Pathoma- HTN

Question 1

What types of circulations can HTN involve?

Answer 1

systemic or pulmonary

Question 2

Etiology of primary HTN

Answer 2

Unknown etiology

Question 3

Risk factors for primary HTN

Answer 3

• age
• race (increased risk in African Americans, decreased risk in Asians)
• obesity
• stress
• lack of physical activity
• high salt diet

Question 4

How can high salt diet lead increase both systemic and diastolic bp?

Answer 4

Systemic blood pressure is a function of SV while diastolic blood pressure is a function of TPR. High salt content increases both SV and TPR, and therefore increases both systemic and diastolic bp.

Question 5

What type of HTN is more common (primary or secondary?)

Answer 5

Primary= 95% of cases

Secondary= 5% of cases

Question 6

What is secondary HTN

Answer 6

HTN due to an identifiable etiology

Question 7

What are some important causes of stenosis that cna lead to HTN in elderly males and young females?

Answer 7

Elderly males- atherosclerosis

Young females- fibromuscular dysplasia

Question 8

How does angiotensin II affect blood pressure?

Answer 8

Increases BP by:

1) Contracting arteriolar smooth muscle, increasing TPR
2) Promoting adrenal release of aldosterone, which increases resorption of sodium in distal convoluted tubule, expanding plasma volume.

Question 9

Why is renal artery stenosis a common cause of HTN? (explain mechanism)

Answer 9

1) Stenosis decreases blood flow to the glomerulus
2) Juxtaglomerular apparatus (JGA) responds by secreting renin, converting angiotensinogen → angiotension I
3) Angiotension I is converted to Angiotensin II by angiotensin converting enzyme (ACE)
4) ATII increases blood pressure by 1) contracting arteriolar smooth muscle, increasing TPR and 2) Promoting adrenal release of aldosterone, which increases resorption of sodium in the distal convoluted tubule (expand plasma volume).
5) This leads to HTN with increased plasma renin + unilateral atrophy of affected kidney from low blood flow.

Question 10

What is fibromuscular dysplasia

Answer 10

Developmental defect of BV wall, resulting in irregular thickening of large and medium sized arteries, esp. in renal artery

Question 11

Besides primary and secondary HTN, what is another way that HTN can be classified?

Answer 11

Benign or malignant

Question 12

What is benign HTN?

Answer 12

Mild or moderate elevation in BP; most cases of HTN are benign

Question 13

What are the sx/ manifestations of benign HTN?

Answer 13

Clinically silent; vessels and organs are damaged slowly over time

Question 14

What is malignant HTN?

Answer 14

Severe elevation in blood pressure (>180/120 mm Hg); comprises <5% of cases

Question 15

Etiology of malignant HTN

Answer 15

Preexisting benign HTN or de novo

Question 16

How does pt with malignant HTN present?

Answer 16

with acute end-organ damage (e.g. acute renal failure, HA, papilledema). This is medical emergency.

Question 17

What type of finding will occur in pts with severe HTN in the BV wall?

Answer 17

Fibrinoid necrosis