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CVS > L15 - Hypertension > Flashcards

L15 - Hypertension Flashcards

1
Q

What does blood pressure increase naturally with?

A

Age and in males

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2
Q

What are the normal blood pressures during diastole?

A 
Normal BP - <85
High normal BP – 85-89
Mild hypertension – 90-104
Moderate hypertension – 105-114
Severe hypertension - >114
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3
Q

What are the normal blood pressures during systole?

A

Normal BP - <140
Systolic hypertension – 140-159
Isolate systolic hypertension - >160

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4
Q

How do you calculate mean arterial blood pressure?

A

Mean arterial blood pressure = cardiac output x total peripheral resistance
Cardiac output decreases with age
Total peripheral resistance increases with age – arteries stiffen

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5
Q

What are the symptoms of essential hypertension?

A

Cardiac dysfunction
Vessel abnormalities
Kidney dysfunction

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6
Q

What is cardiac dysfunction? - essential hypertension

A

Have increased response to stress and catecholamines

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7
Q

What are vessel abnormalities? - essential hypertension

A 
Sympathetic nervous system abnormalities 
Local factors 
- Low nitric oxide (EDRF)
- Smooth muscle ion channel defects 
Muscle hypertrophy and rigidity
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8
Q

What is kidney dysfunction? - essential hypertension

A

Issues controlling volume – induced hypertension

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9
Q

What are the genetic factor of essential hypertension?

A

30-50% of population have a genetic predisposition
5 different genes - best evidence for polymorphisms in
- Angiotensinogen
- ENaC
Varies with race
- Higher among African-Caribbean

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10
Q

What are the environmental risk factors of essential hypertension?

A

Diet (high salt) and obesity (metabolic syndrome)
Western lifestyle
Vitamin D deficiency

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11
Q

What clinical conditions can secondary hypertension be the consequence of?

A

Renal disease
Renal artery stenosis
Hormone imbalance

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12
Q

Secondary hypertension - renal disease

A

Nephron function impaired
Blood volume and blood pressure increase
Leads to more damage and kidney failure

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13
Q

Secondary hypertension - renal artery stenosis

A

Narrowing of renal arteries

Renin production and increased blood pressure

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14
Q

Secondary hypertension - hormone imbalance

A

Aldosterone increases Na and increased blood pressure

Mini adrenal tumours

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15
Q

What is the link between high salt and hypertension?

A

Single mutation in blood pressure diseases increases or decreases HIT Na uptake

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16
Q

What is the link between high salt and hypertension? - animal and human models

A

Animal studies
- Models such as Chimpanzees
Human studies
- Reduce salt by 3g/day
- Reduced mean arterial blood pressure by 5mm Hg
- Equivalent to a drug that reduces strokes

17
Q

What are the consequences of hypertension?

A

Flushing and sweating
Blurred vision
Arteriosclerosis - hardening of the arteries
Atherosclerosis - deposition of cholesterol plaques
Aneurysms – aortic diameter increases by 2-8 cm
Stroke - high systolic with bleeding or thrombosis
Myocardial infarction
Retinal damage – hypertensive retinopathy
- Hard to tell difference between arterioles and venules so fundoscopic examination inconclusive

18
Q

What are the 4 different treatments for hypertension?

A

Non-pharmacological
Pharmacological
RAA system
Dual approach

19
Q

Treatments for hypertension - non pharmalogical

A 
Weight loss 
Exercise 
Diet – salt, alcohol, caffeine  
Smoking 
Relaxation
20
Q

Treatments for hypertension - pharmalogical - what are the 3 types?

A

Diuretics
Sympatholytics
Ca channel blockers

21
Q

Treatments for hypertension - diuretics

A

Thiazides – increase Na and Cl excretion

22
Q

Treatments for hypertension - sympatholytics

A

Alpha blockers
- Clonidine - decreases CNS sympathetic output
- Prazosin – relaxes smooth muscle and decreases total peripheral resistance
Beta blockers
- Propranolol – decreases heart rate and contractility

23
Q

Treatments for hypertension - Ca channel blockers

A 
Broad spectrum
- Minoxidil – decreases cardiac contractility and vascular muscle 
Selective 
- Manidipine 
- Vascular muscle
24
Q

Treatments for hypertension - RAA system

A

ACE inhibitors – moexipril

Angiotensin II receptor blockers – sartan family

25
Q

Treatments for hypertension - dual approach

A

Diuretic and something else

CVS (15 decks)

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