Lecture 2 Hypertension and Drug targets Flashcards
What is does an ambulatory blood pressure have to be in order to get a hypertension diagnosis?
140/90
What are the different hypertensions and how are they diagnosed?
Stage 1: Clinical BP 140/90 - 159/99 Ambulatory BP 135/85 - 149/94
Stage 2: Clinical BP 160/100 or higher Ambulatory BP 150.95 or higher
Why does the mechanism of regulating high blood pressure stop working?
As the baroreceptors reset meaning the higher blood pressures are seen as normal so no physiological changes occur
What are the different receptors used for blood pressure regulation?
Beta 1 adrenergic receptors in the heart (contractility)
Alpha 1 adrenergic baroreceptors (smooth muscle contraction/relaxation)
What is essential/primary hypertension?
Development of hypertension gradually over many years after young adulthood (increased prevalence with age)
High cardiac output with normal total peripheral resistance (usual characteristic)
Older patients have normal/reduced cardiac output but high total peripheral resistance
What is secondary hypertension?
Caused by an underlying condition, can appear suddenly
Kidney, adrenal gland tumour, thyroid issues, medications
Linkage to chronic obstructive sleep apnoea
What is malignant hypertension?
A severe (often acute) form which increases risk of cardiovascular events - very urgent
What are the effects of angiotensin II?
Stimulates release of aldosterone, promotes sodium and fluid retention - blood volume increases and blood pressure
Release of ADH promoting water reabsorption in kidneys, increasing blood volume and pressure
Stimulates thirst so blood volume and pressure increases
Vasoconstriction
Cardiac and vascular hypertrophy - more muscle mass (stiffness) - increases cardiac output hence blood pressure
What is the effect of hypertension with increased afterload, left ventricle hypertrophy, systolic and diastolic dysfunction?
Heart failure
What is the effect of hypertension, increased afterload, increased myocardial oxygen demand and decreased coronary myocardial oxygen supply?
Heart attack (myocardial ischema/infarction)
What is the effect of hypertension, arterial damage, atherosclerosis, weakened vessel wall, thombosis in cerebrum impacts aorta and cerebral hemorrhage?
Aneurism and stroke
What is the best way to diagnose or treat hypertension?
Using NICE guidelines
What is the main treatment for sleep apnoea?
CPAP - creating continuous air pressure meaning breathing is regulated
What is the likely diagnosis for a patient with clinic BP recordings of 168/108 mmHg, 162/103 mmHg, and 161/104 mmHg, and an ambulatory BP of 152/98 mmHg?
Stage 2 Hypertension
>160/100 mmHg <180/120 mmHg
Why does the mechanism to sustain elevations in arterial blood pressure fail?
Nerve activity reduces with sustained high blood pressures - which happens in chronic hypertension
Which of the following is not a recognized link to secondary hypertension?
Having a relative with hypertension
What stimulates the adrenal cortex to release aldosterone?
Angiotensin II
What is the mechanism of the renin-angiotensin-aldosterone pathway?
Renin release from kidney
Angiotensinogen to angiotensin I
ACE enzyme to angiotensin II
What does the release of ADH promote in the kidneys?
Water reabsorption
This leads to an increase in fluid volume, blood volume, and blood pressure
True or False: Secondary hypertension can appear suddenly and cause very high blood pressure
True
From underlying conditions and can arise abruptly
What is the purpose of the QRISK3 online calculator?
Calculate the risk of a heart attack or stroke in the next 10 years
It uses various health factors to estimate cardiovascular risk
