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MD3001 - Cardiology Disease and Pathology > Pathophysiology of Hypertension > Flashcards

Pathophysiology of Hypertension Flashcards

1
Q

What type of hypertension is most common?

A

Systemic

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2
Q

Why is pulmonary hypertension less common?

A

May be idiopathic or associated with other diseases and is usually only diagnosed when severe and symptomatic

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3
Q

Causes of pulmonary hypertension

A
  • Hypoxia (decreased perfusion of the lungs)
  • Endothelial dysfunction
  • Genetics
  • Blockage/damage to pulmonary blood vessels (PE, sickle cell)
  • Side effects of some drugs
  • Left sided heart failure
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4
Q

What is abulatory blood pressure monitoring

A

when your blood pressure is being measured as you move around, living your normal daily life. Normally carried out over 24hrs

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5
Q

What is stage 1 systemic hypertension?

A

140/90mmHg or higher

(ABPM = 135/85mmHg)

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6
Q

What is stage 2 hypertension?

A

160/100mmHg or higher

(ABPM = 150/95mmHg)

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7
Q

What is severe/stage 3 hypertension?

A

BP is higher than 180mmHg systolic and higher than 110mmHg diastolic

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8
Q

What occurs in BP as you get older?

A
  • CO decreases
  • TPR increases
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9
Q

What is the cause of primary hypertension?

A

idiopathic or essential

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10
Q

What percentage of all cases of hypertension is primary hypertension?

A

>90%

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11
Q

What is secondary hypertension?

A

Hypertension with a known cause

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12
Q

What are the 2 main possible causes of primaru hypertension?

A
  • Increased TPR
  • Increased vascular reactivity
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13
Q

What occurs when there is an increase in TPR?

A
  • Balance between contraction/relaxation changes
  • Increased sympathetic nerve activity
    • Increased firing rate
    • Increased NA released (pre-synpatic effects of adrenaline and angiotensin II)
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14
Q

What occurs when there is an increase in vascular reactivity?

A
  • Increased [Na+]ECF
  • Pathological Na+/K+- ATPase inhibition
  • Damage to endothelium = decreased NO production
  • Altered blood vessel wall morphology = increased wall thickness to lumen ratio
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15
Q

What is nitric oxide?

A

Vasodilator substance

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16
Q

What occurs in the CNS to cause primary hypertension?

A
  • Increased basal sympathetic tone
  • abnormal stress response
  • abnormal response to signals from baroreceptors and volume receptors
17
Q

What occurs in the blood vessels to cause primary hypertension?

A
  • Decreased NO secretion
  • Increased endothelin production
  • Ca2+ or Na+/K+ channel defects
  • Hyperresponsiveness to catecholamines
  • Exagerrated medial hypertrophy
18
Q

What occurs in the adrenal gland to cause primary hypertension?

A

Catecholamine leak or malregulation

19
Q

What occurs in the baroreceptors to cause primary hypertension?

A

desensitisation

20
Q

What occurs in the kidney to cause primary hypertension?

A
  • RAA dysfunction
  • Ion channel defects **upregulation of renin release
21
Q

Causes of secondary hypertension

A
  • Chronic renal disease
  • Endocrine disorders
  • Coarctation of the aorta
  • Renovascular
  • Drugs
  • Pregnancy; pre-eclampsia, eclampsia
22
Q

Give examples of the endocrine disorders that can cause secondary hypertension

A
  • Cushing’s
  • Conn’s/Primary aldosternosism
  • Pheochromocytoma
23
Q

Risk factors for hypertension

A
  • Age
  • Modifable factors
  • Genetic factors
  • Psychogenic factors
24
Q

What are the modifable factors that cause hypertension?

A
  • Excercise
  • Diet
  • Obesity
  • Smoking
  • Alcohol intake
  • Stress
25
Q

What are the genetic factors that cause hypertension?

A
  • Abnormal inhibition of Na/K - ATPase
  • Family history
  • Being african or caribean in origin
  • Male
26
Q

What are the psychogenic factors that cause hypertension?

A

personality type

27
Q

What factors affect TPR by increasing SNS activity?

A
  • Psychogenic factors
  • Baroreceptor adaptation (high = new normal)
  • Presynaptic effects
28
Q

What factors affect TPR by increasing vascular reacitivy?

A
  • Damage to endothelium
  • Na/K - ATPase inhibitor
  • Dietry alterations of K and Na
  • Blood vessel structural changes
29
Q

What are the major causes of sudden death due to hypertension

A
  • Heart failure
  • myocardial infarction
  • Stroke
  • renal failure
30
Q

What occurs in heart failure?

A
  • Pressure overload from increased TPR; LV hypertrophy
  • Volume overlaod due to kidney failure; decreased actin-myosin overlap
31
Q

How does hypertension affect the vasculature?

A
  • Accelerated atherosclerosis
  • Stroke
  • Retinopathy
32
Q

What occurs in renal failure due to hypertension?

A
  • Autoregulation stops protecting the glomerulus
  • Albuminuria
  • Contained high pressure
    • Arteriolar walls thicken and narrow (sclerosis due to fibroblast activity)
  • Urine formation falls
    • Volume overload
    • Decreased clearance of creatine, urea and waste
33
Q

What affects does stage 1 hypertension have on the heart?

A
  • Normal size
  • Normal ECG
34
Q

What affects does stage 2 hypertension have on the heart?

A
  • LV hypertrophy
  • Left axis deviation
35
Q

What affects does stage 3 hypertension have on the heart?

A
  • Marked LV hypertrophy
  • Increased left axis deviation
  • Inverted T waves
36
Q

What affects does stage 1 hypertension have on the blood vessels/renal?

A
  • Narrowed retinal arteries
  • Renal function normal
37
Q

What affects does stage 2 hypertension have on the blood vessels/renal?

A
  • Retinal vein changes
  • Microalbuminuria but renal function = OK
38
Q

What affects does stage 3 hypertension have on the blood vessels/renal?

A
  • Retinal oedema/haemorrhage
  • Marked albuniburia
  • Falling creatine clearance

MD3001 - Cardiology Disease and Pathology (10 decks)

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