Pathophysiology of HTN Flashcards
What are the JNC8 Reccomendations for HTN?
Age >60:
How can “White coat HTN” be minimized?
Have Pts take BP at home throughout the day to get an average
What defines normal and Hypertensive BP?
Norm: 160 or 100
What is the Effect of Incremental increase in SBP?
increase by 20mmHg
Doubles risk for MI, HF, Stroke, KD
What happens to BP with Age?
S and D increase together til 50 years old
Diastolic BP decreases after that
Systolic Continues to rise
What are Age related BV changes?
Young: Compliant vessels accomodates pulsitile fluid flow
Lots of ELASTIN
Older: Vessel Wall doesn’t change with each ventricular ejection
Lots of COLLAGEN
Sharp peak in pulse pressure
Differences are transmitted downstream
What are the causes of Essential vs Secondary HTN?
Ess: Genes, Environment
Sec: Chronic Kidney Disease, Renovascular Disease
Other(PheoCC(NE), Coarctation, Aldosteronism, Cushing)
What are the adaptations to the BV in response to HTN?
Atherosclerosis
Vasculitis(large stretches of narrowed BV)
Fibromuscluar Dysplasia
What is the difference in Tx between Essential and Secondary HTN?
2ndary: Treat the underlying cause
Essential: Need to treat the actual HTN. Much harder
What are the internal feedback mechanisms of blood pressure?
Baroreceptors
How does Obstructive Sleep apnea Affect BP?
Decreased threshold for activation of Chemoreceptors
Enhanced responsiveness of SNS/PNS outflow
What are the different Tx for Secondary HTN? Renovascular HTN Renal Parenchymal Disease Coarctation of Aorta Cush Dis/PCC Obs Sleep Apnea
Renovascular HTN: Correct Vascular Lesion(surgical)
Renal Parenchymal Disease: Replace Kidney
Coarctation of Aorta: Surgically fix the aorta
Cush Dis/PCC: Excise Tumor
Obs Sleep Apnea: Open the Airway btu there are many other factors
What is the Pathogenesis of Essential HTN? Genetic? Environmental?
Genetic: Salt Sensitivity Renal Clearance Abn Na Retension RAAS Symp Hyperactivity Immune Function
Envt: Stress
High Salt intake
Inactivity and Obesity
Drug and alcohol intake
What are lifestyle modifications to manage HTN?
Weight Reduction DASH eating plan Dietary Na Restriction Physical Activity Moderate EtOH consumption
What are the device based therapies to treat HTN?
Carotid Sinus Stimulation
BARORECEPTORS
