Module 13

Question 1

Elevated systemic arterial blood pressure.

Answer 1

HTN

Question 2

Measurement of the force against the walls of your arteries as the heart pumps blood through the body

Answer 2

BP

Question 3

BP is measured with this

Answer 3

Sphygmomanometer

Question 4

When the heart contracts

Answer 4

systole

Question 5

Period of time when the heart fills after a contractoin

Answer 5

Diastole

Question 6

BP numbers
Normal
Pre-hypertension
Stage 1 HTN
Stage 2 HTN

Answer 6

< 120 and <80
120-139 or 80-89
140-159 or 90-99
>160 or >100

Question 7

HTN of no known cause

The _____ of cases of HTN

Answer 7

Primary HTN

Majority of HTN cases

Question 8

HTN with an identifiable cause.

Answer 8

Secondary HTN

Question 9

What are the different causes of secondary HTN?

Answer 9

Kidney disease
Hyperthyroidism
Pregnancy
Erythropoeitin
Pheochromocytoma
Sleep apnea
Contraceptive use

Question 10

Tumour on the adrenal gland that causes excess epinephrine release

Answer 10

Pheochromocytoma

Question 11

What are three major factors that influence BP?

Answer 11

1 - The amount of water and salt in the body
2 - The condition of your kidneys, NS and blood vessels
3 - Hormone levels in the body

Question 12

What are risk factors for HTN?

Answer 12

Obesity, stress, smoking, high salt, diet, diabetes, African descent

Question 13

What are certain drugs that are known to cause HTN?

Answer 13

NSAIDs, oral contraceptives, and cold medicines that contain pseudoephedrine

Question 14

If untreated, HTN can cause these, potentially fatal consequences.

Answer 14

MI, kidney failure, stroke, retinal damage

Question 15

Why is HTN called a silent killer?

Answer 15

Since many patients may have elevated BP for years before they show any symptoms

Question 16

How does HTN affect the brain?

Answer 16

The brain swells and has multiple areas of hemorrhage

Question 17

How does HTN affect the kidneys?

Answer 17

The vasculature of the kidney is dramatically constricted and the urine output is reduced

Question 18

How does HTN affect the heart?

Answer 18

The heart is dilated (enlarged) and in cardiac failure

Question 19

What are the determinants of BP?

Answer 19

Cardiac output and Peripheral (vascular) resistance

Question 20

What is cardiac output determined by?

Answer 20

Heart rate, heart contractility, blood volume and venous return

Question 21

An increase in what factors increases cardiac output?

Answer 21

HR, heart contractility, blood volume and venous return

Question 22

Determined by arteriolar constriction.

Answer 22

Peripheral resistance

Question 23

What are the three systems that our body uses to regulate BP?

Answer 23

1 - Sympathetic nervous system
2 - RAAS - renin-angiotensin-aldosterone system
3 - Renal regulation of BP

Question 24

The sympathetic nervous system has a reflex circuit called the ______ _____ that helps keep BP at a set level

Answer 24

Baroreceptor reflex

Question 25

Constantly active to help keep body functions in homeostasis.

Answer 25

Sympathetic nervous system

Question 26

Consists of the brain stem, receptors on the aortic arch and carotid sinus of the heart, and vascular smooth muscle

Answer 26

Baroreceptor reflex

Question 27

If BP is too low, describe the action of the baroreceptor reflex.

Answer 27

If BP is perceived to be too low by baroreceptors on the aortic arch and carotid sinus, they relay the information to the brainstem The brainstem then sends impulses along sympathetic neurons that stimulate the heart to increase CO and cause constriction of smooth muscles on arteries Blood pressure then increases

Question 28

If BP is perceived as too high by baroreceptors of the aortic arch and carotid sinus, what occurs?

Answer 28

Sympathetic activity is decreased, causing decreased CO and vasodilation

Question 29

The activity of baroreceptors can ______ our attempts to lower BP with drugs, since the "set point" in patients with HTN is _____.

Answer 29

oppose | high

Question 30

Unlike the baroreceptors reflex, activation of the RAAS may take _____ or _____ to influence BP.

Answer 30

hours to days

Question 31

What is the RAAS pathway?

Answer 31

Angiotensinogen -- Renin --> angiotensin I (inactive) -- ACE --> angiotensin II (Active) --> aldosterone + ADH

Question 32

Enzyme that catalyzes the formation of angiotensin I from angiotensinogen

Answer 32

Renin

Question 33

Rate-limiting step in RAAS.

Answer 33

Renin step

Question 34

Renin is synthesized and secreted by the __________ cells of the kidney into the blood.

Answer 34

Juxtaglomerular

Question 35

These all increase renin release.

Answer 35

1 - Decreased blood volume 2 - Low BP 3 - Stimulation of beta 1 receptors on juxtaglomerular cells of the kidney

Question 36

Converts inactive angiotensin I into the active angiotensin II.

Answer 36

ACE - angiotensin converting enzyme

Question 37

Activated angiotensin II is a potent ________. It binds to its receptor (the __________ on smooth muscle) to produce _________. Activated angiotensin II also stimulates the release of ________ from the ________ _______. This in turn acts on the kidneys to increase _______ retention, thereby increasing ______ retention.

Answer 37

vasoconstrictor AT1 receptor on smooth muscle vasoconstriction aldosterone, adrenal cortex sodium water

Question 38

Angiotensin II also acts on the ________ _______ ______ to release ________ ________ (also called _________). This in turn causes ______ retention by the kidneys.

Answer 38

posterior pituitary gland Antidiuretic hormone (aka vasopressin) causes water retention by the kidney

Question 39

Increased retention of water and sodium from the RAAS system causes an increase in ______ ______, which in turn increases ____.

Answer 39

blood volume | CO

Question 40

If blood pressure decreases for a prolonged period of time, the kidney retains ______. This causes an increase in ______ ____, and thus an increase in ____ and thus BP.

Answer 40

water blood volume CO

Question 41

Decreasing body weight: There is a _______ relationship between obesity and HTN Obesity is thought to cause HTN by two mechanisms: 1 - Increased _______ secretion, causing tubular reabsorption of ______ and thus ______ reabsorption and a higher blood volume, higher CO and thus BP 2 - Obese patients also have increased _________ nervous activity

Answer 41

direct insulin, Na+, water reabsorption sympathetic

Question 42

How does salt affect BP?

Answer 42

When salt levels are too high, it causes water to be reabsorbed from the kidney into the blood, causing increased BP.

Question 43

How does exercise affect BP?

Answer 43

Regular exercise decreases ECF fluid volume and circulating levels of plasma catecholamines (e.g. epinephrine)

Question 44

The benefits of _______ to BP are seen even in patients that do not restrict their ______ intake or _____ ______ during the training period.

Answer 44

exercise sodium lose weight

Question 45

Total body ________ levels are inversely correlated with BP.

Answer 45

Potassium

Question 46

High potassium diets decrease BP in what ways?

Answer 46

Increased sodium excretion Decreased renin release Vasodilation (think opposite of action potential so less contraction)

Question 47

Preferred sources of potassium are fresh _____ and ______.

Answer 47

fruits and vegetables

Question 48

Patients taking ___ ________ should NOT be on a high potassium diet.

Answer 48

Ace inhibitors

Question 49

For the DASH diet, the best results were seen in patients with _______.

Answer 49

pre-hypertension

Question 50

How is smoking related to HTN?

Answer 50

Smoking acutely elevates BP, but has not been linked to the causal development of HTN

Question 51

How does alcohol affect BP?

Answer 51

Excessive alcohol consumption increases BP | Alcohol can decrease responses to anti-hypertensive