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
Clinical Presentation:
Are there symptoms?
What usually uncovers it?
What are the serious fatal complications of HTN?
Clinical Presentation:
- No symptoms per se, maybe a headache, fatigue
- Routine screening uncovers it
Serious/fatal complications: MI, Heart Failure, Strokes, Hypetensive Encephalopathy, Renal Failure
Advanced cases of HTN can manifest with:
______ retinopathy
left ventricle _____
renal ______
Advanced cases of HTn can manifest with:
hypertensive retinopathy (diagnose via a fundoscopic exam)
Left ventricle hypertrophy
Renal hypertension
On average, untreated HTN reduces life expectancy by ______ yrs
On average, untreated HTN reduces life expectancy by 10-20 years
Explain what hypertensive encephalopathy causes
Hypertensive encephalopathy causes
confusion, seizures, altered mental status
Explain what happens with the HTN etiology (cause) of “coarctation of the aorta”
what fixes this problem?
Coartctation of the aorta:
- narrowing of the aorta
- elevated BP in upper half of body, normal bp in legs
- Increased renin secretion
- surgery fixes this problem
Salt mediated hypertension mechanisms of activation of VSM contraction
- Salt stimulation of G proteins that activate MLCK which activates myosin and….. cause ______
- Salt stimulates Rho/RhoK which leads to inhibition of MLC phosphatase_____
- Increased dietary salt leads to secretion of _____
- Salt stimulation of G proteins….. contraction of Vascular smooth muscle
- salt stimulates rho/rhokinase…. preventing SMC release
- increased dietary salt leads to secretion of ouabain (a Na/K ATPase inhibitor) which affects Na/Ca exchanger, which in turn increases smooth muscle tone
Neurologic Disorders:
The CNS controls blood pressure
_____ reduces blood pressure by decreasing sympathetic discharge
Explain what that substance is
CNS controls blood pressure
Clonidine reduces blood pressure by decreasing sympathetic discharge
Cholidine is an alpha 2 agonist and is given to decrease TPR
Patients with hypertension show increased incidinces of :
1.
2.
3.
The combination of these factors is called “metabolic syndrome”
Patients with HTN show increased incidence of
hyperlipidemia
insulin resistance (diabetes)
obesity
The combo of these factors is called “metabolic syndrome”
All forms of hypertension are treated with which drugs?
1.
2.
3.
4.
All forms of HTN are treated with:
- Beta blockers
- inhibitors of renin-angiotensin
- Ca channel inhibitors
- diurhetics
to reduce blood pressure to normal levels
