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BMS242 CVS Phys > L16 - Hypertension > Flashcards

L16 - Hypertension Flashcards

1
Q

How many deaths per year in the US due to hypertension

A

One million

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2
Q

How does BP vary with age

A

Increases

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3
Q

How does BP vary with gender, what causes this?

A

Higher in males - due to presence of testosterone

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4
Q

Normal diastolic pressure

A

85

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5
Q

What would be considered a high normal diastolic pressure

A

85-89

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6
Q

What would be considered mild hypertension as a diastolic pressure

A

90-104

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7
Q

What would be considered moderate hypetension as a diastolic pressure

A

105-114

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8
Q

What diastolic pressure would be considered severe hypertension

A

Greater than 114

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9
Q

What systolic pressure would be considered normal

A

140 or below

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10
Q

What systolic pressure/s would be considered to be borderline systolic hypertension

A

140-159

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11
Q

What systolic pressure/s would be considered to be isolated systolic hypertension

A

Greater than 160

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12
Q

What do more recent BP guidelines suggest

A

BP should be kept as low as possible - but so that perfusion throughout the body can be maintained

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13
Q

What are the two types of hypertension

A

Essential hypertension

Secondary hypertension

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14
Q

Essential hypertnesion

A

Many risk factors but no clear cause

Can be spontaneous

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15
Q

Secondary hypertension

A

Consequence of a clinical condition

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16
Q

MABP is proportional to

A

CO x TPR

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17
Q

How does CO vary with age?

Why is this the case

A

Decreases

The heart is a mechanical pump - this will have a finite number of beats

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18
Q

How does TPR vary with age

Give examples of what causes this variation

A

Increases

Arteriosclerosis - stiffening of the vessels

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19
Q

What are the likely causes of essential hypertension

A

Cardiac dysfunction
Vessel abnormalities
Kidney dysfunction

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20
Q

Explain how kidney dysfunction could lead to essential hypertension

A

In the long term - unable to control total blood volume
Kidneys will naturally vary with age
Known as volume induced hypertnesion

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21
Q

Explain how cardiac dysfunction could lead to essential hypertension

A

Increased repsonse to stress and catecholamines, also increase sensitivity to cortisol
Leads to vessel constriction

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22
Q

What sorts of vessel abnormalities may lead to essential hypertension

A

Sympathetic NS abnormalities
Abnormalities of local factors
Smooth muscle hypertrophy

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23
Q

How may smooth muscle hypertrophy lead to EH - what is the name given for the process

A

Smooth muscle is made to work harder
Any further contractions will be more powerful - causing greater constriction
Leads to VASCULAR REMODELLING

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24
Q

Why is hypertension classed as a syndrome

A

Syndrome due to being caused by many different factors

25
Q

EH is

A

Familial

26
Q

Is EH genetic - evidence

A

Corrleation between twin studies

27
Q

What races are of an increased EH risk

A

African-Caribbean

28
Q

What are some known environmental risk factors for EH

A

Diet and obesity (metabilic syndrome)
Adopting a western lifestyle
Salt intake
Vit D deff syndrome

29
Q

What is metabolic syndrome

A

Collection of symptoms which can lead to type 2 diabetes mellitus

30
Q

What % of the population has a predisposition to Eh

A

30-50%

31
Q

What are the common polymorphisms that contribute to EH

A 
Angiotensinogen 
ENaC (epithelial Na channel)
32
Q

What converts angiotensionogen to angiotensin I

A

Renin

33
Q

What converts angiotensin I to angiotensin II

A

ACE

34
Q

What is the ‘case against salt’

A

In human studies reduction of salt by 3g/day leads to reduced MABP of 5 mmHg
This is equivilant to drug therapy which reduces strokes

35
Q

What was the problem with low salt (KCl)

A

Must be reduction in NaCl

36
Q

What does aldosterone bind to what is its effect

A

Binds to mineralocorticoid R

Increases the reabsorpiton of Na

37
Q

What are three potential causes of secondary hypertension

A

Renal disease
Renal artery stenosis
Hormone inbalance

38
Q

How might renal disease lead to secondary hypertension

A

Nephron fucntion imparied
Blood volume and BP increases
More damage and kidney failure
Viscious circle

39
Q

How might renal artery stenosis lead to secondary hypertension

A

Narrowing of the arteries
Caused by atheroscleosis
Increased renin production and increased BP

40
Q

How might a hormone imbalance lead to secondary hypertension

A

Aldosterone increased the NA reabsorption leads to inc BP

If mini adrenal tumours ==> would change ammount of aldosterone produced

41
Q

What is ateriosclerosis

A

Arteries become less compliant with age - vascular remodelling

42
Q

What is arteriosclerosis

A

Deposition of cholesterol plaques reduced the diameter of the lumen

43
Q

Symptoms of secondary hypertension

A

FLusing, sweating and blurred vission
USUALLY A-SYMPTOMATIC
Arterio/atherosclerosis

44
Q

What is an aeurysm

Where is a common place for them to occur

A

Balooning of the arteries

Descending aorta

45
Q

What are the typical sizes of arteries

A

2.5-8cm

46
Q

Why can strokes present as a consequence of secondary hypertension

A

At high systolic pressure could burst the arteiries which enter the brain

47
Q

Describe how necrotic tissue which has undergone infarction would be recognised
How would this interfere with the normal conduction of the heart

A

Would interfere with the conducting systems of the heart

48
Q

How can retinal damage be used to diagnose secondary hypertension

A 
Eye is the only place where blood vessels can be seen non invasively 
Small haemhorrages (spots) of hard and soft exudates would be indicative of hypertension
49
Q

Give some non pharmacological treatments for secondary hypertension

A 
Weight loss 
Diet (decrease in salt alcohol and caffine)
Exercise
Stopping Smoking 
Relaxation
50
Q

What classes of drug may be used to treat secondary hypertension

A

Diuretics
Sympatholytics
Ca channel blockers
Drugs which interfere with the RAA sysytem

51
Q

RAA system

A

Renin - angiotensin - aldosterone

52
Q

Explain how diuretics may be used to treat secondary hypertension

A

Thiazdes would increase secretion of Na and Cl lowering the total blood volume

53
Q

Explain how sympatholytics (two classes) may be used to treat secondary hypertension

A

Alpha blockers
Clonidine - decrease sympathetic outflow to reduce the vascular tone
Prazoin - relaxes the smooth muscle to cause a fall in TPR

Beta blockers
Propanolol - To decrease HR and decrease contractility

54
Q

Describe how Ca channel blockers (BROAD SPECTRUM) may be used to treat secondary hypertension

A

Minoxidal

Decreases the contractility and the vascular tone

55
Q

What is another use for minoxidal

A

Topical application for hair growth

56
Q

Describe how selective Ca blockers may be used to treat hypertension

A

Manidipine

Relaxation of the vascualr smooth muscle H

57
Q

How may ACE inhibitors be used to treat hypertension

A

E.g. moexipril
Inhibition of vascular remodelling
Prevention of the proliferation of the cells of the smooth muscle

58
Q

Unwanted side effect of using ACE inhibitors

A

Bradykinin cough

59
Q

Aside from ACE inhibitors what is a common treatment for secondary hypertension

A

AGII receptor blockers

BMS242 CVS Phys (12 decks)

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