriction of arterioles (chronic short term regulation via this) causes a reduction in GFR and thus Na retention, vasoconstriction also stimulates renin-angiotensin system

17
Q

How is ADH involved in long term blood pressure regulation

A

Increases water retention via upregulation of AQP2 and also increases Na retention

Activated by plasma osmolarity and severe hypovolaemia

18
Q

Describe the actions of ANP and how it’s release is stimulated

A

Causes vasodilation of afferent arteriolar of kidney:
Increases blood flow -> increases GFR -> inhibits sodium reabsorption so sodium is lost in urine

Stimulated by atrial stretch. Acts to decrease BP, if circulating volume is low ANP release is inhibited

19
Q

Prostaglandins are local vasodilators, they work by enhancing GFR and reducing Na reabsorption, they are useful when levels of what are high?

A

Angiotensin II

20
Q

Dopamine is made in the kidney from circulating levels of L-DOPA, what action does it have here?

A

Vasodilation and increasing GFR

21
Q

Explain how renovascular disease causes a long term increase in blood pressure

A

Occlusion of the renal artery causes a fall in kidney perfusion pressure -> decreased perfusion to kidney -> activation of renin-angiotensin system -> vasoconstriction

22
Q

How does

a) renal parenchyma disease
b) Cushing syndrome cause long term hypertension?

A

a) inadequate glomerular filtration -> activation of renin-angiotensin system
b) excess cortisol production -> acts on aldosterone receptors

23
Q

Give some non-pharmacological approaches to treating hypertension

A

Exercise
Diet
Reduced Na+ intake
Reduced alcohol intake

24
Q

Give an example of of an ACE inhibitor and an angiotensin receptor blocker

A

ACE inhibitor - ramipril

ARB - losartan

25
Q

Give some examples of medication that treat hypertension

A

ACEI
ARB’s
Dihidyropyridine or ‘L type ca channel blockers’ (nifedipine)
Alpha 1 receptor blockers at SNS level (doxazosin)
Thiazides diuretics
Beta blockers explanation - target B1 receptors in heart, reduce hr only used in situations with MI as well

26
Q

What are the five major effects of activation of the renin-angiotensin-aldosterone system?

A

Angiotensin I and II - stimulate sodium reabsorption/vasocontstriction/release of ADH/release of NA
Aldosterone - increase in sodium reabsorption and thus fluid retention

CVS (22 decks)

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