Pathophysiology and Pharmacotherapy of Hypertension

Question 1

What is the most common and modifiable cardiovascular disease (CD) risk factor

Answer 1

Hypertension

Question 2

What percentage of adult americans have hypertension

Answer 2

33%

Question 3

CVD risk doubles when Systolic Blood Pressure and Diastolic Blood Pressure is raised by what increments and at what blood pressure

Answer 3

SBP: 20 mmHg, DBP: 10 mmHg, 115/75

Question 4

What are common CVD risk factors for hypertensionthat are modifiable

Answer 4

Smoking, unhealthy diet, physical inactivity, DM2, Dyslipidemia

Question 5

What are fixed CVD risk factors for hypertension

Answer 5

increased age, family history, CKD, being male, emotion, race

Question 6

What is primary hypertension, what is the goal for a patient with primary hypertension

Answer 6

high blood pressure that doesn’t have a known cause, control the blood pressure

Question 7

What is secondary hypertension, what is the goal for patient with secondary hypertension

Answer 7

Comorbid condition or medication contributes to the hypertension, remove causative agent or treat underlying condition

Question 8

What medications that may cause secondary hypertension

Answer 8

Ampethamines, steroids, calcineurin inhibitors, decongestants, NSIADS, estrogen

Question 9

What food may cause secondary hypertension

Answer 9

Sodium, Alcohol, Black Licorice

Question 10

What disease complications can hypertension lead to

Answer 10

Stroke, Retinopathies, Heart attack, CKD, Hardened arteries

Question 11

What is the equation that determines blood pressure

Answer 11

Blood Pressure = Cardiac Output (CO) X Peripheral Resistance (PR)

Question 12

What is the equation that determines Cardiac Output

Answer 12

Cardiac Output = Stroke Volume (SV) X Heart Rate (HR)

Question 13

What determines the peripheral resistance

Answer 13

Vascular structure and Vascular Function

Question 14

What is systolic Blood pressure

Answer 14

Peak value during contraction

Question 15

What is diastolic Blood pressure

Answer 15

Peak value during rest/cardiac chamber filling

Question 16

What is the main neurotransmitter of the parasympathetic nervous system, how does it influence Heart Rate

Answer 16

Acetylcholine, decrease Heart Rate

Question 17

What is the main neurotransmitter of the sympathetic nervous system, how does it affect the heart

Answer 17

Norepinephrine/Epinephrine, increase heart rate and stroke volume and peripheral resistance

Question 18

What causes increased cardiac output

Answer 18

increased sodium intake/retention, increased renin-angiotensin-aldosterone system (RAAS) stimulation, increased sympathetic nervous system

Question 19

What causes increased peripheral resistance

Answer 19

Vascular contrstiction and/or vascular hypertrophy, genetics

Question 20

What are the steps of the RAAS

Answer 20

Renin converts the angiotensinogen into angiotensin 1 -> angiotensin 1 is converted to angiotensin 2 by angiotensin-converting enzyme (ACE) -> angiotensin two stimulates the release of aldosterone

Question 21

What does angiotensin 2 do that contributes to high blood pressure, what medication class is used to inhibit this

Answer 21

Sodium and Chloride reabsoprtion = H20 retnetion, aldosterone secretion, ateriolar vasoconstriction/ ACE inhibitors

Question 22

What is normal and elevated blood pressure

Answer 22

Normal less than 120 mmHg/less than 80 mmHg, Elevated: 121-129 mmHg/less than80 mmHg

Question 23

What are blood pressure levels for stage 1 Hypertension

Answer 23

130-139 mmHg/80-89 mmHg

Question 24

What are blood pressure levels for Stage 2 Hypertension

Answer 24

Greater than 140 mmHg/greater than 90 mmHg

Question 25

When a person has no clinical CVD and a 10 year ASCVD risk less than 10% what blood pressure would cause a need for intervention, what is the goal blood pressure

Answer 25

Greater than 140/90, less than 130/80

Question 26

T/F: Patients with Clinical CVD, 10 year ASCVD risk greater than 10%, or are older than 65 have a BP threshold of greater than 130 and a BP goal of less than 130

Answer 26

True

Question 27

What specific comorbidities would lead a patient to need intervention at a BP of greater than130/80 and a BP goal of less 130/80

Answer 27

DM, CKD, CHF