Patho Exam 2 Hypertension Flashcards
What are the four factors that increase blood pressure?
increased CO
increased blood viscosity
increased vascular resistance
increased sympathetic signals
Four hormones that increase blood pressure
epi, norepi, AHD, and angiotension II
How do epi and norepi increase BP?
increased cardiac output and causes vasoconstriction
How does ADH increase BP?
vasoconstriction increased salt and water reabsorption
How does angiotension II cause increased BP?
causes vasoconstriction of arterioles and causes aldosterone secretion
Which hormones decrease BP?
Atrial natriuetic peptide
histamine
Nitric oxide
How does ANP reduce BP?
causes vasodialation and promotes salta and water loss in urine
How does histamine reduce BP?
vasodilation of arterioles
How does nitric oxide reduce BP?
vasodilation of arterioles
What is the funtion of baroreceptors and where are they?
Located in aortic arch and carotid sinus
Maintain BP by sensing stretch of artery. When BP is low, baroreceptors send a signal to the brain to signal to the B1 and alpha receptors. B1 increase CO and Alpha cause vasoconstriction
What damage does HTN cause for the heart?
left ventricular hypertrophy
angina or myocardial infarction
coronary revascularization
heart failure
What damage does HTN cause for the brain?
stroke or TIA
What damage does HTN cause for the kidneys?
chronic kidney disease
What damage does HTN cause for the arteries?
peripheral arterial disease
What damage does HTN cause for the eyes?
retinopathy
MAP equation
MAP= 1/3 systolic + 2/3 diastolic
What causes primary HTN?
environmental, genetic, and lifestyle factors/unknown
What causes secondary hypertension?
Caused by conditions that affect the kidneys, arteries, heart or endocrine system. Secondary hypertension can also occur during pregnancy.
ex. diabetes, chronic kidney disease, renal artery stenosis, pheochromocytoma, obesity/sleep apnea
What is the first treatment for primary hypertension?
lifestyle modifications
weight loss, exercise, DASH diet, decrease alcohol, decrease sodium
hypertensive urgency
BP of 180/110 or higher but no organ damage. Can be corrected with immediate care and medicine over 24-48 hours
hypertensive emergency
BP of 180/110 or higher with organ damage. Critical emergency. Can result in stroke, heart attach, aortic dissection, and death.
orthostatic hypotension
decrease in systolic bp >20mmHg or >10mmHg within three mins when moving to an upright position. Increase of HR by 20-30 bpm may be diagnostic
symptoms of orthostatic hypotension
dizziness, blurred vision, confusion, and possible syncope
What is orthostatic BP associated with?
cardiovascular disease and a risk factor for stroke, cognitive impairment, and death.
What can cause orthostatic hypotension?
issues with baroreceptor or vasomotor response
adverse drug therapy
arterial stiffness
volume depletion
secondary disease process
vasovagal response
cardiac dysrhythmias
Orthostatic hypotension treatments
slow positional changes
avoid heat
avoid large or high carb meals
increase salt and fluid intake
When ace inhibitors are used what are the 4 results?
- arteriole dilation which improves blood flow to kidneys, decreases renal constriction, reduces afterload, increases stroke volume/CO, and promotes excretion of sodium and water
- venous dilation which reduces venous pressure, reduces pulmonary congestion, reduces peripheral edema, and increases preload and cardiac dilation
- suppression of aldosterone release
- reduced cardiac remodeling
pathophysiologic mechanism for hyperkalemia
Due to the suppression of aldosterone, K+ is not secreted into the urine
What other pre existing conditions or drugs may increase K levels when given with ACEi?
naturally higher K+ value
poor renal function
diabetes
K supplements or sparing diuretics
NSAIDs and salt substitutes
Ischaemia-Reperfusion injury (IRI)
the paradoxical exacerbation of cellular dysfunction and death, following restoration of blood flow to previously ischaemic tissues.
What are the 4 B side effects of beta blockers?
bradycardia, low BP, low blood glucose, and bronchoconstriction
