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3.23 > Lecture 4: Mechanism of Hypertension - pathophysiology > Flashcards

Lecture 4: Mechanism of Hypertension - pathophysiology Flashcards

1
Q

What are the values for prehypertension?

A

120 - 139 / 80 - 89

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2
Q

What are the values for Stage I ?

A

140 - 159 / 90 - 99

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3
Q

What are the values for stage II?

A

160 - 179 / 100 - 109

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4
Q

What are the values for stage III?

A

> 180 / > 110

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5
Q

What are the determinants of blood pressure?

A

Mean systemic arterial pressure - which is the product of cardiac output and total peripheral resistance

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6
Q

What percentage of hypertension cases are primary?

A

90 - 95%

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7
Q

What percentage of hypertension cases are secondary?

A

5%

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8
Q

What can cause secondary hypertension?

A
  • Renal or renovascular disease
  • Endocrine disease
  • Contraction of the aorta
  • Latrogenic: hormonal/ oral contraceptive, NSAIDs
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9
Q

What endocrine diseases can cause secondary hypertension? (4)

A
  • Phaechomocytoma
  • Cushings syndrome
  • Crohns Syndrome
  • Acromegaly and hypothyroidism
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10
Q

What are the common causes of secondary hypertension?

A
  • Intrinsic renal disease
  • Renovascular disease
  • Mineralocortacoid excess
  • Sleep breathing disorder
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11
Q

What are the uncommon causes of secondary hypertension? (4)

A
  • Phaechomocytoma
  • Glucocoticoid excess
  • Coarction of Aorta
  • Hyper/ Hypothyroidism
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12
Q

What causes renovascular hypertension?

A
  • Atherosclerosis 75-90%
  • Fibromascular dysplasia 10-25% (more common in young patients, espescially females)
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13
Q

What are the risk factors for hypertension? (12)

A
  • Family history
  • Smoking
  • Diabetes
  • Obesity
  • Hypercholestolaemia
  • Physical inactivity
  • Stress
  • Infection
  • Hypertension
  • Microalbuminia or estimated GFR < 60mL/min
  • Age ( >55 men, 65 woman)
  • Lifestyle
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14
Q

What are the target organs for hypertension?

A
  • CVS (heart and blood vessels)
  • The kidneys
  • Nervous system
  • Eyes
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15
Q

What are the effects on the CVS of hypertension?

A
  • Ventricular hypertrophy, dysfunction and failure
  • Arrhythmias
  • Coronary heart disease, acute MI
  • Arterial aneurysm, dissection and rupture
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16
Q

What are consequences of hypertension on the heart?

A

LV hypertrophy
- Increased workload of LV
- Increased afterload
- LV tries to compensate for increased workload

17
Q

What is LV hypertrophy a major risk factor for?

A
  • Ischemic heart failure
  • Arrhythmias
  • Heart failure
  • Sudden death
18
Q

What are the effects of hypertension on the kidneys?

A
  • Glomerular sclerosis leading to impaired kidney function and finally end stage kidney disease
  • Reduction in GFR
  • Ischemic kidney disease especially when renal artery stenosis is the cause of hypertension (secondary)
19
Q

What are the effects of hypertension on the nervous system?

A
  • Stroke, intracerebral and subaranchnoid hemorrhage
  • Cerebral atrophy and dementia
20
Q

What are the effects of hypertension on the eyes?

A
  • Retinotherapy, retinal hemorrhages and impaired vision
  • Vitreals hemorrhage, retinal detatchment
  • Neuropathy of the nerves, leading to extraocular muscle paralysis & dysfunction
21
Q

Where do nerve impulses that monitor joint movements come from?

A

Proprioreceptors

22
Q

Where do nerve impulses that monitor blood pressure come from?

A

Baroreceptors

23
Q

Where do nerve impulses that monitor blood acidity come from?

A

Chemoreceptors

24
Q

What nerves cause a decrease in heart rate?

A

Vagus nerves - parasympathetic

25
Q

What nerves cause an increase in heart rate?

A

Cardiac accelerator nerves - sympathetic

26
Q

What nerves cause vasoconstriction of blood vessels?

A

Vasomotor nerves - sympathetic

27
Q

What are the determinants of blood pressure?

A
  • Blood volume
  • Overall compliance
  • Cardiac output
  • Vascular resistance
28
Q

What is blood volume?

A

The volume of blood available in the system

29
Q

What is overall complance?

A

The elastic characteristics of the vessels contribute to the overall pressure

30
Q

What is cardiac output?

A

Related to two other factors - heart rate and stroke volume

31
Q

What are the sympathetic fibres of the heart?

A

Noradrenaline - B1 receptors

32
Q

What do the sympathetic fibres of the heart do?

A

Increase the permeability of the nodal cell plasma membrane to Na and Ca

33
Q

What are the parasympathetic nerves of the heart?

A

Acytylecholine M2 receptors

34
Q

How do you regulate arterial blood pressure?

A
  • Baroreceptol reflex
  • Chemoreceptor reflex
35
Q

What controls long term blood pressure?

A

The kidneys

36
Q

What does a reduction in renal pressure result in?

A

Intrarenal redistribution of pressure and increased absorption of salt and water

37
Q

What does a decrease in pressure in renal arterioles and sympathetic activity result in?

A

Renin production - angiotensin II production

38
Q

What does angiotensin II do?

A
  • Causes direct constriction of renal arterioles
  • Stimulation of aldosterone synthesis - sodium absorption and increase in intravascular blood volume
39
Q

How is RAAS activated?

A

In response to reduced blood flow.

3.23 (26 decks)

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