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Cardiovascular System > Long Term Control of Blood Pressure > Flashcards

Long Term Control of Blood Pressure Flashcards

1
Q

Long term control of blood pressure revolves around what?

A

control of plasma volume by the kidneys

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2
Q

Outline the three hormone systems involved in blood pressure control.

A
  • Renin-angiotensin-aldosterone system
  • Antidiuretic factor (ADH, vasopressin)
  • Atrial natriuretic peptide
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3
Q

What are the functions of the kidneys? (5)

A
  • Excretion of waste products
  • Maintenance of ion balance
  • Regulation of pH
  • Regulation of osmolarity
  • Regulation of plasma volume
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4
Q

Controlling plasma volume is used to regulate ______.

A

MAP

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5
Q

What determines how big the osmotic gradient outside the collecting duct is?

A

Control over Na+ transport

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6
Q

Control over the _________ of the collecting duct to water determines if water follows that ________ ________ or not.

A

permeability

osmotic gradient

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7
Q

Making the collecting duct very permeable to water will result in…

(3)

A
  • lots of water reabsorption
  • little filtrate/urine
  • conserve plasma volume
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8
Q

Making the collecting duct very impermeable to water will result in…

(3)

A
  • little reabsorption
  • lots of urine
  • reduction in plasma volume
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9
Q

What is the clinical term for lots of urine output?

A

diuresis

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10
Q

If there is little urine output (diuresis), what will happen to the plasma volume, and why?

A

it will increase, due to increased water.

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11
Q

How permeable will the collecting duct be if there is a hypo-osmotic urine output?

A

very impermeable

large volume (low conc.)

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12
Q

How permeable will the collecting duct be if there is a hyper-osmotic urine output?

What volume of urine will be produced?

A

very permeable

small volume (high conc.)

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13
Q

If there is watery urine, there will be ________ plasma volume?

A

reduced

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14
Q

The kidney/hormonal regulation systems are all what type of mechanisms?

A

negative feedback

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15
Q

Renin-angiotensin-aldosterone system

Where is renin produced?

A

From the juxtaglomerular (= granule cells) of the kidney

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16
Q

Renin-angiotensin-aldosterone system

What triggers renin production?

(3)

A
  • Activation of sympathetic nerves
  • Decreased distension of afferent arterioles (the “renal baroreflex”)
  • Decreased delivery of Na+/Cl- through the tubule (low BP = less filtrate being produced)
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17
Q

In the ‘Renin-angiotensin-aldosterone system’, how are all the mechanisms signalling renin production activated?

A

low MAP (BP)

18
Q

Which part of the nephron detects the decreased Na+ and Cl- ion concentration which causes the release of renin?

A

macula densa

19
Q

What does renin do?

2

A
  • Converts inactive angiotensinogen to angiotensin I

- angiotensin I is converted by an enzyme to angiotensin II

20
Q

What is the name of the enzyme which converts angiotensin I to angiotensin II?

A

angiotensin converting enzyme (ACE)

21
Q

Briefly, what does angiotensin II do?

3

A
  • Stimulates the release of aldosterone from the adrenal cortex
  • increases the release of ADH from the pituitary
  • acts as a vasoconstrictor
22
Q

Describe what the hormone, aldesterone, does?

4

A
  • Increases Na+ reabsorption in the loop of Henle
  • reduces diuresis (urine output)
  • Increases plasma volume
  • Increases MAP
23
Q

What is ADH? (1)

What does an increase in ADH from the pituitary gland do? (5)

A

Antidiuretic hormone

  • Increases permeability of the collecting duct
  • reduces diuresis
  • increases plasma volume
  • increased MAP
  • It also increases the sense of thirst.
24
Q

How does renin being a vasoconstrictor affect MAP? (1)

A
  • increases TPR
  • increasing MAP

(MAP = CO x TPR)

25
Q

Where is ADH synthesised and released from?

2

A
  • synthesised in the hypothalamus

- released from the posterior pituitary gland

26
Q

Outline what triggers the release of ADH.

3

A
  • low plasma volume
  • circulating angiotensin II
  • increase in interstitial fluid osmolarity
27
Q

Where is a low plasma volume detected in order for ADH to be released?

(2)

A
  • cardio-pulmonary baroreceptors

- relayed via the medullary cardiovascular centres

28
Q

Where is an increase in interstitial fluid osmolality detected in order for ADH to be released?

(2)

A
  • osmoreceptors

- in the hypothalamus

29
Q

What is common about all the triggers which release ADH?

Therefore, what outcome should we anticipate from the release of ADH?

A

They are all a result of low plasma volume/MAP

An increase in MAP

30
Q

Why is ADH also called vasopressin?

A

It is a vasoconstrictor

31
Q

What does ADH do?

A
  • Increases permeability of collecting duct
  • reduces diuresis
  • increases plasma volume
  • vasoconstriction
  • increases MAP
32
Q

What is ANP?

Where is it produced?

A

Atrial natriuretic peptide

myocardial cells in the atria

33
Q

Where is brain natriuretic peptide (BNP) released from?

A

The myocardial cells of the ventricles

34
Q

What triggers the release of ANP and BNP?

A

ANP - increased distension in the atria.

BNP - increased distension in the ventricles.

i.e. increased plasma volume, increased MAP.

35
Q

What is the clinical term for the increased secretion of Na+ in the urine?

A

natriuresis

36
Q

What do ANP do?

3

A
  • Increases excretion of Na+ (natriuresis)
  • Inhibits the release of renin (opposite)
  • Acts on medullary CV centres to reduce MAP
37
Q

How is the release of ANP different to the release of ADH and renin? (2)

How are they the same? (1)

A

ANP - for MAP reduction
renin/ADH - for MAP increase

They are all negative feedback systems.

38
Q

What is the difference between primary and secondary hypertension?

A

primary - idiopathic

secondary - known cause

39
Q

What are some classes of anti-hypertensive drugs? (4)

A
  • Ca2+ channel blockers
  • B1 antagonists (beta blockers)
  • thiazide diuretics
  • angiotensin converting enzyme inhibitors
40
Q

Briefly outline how Ca2+ channel blockers work in treating hypertension?

(3)

A
  • target Ca channels in heart and in some smooth muscle,
  • reduces SV/CO
  • reduces BP
41
Q

Briefly outline how thiazide diuretics work in treating hypertension?

(4)

A
  • Na+ transporters
  • reduces size of Na+ gradient in kidneys
  • reduces PV
  • reduces BP

Cardiovascular System (37 decks)

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