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IPC Cardiology 1 > Pathophysiology of Hypertension > Flashcards

Pathophysiology of Hypertension Flashcards

1
Q

Types blood vessels

A
  • Arteries
  • Capillaries
  • Venules/veins
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2
Q

Arteries

A
  • Made of connective tissue,muscle,and endothelial cells
  • Take blood from heart to organs/tissues
  • Offer resistance to blood flow=resistance vessels
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3
Q

Capillaries

A

Termninal portions of arteries thar deliver oxygen/nutrients to organs

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3
Q

Venules/veins

A
  • Made up of small amount of muscle and connective tissue
  • Drain blood back from capillaries to heart
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3
Q

What are the arteries?

A
  • Has 3 layers(intima,media,adventitia)
  • Muscle: innervated by noradrenergic nerver fibers,constrictor in function
  • Endothelial cells: maintain structural, metabolic and signaling functions to maintain homeostasis
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4
Q

What is blood pressure?

A

Systolic(peak pressure during contraction)/diastolic(nadir pressure when cardiac chambers are filling)

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5
Q

BP equation

A

BP=(Cardiac output) x(Total Vascular Resistance)

Cardiac output= Stroke volume x Heart Rate

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6
Q

Factors that increase Cardiac ouput

A

Increased cardiac preload
—>Sodium and water retention from excess sodium intake or kidney sodium retention

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7
Q

Fcators that increase total vascular resistance

A

Vascular constriction
* Excess stimulation of RAAS
* Sympathetic system overactivity
* Endothelial derived factors

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8
Q

Factors influencing blood pressure

Cardiac output

A

Heart Rate
1. increase norepi and epi
2. increased sympathetic NS
3. decreased parasymp NS
Stroke volume
1. increased norepi and epi
2. increaed sympathtic NS
3. decreased parasympthetic NS
4. increased aldosterone
5. increased antidiuretic hormone

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9
Q

Factors influencing blood pressure

Total vascular resistance

A

**Circulating factors **
1. increased angiotensisn II
2. increased norepi and epi
Innervation
1. increased alpha-1
2. decreased beta-2
Local regulators
1. decreased Nitiric oxide
2. decreased Prostaglandins

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10
Q

Normal BP

A
  • SBP= <120mmHG
  • DBP=<80mmHg
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11
Q

Elevated BP

A
  • SBP=120-129mmHg
  • DBP=<80mmHg
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12
Q

Hypertension BP

A

** Stage 1**
SBP=130-139mmHg
DBP=80-89mmHg
Stage 2
SBP= >140mmHg
DBP= >90mmHg

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13
Q

Hypertensive urgency/emergency

A

SBP= >180mmHg
DBP= >120mmHg

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14
Q

What contributes to hypertension?

A
  • Autoregulation
  • Adrenergic tone(Sympa NS)
  • Humoral response
  • Diet and lifestyle
15
Q

Factors playing a role in elevated BP

A
  • Genetics
  • diet
  • physical activity
  • alcohol consumption
  • obesity
16
Q

Primary vs. Secondary Hypertension

A

Primary —> can not be attributed to any other single cause and can not be cured, but can be medically managed
Secondary —> attributed to another disease or medication

17
Q

Neuronal Regulation

A
  • alpha-1(arterioles and venules)—> stimulation causes vasoconstriction:** increased TVR**
  • alpha-2(central nervous system) : stimulation causes decreased release of peripheral catecholamines–> decreased BP
  • Beta-1 (heart) : stimulation causes increased HR(chronotropy) an increased force of contraction (ionotropy)–> increased BP
  • Beta-2 (arterioles and venules):vstimulation causes vasodilation–> decreased TVR
18
Q

Baroreceptor reflex system

A

Senses volume in large arteries
1. Decreased volume–> vasoconstriction, increased HR, increased contractility ->increased BP
2. Increased volume –>Vasodilation, decreased HR,decreased contractility->decreased BP

19
Q

Peripheral Autoregulation

A

Acute:increased BP due to reversible increased total vascular resistance
Chronically:areteriolar hypertrophy and thickening causing irreversible increase in totalvascular resistance

20
Q

Endothelial derived factors

A

Cause vasodilation and decreased total vascular resistance
* Nitric oxide
* Prostacyclin
* Bradykinin
Causes vasoconstriction and increased total vascular resistance
* Endothelin

21
Q

Non-endothelial derived factors that cause vasconstriction

A
  • increased intracellular calcium
  • Angiotensin II
  • Serotonin
  • Norepinephrine/epinephrine
22
Q

Natriuretic Hormones

A
  • Arial-derived natriuretic protein(ANP)
  • B-type natriuretic protein(BNP)
23
Q

Environmental factors that lead to hypertension

A
  • High sodium diet–> affects TVR
  • Low potassium diet–>increased total peripheral resistance
  • Low clacium diet–>increased vascular smooth muscle contraction due to increased gradient of intracellular vs. extracellular calcium
  • Obesity/physical inactivity–>overactivation of SNS, renal compression
24
Q

Secondary causes of hypertension

A
  1. Diseases
  2. Medications
  3. Diet
25
Q

Secondary Hypertension

Diseases

A
  • Chronic kidney diseas
  • Cushing’s disease(hypercortisolemia)
  • Obstructive sleep apnea
  • Pheochromocytoma
  • Primary aldosteronism
  • Hyperthyroidism
26
Q

Secondary Hypertension

Medications

A
  • Amphetamines(methylphenidate,detroamphetamine)
  • Corticosteroids(prednisone,dexamethasone)
  • Estrogen-containing oral contraceptives
  • Testosterone
  • Decongestants(pseudoephedrine)
  • Erythropoiesis stimulating agents(epoetin alfa)
  • NSAIDs
  • Certain anti-depressants(desvenlafaxine,venlafaxine,bupropion)
  • Cocaine

Abrupt withdrawal of central alpha-agonist(e.g clonidine) or beta-blocker

27
Q

Secondary Hypertension

Diet

A
  • High sodium diet
  • Excssive ethanol consumption
  • Licorice
28
Q

Complications of Hypertension

A

Starting at 115/75mmHg the risk of cardivascular disease DOUBLeS with every 20/10mmHg increase in BP

29
Q

Hypertension Screening

A
  • CVD Risk factors
  • Basic testing
  • Optional testing

Blood pressure readings :Average based on >2 readings obtained on > 2 occasions

30
Q

CVD Risk factors

Hypertension screening

A
  • Smoking
  • Diabetes
  • Dyslipidemia
  • Physical inactivity
  • Diet
  • Stress
  • Obstructive sleep apnea
31
Q

Basic Testing

Hypertension Screening

A
  • Fasting blood glucose
  • Complete blood cell count
  • Lipids Basic metabolic panel
  • Thyroid stimulating hormone
  • Unirnalysis
  • Electrocardiogram
32
Q

Optional testing

Hypertension screening

A
  • Echocardiogram
  • Uric acid
  • Urinary albumin-to-creatinine ratio
33
Q

What is BP?

A
  • BP–> The force o blood as it pushes on the arterial walls, depends on cardiac output and total vascular resistance
  • Systolic BP–>Maximal pressure on the arteries during ventricular contraction
  • Diastolic BP—>Resting pressure that the blood exerts between each ventricular contraction
34
Q

Fcators that may decrease BP readings

A
  • Acute meal ingestion(-6)
  • Cuff too large(-4)
  • Observer hearing deficit(-1 to -2)

IPC Cardiology 1 (6 decks)

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