Lecture 13

Question 1

Characteristics of Hypertension

Answer 1

Increased cardiac output
Increased sympathetic nerve activity
Increase in angiotensin II and aldosterone levels
Impairment of renal-pressure natriuresis mechanism
Inadequate secretion of salt and water

Question 2

Primary Hypertension (Essential Hypertension)

Answer 2

Hypertension of unknown origin; represents 90-95% of hypertension; caused by:

Weight gain, resulting in - increased cardiac output, increased sympathetic nerve activity, increased angiotensin II and aldosterone levels, and impaired renal-pressure natriuresis mechanism

Sedentary life style

Question 3

Secondary Hypertension

Answer 3

Hypertension second to some other cause, such as:

Tumor affecting renin-secreting juxtaglomerular cells, renal artery constriction, coarctation of the aorta, preeclampsia, neurogenic hypertension, genetic causes

Question 4

Factors Contributing to Hypertension

Answer 4

Genetic factors, other single-gene disorders that alter sodium reabsorption by the kidneys, genetic variants in the renin-angiotensin system, stress, obesity, smoking, physical inactivity, heavy consumption of salt

Question 5

Factors that Decrease Peripheral Resistance (Vessel Dilation) leading to Decreased Blood Pressure

Answer 5

Increased production of nitric oxide
Increased release of prostacyclin
Increased release of kinins
Increase in atrionatriuretic peptide (ANP)
Decreased neural factors (beta-adrenergic)

Question 6

Factors that Decrease Cardiac Output leading to Decreased Blood Pressure

Answer 6

Decreased blood volume
Decreased heart rate
Decreased contractility

Question 7

Factors that Increase Cardiac Output leading to Increased Blood Pressure

Answer 7

Increased heart rate
Increased contraction
Increased blood volume (due to aldosterone)

Question 8

Factors that Increase Peripheral Resistance leading to Increased Blood Pressure

Answer 8

Increased angiotensin II
Increased catecholamines
Increased thromboxane
Increased neural factors (alpha-adrenergic)

Question 9

Renal Causes of Hypertension

Answer 9

Chronic renal disease
Renal artery stenosis
Renin-producing tumors
Acute glomerulonephritis
Polycystic disease
Renal vasculitis

Question 10

Endocrine Causes of Hypertension

Answer 10

Cushing syndrome (adrenocortical hyperfunction), exogenous hormones (glucocorticoids, estrogen), pheochromocytoma, acromegaly, hypothyroidism (myxedema), hyperthyroidism (thyrotoxicosis), pregnancy induced

Question 11

Cardiovascular Causes of Hypertension

Answer 11

Coarctation of the aorta, polyarteritis nodosa, increased intravascular volume, rigidity of the aorta, increased cardiac output

Question 12

Neurologic Causes of Hypertension

Answer 12

Psychogenic, increased intracranial pressure, sleep apnea, acute stress

Question 13

Lethal Effects of Chronic Hypertension

Answer 13

Early heart failure and coronary artery disease, cerebral infarct, kidney failure

Question 14

Atherosclerosis

Answer 14

Type of arteriosclerosis; major characteristic of atherosclerosis is the presence of lesions within the intima of the vessel wall that protrude into the vessel lumen

Question 15

Non-Modifiable Risk Factors for Atherosclerosis

Answer 15

Age (risk increases between ages of 40-60; death rates from ischemic heart disease increase with each decade); gender (uncommon in premenopausal women without other risk factors; increases after menopause and eventually exceeds that of men); Genetics (some mendelian disorders associated with atherosclerosis but mostly multifactorial)

Question 16

Modifiable Risk Factors for Atherosclerosis

Answer 16

Hyperlipidemia/Hypercholesterolemia (major risk factor, correlated with high levels of LDL as opposed to HDL); Hypertension (increases risk of IHD by 60%, most important cause of left ventricular hypertrophy); Cigarette smoking, Diabetes

Question 17

LDL vs HDL

Answer 17

LDL carries cholesterol to peripheral tissues

HDL carries cholesterol to liver

Question 18

Hyperhomocystinemia

Answer 18

Inborn error of metabolism; associated with premature vascular disease

Question 19

Enodthelial Dysfunction/Injury

Answer 19

Results in intimal thickening and may lead to formation of atheroma in presence of hyperlipidemia

Question 20

Factors Related to Endothelial Dysfunction

Answer 20

Hypertension, hyperlipidemia, cigarette smoke, homocysteine, infectious agents, hemodynamic disturbances, hypercholesterolemia

Question 21

Smooth Muscle Proliferation

Answer 21

Intimal smooth muscle cell proliferation and extracellular matrix deposition converts a fatty streak into a mature atheroma

Question 22

Atheroma

Answer 22

Consists of a cap of smooth muscle cells, macrophages, foam cells (converted macrophages), and other extracellular components, overlying a necrotic center composed of cell debris, cholesterol, foam cells, and calcium

Question 23

Common Arterial Sites for Atherosclerosis

Answer 23

Lower abdominal aorta, coronary arteries, popliteal arteries, internal carotid arteries, Circle of Willis

Question 24

Short Term Control of Arterial Pressure

Answer 24

Via sympathetic nervous system effects on total peripheral vascular resistance and capacitance and cardiac pumping ability

Question 25

Long Term Control of Arterial Pressure

Answer 25

Via multiple nervous and hormonal controls and via local controls in kidney that regulate salt and water excretion

Question 26

Pressure Diuresis

Answer 26

Arterial pressure increases which leads to an increase in urine output

Question 27

Pressure Natriuresis

Answer 27

Arterial pressure increases which leads to an increase in sodium output

Question 28

Chronic Hypertension

Answer 28

One’s mean arterial pressure is greater than the upper range of the accepted normal measure

Question 29

Normal BP

Answer 29

90 mm Hg (110/70)

Question 30

Hypertensive BP

Answer 30

110 mm Hg (135/90)

Question 31

Severe Hypertensive BP

Answer 31

150-170 mm Hg (250/130)

Question 32

Lethal Effects of Chronic Hypertension

Answer 32

Early heart failure, coronary heart disease, heart attack, cerebral infarct, destruction of areas of kidney which leads to kidney failure which leads to uremia which leads to death