Arteries Capillaries Venules/veins

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

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

Pathophysiology of Hypertension Flashcards by Shaneka Johnson

Types blood vessels

Arteries
Capillaries
Venules/veins

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Arteries

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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Capillaries

Termninal portions of arteries thar deliver oxygen/nutrients to organs

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Venules/veins

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

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What are the arteries?

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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What is blood pressure?

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

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BP equation

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

Cardiac output= Stroke volume x Heart Rate

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Factors that increase Cardiac ouput

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

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Fcators that increase total vascular resistance

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

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Factors influencing blood pressure

Cardiac output

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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Factors influencing blood pressure

Total vascular resistance

**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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Normal BP

SBP= <120mmHG
DBP=<80mmHg

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Elevated BP

SBP=120-129mmHg
DBP=<80mmHg

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Hypertension BP

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

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Hypertensive urgency/emergency

SBP= >180mmHg
DBP= >120mmHg

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What contributes to hypertension?

Autoregulation
Adrenergic tone(Sympa NS)
Humoral response
Diet and lifestyle

Factors playing a role in elevated BP

Genetics
diet
physical activity
alcohol consumption
obesity

Primary vs. Secondary Hypertension

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

Neuronal Regulation

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

Baroreceptor reflex system

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

Peripheral Autoregulation

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

Endothelial derived factors

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

Non-endothelial derived factors that cause vasconstriction

increased intracellular calcium
Angiotensin II
Serotonin
Norepinephrine/epinephrine

Natriuretic Hormones

Arial-derived natriuretic protein(ANP)
B-type natriuretic protein(BNP)

Environmental factors that lead to hypertension

* 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

Secondary causes of hypertension

1. Diseases 2. Medications 3. Diet

Secondary Hypertension | Diseases

* Chronic kidney diseas * Cushing's disease(hypercortisolemia) * Obstructive sleep apnea * Pheochromocytoma * Primary aldosteronism * Hyperthyroidism

Secondary Hypertension | Medications

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

Secondary Hypertension | Diet

* High sodium diet * Excssive ethanol consumption * Licorice

Complications of Hypertension

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

Hypertension Screening

* CVD Risk factors * Basic testing * Optional testing ## Footnote Blood pressure readings :Average based on >2 readings obtained on > 2 occasions

CVD Risk factors | Hypertension screening

* Smoking * Diabetes * Dyslipidemia * Physical inactivity * Diet * Stress * Obstructive sleep apnea

Basic Testing | Hypertension Screening

* Fasting blood glucose * Complete blood cell count * Lipids Basic metabolic panel * Thyroid stimulating hormone * Unirnalysis * Electrocardiogram

Optional testing ## Footnote Hypertension screening

* Echocardiogram * Uric acid * Urinary albumin-to-creatinine ratio

What is BP?

* 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

Fcators that may decrease BP readings

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