Overview of HTN: Epidemiology and Consequences AND Pathology of HTN Flashcards

1
Q

T/F Hypertension encompasses a large group of disorders.

A

T

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2
Q

Two broad groups of htn

A
  1. primary/essential: resistance or compliance htn

2. secondary

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3
Q

What is the underlying abnormal regulation that contributes to htn?

A

drysregulated svr supplemented by abnormal regulation of sodium/fluid and abnormal fibrosis of tissues

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4
Q

Consequences of htn: left ventricle

A

higher systolic pressure, higher systolic wall stress, hypertrophy, fibrosis of myocardium leading to impaired diastolic relaxation

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5
Q

Consequences of htn: arterial system

A

increased wall stress, arterial vascular disease (aneurysms, atherosclerosis), arteriolar disease (obliterative destruction of systemic arterioles) leading to even more increased SVR

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6
Q

Consequences of htn: kidney

A

destruction of kidney due to arteriolar destruction leading to even more reduced ability to excrete sodium –> nephroarteriolosclerosis

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7
Q

Why is htn regarded the “silent killer”?

A

leads to conditions that actually have lots of symptoms and damage

  1. cardiac dysfunction secondary to progressive lvh and myocardial fibrosis –> increased frequency of systolic/diastolic chf
  2. accelerated atherosclerotic disease in large/small arteries –> MI, stroke, aneurysm
  3. renal dysnfucntion secondary to progressive renal destruction –> chronic renal failure
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8
Q

What is secondary htn and how common is it?

A

5-10% of pts –> due to underlying disease process, most often renal or adrenal

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9
Q

What is primary htn?

A

multigene controlled plus environmental factors leading to htn syndrome

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10
Q

What is benign htn?

A

adaptive: any most people have this: diastolic bp>90 or systolic > 140 –> clinically silent until later in course

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11
Q

What is malignant htn?

A

5% of pts –> usually follows benign ht –> diastolic bp>120, systolic>210 w/clinical symptoms that will be lethal if not treated rapidly

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12
Q

What vascular diseases can be accelerated by htn but may exist otherwise?

A
  1. atherosclerosis

2. hyaline arteriolosclerosis

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13
Q

What vascular disease are the consequence of htn?

A
  1. adaptive: vasoconstriction, hypertrophy, fibroelastic intimal hyperplasia
    destructive: fibrinioid necrosis, hyperplastic arteriolitis, microangiopathic hemolytic anemia
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14
Q

What is the difference between adaptive and destructive htn w/regards to their according causative htn?

A

adaptive: any htn
destructive: only malignant htn

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15
Q

What kinds of vascular changes are irreversible?

A

arterial fibroelastic intimal hyperplasia, hyalin arteriosclerosis, advanced atherosclerosis

vs reversible vasoconstriction, medial hypertrophy

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16
Q

What is hte consequence of irreversible change

A

fixed increase in vascular resistance causing difficulty to treat

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17
Q

What hypothesis explains destructive vascular changes w/htn?

A

upregulation of RAAS –> toxic effects on blood vessels as in fibrinoid necrosis or hyperplastic intimal arteriolitis

18
Q

Consequences of htn: cardiac (not just left ventricle)

A

coronary atherosclerosis leading to CHF, angina, MI

19
Q

Consequences of htn: cerebral

A

microaneurysms, rupture of berry, lacunae, charcot-bourchard aneurysms leading to intracerebral hemorrhage, white infarcts from ischemia due to emboli from larger cerebral vessels

20
Q

Which effects of nephroarteriolosclerosis are aggravators of htn?

A
  1. decreased GFR, decreased Na excretion
  2. activation of RAA
  3. loss of urodilatin/natriuretic peptides from kidney

loss of renal excretory function produces chronic renal failure

21
Q

Risk factors for malignant htn?

A

men, smokers, African Americans, low SES status

22
Q

Mortality associated with malignant htn?

A

90% in 1 year untreated

75% in 5 years if treated

23
Q

Clinical presentation of malignant htn

A

headache, nausea, vomiting, visual, papilledema, retinal flame-shaped hemorrhage, hematuria, proteinuria, MAHA, activation of RAAS, azotemia

24
Q

Causes of death in malignant htn

A
  1. acute renal failure
  2. stroke
  3. acute congestive heart failure w/wo MI
25
Causes of renal artery stenosis
1. atherosclerosis (eccentric narrowing in older patients) --> proximal artery 2. fibromuscular dysplasia (concentric narrowing in younger patients, women) --> distal to middle renal artery
26
3 adrenal causes of htn
1. adrenal cortical adenoma 2. adrenal cortical hyperplasia 3. adrenal medullary pheochromocytoma
27
Mechanisms that should prevent development of htn
1. baroreceptor reflex 2. pressure natriuresis 3. RAAS
28
intrinsic phenomenon whereby the rate at which kidney puts out sodium in urine is determined by input blood pressure
pressure natriuresis
29
What kind of htn? abnormality is abnormal regulation of vascular resistance
resistance: svr is elevated, systolic, diastolic, map elevated, pulse pressure elevated --> 150/100 typical
30
What kind of htn? decreased vessel compliance/stiff pipes
compliance --> older people, moderately incr/normal svr, elevated systolic, modestly elevated map, pulse pressure elevated --> 170/60 typical
31
What do we think renal natriuretic hormone does?
Na/K inhibitor --> drives up Na/Ca exchanger --> increase svr
32
What happens to renal sympathetic function in those with htn?
increase afferent and efferent sympathetic nerve activity --> if these pathways can be calmed down, maybe therapeutic
33
Receptor role on kidney: alpha-1b
reduce renal blood flow, reduce glomerular filtration -renal arteriole cells
34
Receptor role on kidney: alpha 1 a
activate Na/K atapse, increase na/h2o reabsorption -renal tubule cells
35
Receptor role on kidney: b1
increase renin -jg cells
36
localized dilation of blood vessel
aneurysm 1. saccular vs fusiform 2. berry, atherosclerotic, syphilitic 3. dissecting hematoma
37
saccular vs fusiform aneurysm
``` saccular = bulges out fusiform = involves whole circumference of blood vessel ```
38
At what level do AAAs tend to arise?
below renal artery and above iliacs
39
What is the etiology of AAAs?
1. atherosclerosis leading to ischemic injury to the media --> weakening and dilation 2. inflammatory mediators 3. htn can promote growth
40
How does laplace relate to aneurysms?
wall pressure = P*R/W --> r, p goes up and thickness go down so increase wall stress --> tendency to grow and rupture
41
What is a dissecting hematoma?
underlying medial necrosis leading to dilation to thoracic aortic aneurysm (ascending), sometimes cystic, accelerated by atherosclerosis, htn, marfan's syndrome --> aortic valve insufficiency, dissection and loss of blood from vasa vasorum which rupture as aorta dilates