Lecture 4: Hypertension Flashcards
Hypertention Pathogenesis:
What is normal BP:
Hypertension is defined as BP higher then _____ for at least ____ consecutive trips to see the doctor
Anything in between normal and high is considered _______, and pt should modify their lifestyle
Normal BP is considered anything below 120 systolic and below 80 diastolic
Hypertension is defined as BP higher than 140/90 mmHg in at least three consecutive trips to the doctor
Anything in between normal and high is considered pre-hypertension, and the pt should modify their lifestyle accordingly
Give the following systolic and diastolic blood pressures for the following categories of pt’s
Normal
Stage 1 HTN
Stage 2 HTN
Hypertensive Crisis
Normal: 120/80 (less than)
Stage 1 HTN: 140/90
Stage 2 HTN: 160/100
Hypertensive Crisis: 180/110
Essential HTN:
- Accounts for ______ of all cases
- It is heterogenous (meaning factors add up together)
- List the seven etiological factors for essential hypertension:
Essential HTN:
- Accounts for 95% of all cases
- Etiological Factors
- obesity, insulin resistance, stress
- high alcohol intake, high salt intake
- Low K and Low Ca
Inherited BP:
- Familial studies (twin studies) show that inheritance plays a role in BP
- Autosomal ______
- Unknown genes
- Etiological factors are considered “hyper______”
- 10 genes related to ______
Inherited BP;
- Familial studies show that inheritance plays a role in BP
- Autosomal dominant
-Unknown genes
- Etiological factors are considered “hypertensinogenic”
- 10 genes related to Na-H20 reabsorption
Hypertension is _____ a disease but a ______
In most cases, the cause is unknown—> called _______
For secondary hypertension, the cause ____ known
Hypertension is NOT a disease but a syndrome
In most cases, the cause in unknown and this is called “essential hypertension”
For secondary hypertension, the cause IS known
What are some strong genetic traits associated with inherited hypertension?
Genetric Traits:
- Na-Li countertransport
- High fasting plasma insulin
- High LDL
- fat pattern, high BMI
- Angiotensinogen polymorphisms: t704 and M235T
What are some classical features of essential HTN?
Classical features of essential HTN:
- essential htn starts in your 40s
- positive family history of HTN
- asymptomatic
- doctor will do physical exam, routine ab work up, assess for secondary hypertension
Most pt’s BP can be controlled with lifestyle changes and one or two drugs
The elderly:
systolic blood pressure rises throughout life
diastolic pressure rises until _____ and then ____
Therefore pulse pressure continues to increase
_______ account for most HTN in the elderly
Treatment of both diastolic and systolic hypertension in the elderly is important to reduce _______
The elderly:
systolic blood pressure rises throughout life
diastolic rises until 50-60 YO and then drops
Therefore pulse pressure continues to increase
Age related changes account for most of the HTN in the elderly
Treatment of both diastolic and systolic hypertension in the elderly is important to reduce cardiovascular complications
Overly aggressive treatment of diastolic hypertension may be associated with adverse cardiac outcomes (MI) in patients with ______ or _____ because?
Overly aggressive treatment of diastolic hypertension may be associated with adverse cardiac outcomes (like MI) in patients with coronary artery disease or CHF (because adequate cardiac muscle perfusion depends on on higher diastolic bp’s)
What is the most common cause of Hypertension?
Prolonged increases in Cardiac Output can also lead to hypertension….
What are two examples of uncommon things that cause HTN due to increased CO
Most common cause of HTN is increased TPR
Prolonged increases in CO can also cause HTN
Two examples of increased CO causing HTN are
- hyperthyroidism (increased TPR and increased HR)
- “Beriberi” : aka vitamine B1 defeciency, causes rightsided heart failure and increased CO
Secondary Hypertension:
___ % of all cases
- essentially messes with ____ function
explain
Secondary hypertension:
-5% of all cases
Essentially messes with kidney function
Messes with aldosterone, glutococortiroids, increased cortisol, etc
Secondary HTN:
- Explain what happens with the following conditions:
- Autosomal hypertension with bradydactylyly
- Cushing’s syndrome
- Pheocromocytoma
Secondary HTN:
1. Autosomal dominant hypertension with bradydactylyl: chromosome p12, shortened fingers and toes
- Cushing’s syndrome: Excess ATCH and high cortisol
- Pheocromocytoma: non cancerous tumor on the adrenal gland, excess NE and Epi
Diagnosing HTN:
What is important in diagnosing HTN?
Questions you will ask the pt?
Physical exam
Get a good medical history
Family history of CVD?
Three consecutive readings of HTN to the office
Take blood pressure sitting and standing up (bp would spike upon standing for HTN pt)
Check for secondary organ damage: chest x ray, fundoscopic exam for hypertensive retinopathy
Explain the Labs you will order to diagnose HTN:
Which labs will identify cardiovascular risk factors?
Which labs target organ injury?
Which labs screen for secondary hypertension?
Labs to identify cardiovascular risk factors: cholesterol, TAGs, fasting blood glucose
Target organ injury: Chest X Ray, ECG,
Labs to screen for secondary hypertension: serum creatinine, K levels, Ca levels (urinanalysis)
Explain HTN complications:
Essentially HTN leads to two things
1.
2.
these lead to loads of other problems
Essentially HTN leads to two things
- Increased Afterload
- Arterial damage
overtime these can lead to HF, MI, strokes, retinopathy, etc
