L7 Hypertension Flashcards
Explain why Hypertension is such an important condition
- Biggest single contributor to global disease burden and mortality
- Chronic
- Risk factor for CVD
- Asymptomatic
- Expensive (for soceity and individual)
- Treatable
Types of Hypertension?
Types of Hypertension
Systemic hypertension (“hypertension”)
Portal hypertension: increase in blood pressure within the portal venous system in e.g. (cirrhosis of the liver)
Pulmonary hypertension: increase in blood pressure within the right side of the heart and pulmonary arteries (congenital heart disease)
Hypertension defined by what arbitrary cutoff point?
> 140 mmHg typical threshold of hypertension
Diagnosis of Hypertension?
24 Ambulatory testing gold standard -> home testing prefered
Systolic BP increases with age until __________
Systolic BP increases with age until the 8th decade of life
Diastolic BP increases with age until _________
Diastolic BP increases with age until 50yr of age, then flattens or decreases
Normal BP in morning, higher later in day
Masked Hypertension - Normal BP in morning, higher later in day
Pathophysiology of HTN?
Sodium/ Fluid balance - Kidneys key
Peripheral resistance - Increased arterial resistance hallmark of HTN
Genetics - Polygenic
Explain the difference between primary (“essential”) and secondary HTN
Benign vs. Malignanat?
Primary (“essential”): Genetic Cause
Secondary: Acquired due to lifestle
Benign – BP remains stable or rises slowly over years.
Malignant – BP rises rapidly (more likely attributable to a cause)
Causes of Secondary Hypertension
Causes of Secondary HTN
- Oral contraceptives, glucocorticoids
- Primary aldosteronism: Overexcretion from adrenal cortex => increased retention of Na => increased BP
- Renal artery stenosis: decreased blood flow to kidney, thinks BP is low, leads to retention of Na and increased BP
- Obstructive sleep apnea
- Pheochromocytoma: Tumor of adrenal medulla –> increase adrenaline secretion –> hypertension, sweating and anxiety
- Cushing’s syndrome: Excessive secretion of Corticosteroids –> retention of sodium/water –> increased BP
- Coarctation of the Aorta
Renovascular Causes of Hypertension?
Renal artery stenosis: decreased blood flow to kidney, thinks BP is low, leads to retention of Na and increased BP
__________: Overexcretion from adrenal cortex => increased retention of Na => increased BP
Primary aldosteronism: Overexcretion from adrenal cortex => increased retention of Na => increased BP
______________: Tumor of adrenal medulla –> increase adrenaline secretion –> hypertension, sweating and anxiety
Pheochromocytoma:
Tumor of adrenal medulla –> increase adrenaline secretion –> hypertension, sweating and anxiety
______________: Excessive secretion of Corticosteroids –> retention of sodium/water –> increased BP
Cushing’s syndrome:
Excessive secretion of Corticosteroids –> retention of sodium/water –> increased BP
_______________:
Ascending and descending portions of the aorta don’t properly form
=> _______ and improper blood flow downstream
=> Blood pressure_____________________
=> kidneys ____________
=>increased blood pressure
Coarctation of the Aorta:
Ascending and descending portions of the aorta don’t properly form
=> stenosis and improper blood flow downstream
=> Blood pressure downstream of the COARTATION drops
=> kidneys retain more Na
=>increased blood pressure
Pathological changes to Vessels induced by HTN?
Small Vessels
-
Hyaline Arteriosclerosis (arteriolar narrowing)
- Common in BENIGN HTN and diabetes
- Homogenous, pink, hyaline thickening of arteriolar walls
-
Narrowing => Ischemia (often of kidneys )
- Hypertension causes sclerosis and loss of glomeruli in tubules
-
Hyperplastic Arteriosclerosis (thickening of vessel wall)
- Common in MALIGNANT hypertension
- Onion-like thickening of arterial wall
- Hyperplasia and Hypertrophy of VSMC
- Fibrinoid deposits & Necrosis of vessel wall
Large Vessels => accelerates atherosclerosis
_________________________:
- Common in BENIGN HTN and _________
- Homogenous, pink, hyaline thickening of arteriolar walls
- Narrowing=> Ischemia (often of kidneys )
- Causes ______________________
Hyaline Arteriosclerosis (arteriolar narrowing):
- Common in BENIGN HTN and DIABETES
- Homogenous, pink, hyaline thickening of arteriolar walls
-
Narrowing => Ischemia (often of kidneys )
- Causes sclerosis and loss of glomeruli in tubules
_________________________:
- Common in MALIGNANT hypertension
- Onion-like thickening of the arterial wall
- Hyperplasia and Hypertrophy of VSMC
- Fibrinoid deposits & Necrosis of vessel wall
Hyperplastic Arteriosclerosis (thickening of vessel wall)
- Common in MALIGNANT hypertension
- Onion-like thickening of arterial wall
- Hyperplasia and Hypertrophy of VSMC
- Fibrinoid deposits & Necrosis of vessel wal
Complications of Hypertension are Secondary to _________
Complications of Hypertension are Secondary to Vascular Disease
Cardiac Complications of Hypertension?
Cardiac Complications:
Coronary atherosclerosis; Worsened by HTN
Left ventricular hypertrophy: Has to do more work, requires more O2
Left ventricular failure: More O2 required as supply diminished
CNS Complicaitons of Hypertenion?
CNS Complications
Strokes: Hypertension is the most important treatable risk factor in stroke!!!
Cerebral infarction- blockage of artery
Intracerebral Hemorrhage - Bleed damages surrounding tissue
Dementia: Hypertension is the most important modifiable risk factor for the development and progression of cognitive decline and dementia!!!!
Most important treatable risk factor in stroke?
Hypertension
Most important modifiable risk factor for the development and progression of cognitive decline and dementia?
Hypertension
____________ is caused by hemorrhages or exudates (_______) in the eye
Hypertensive Retinopathy is caused by hemorrhages or exudates (fatty deposits) in the eye
What are the main causes of Chronic Kidney Disease?
Hypertension (and diabetes) are the main causes of chronic kidney disease
Benign versus Malignant Nephrosclerosis?
BENIGN Nephrosclerosis:
Characteristics of long-term BENIGN hypertension
Hyaline arteriosclerosis
Kidneys symmetrically atrophic
Granular surface
Glomerular sclerosis
MALIGNANT Nephrosclerosis:
Characteristic of MALIGNANT hypertension
Hyperplastic arteriosclerosis
Kidneys normal sized
Hemorrhages on the surface - Mottled red
Fibrinoid necrosis (necrotizing arteriolitis)
Lifestyle Changes to reduce Hypertension
Lifestyle changes
Healthy dietary pattern
Reduced sodium intake
Reduced body fat
Increased exercise
Drug Therapy for Hypertension
Angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure by relaxing blood vessels
Calcium channel blockers keep calcium from entering the muscle cells of the heart and blood vessels
Diuretics flush excess water and salt from the body through urine
Beta-blockers make heart beat more slowly and with less force
