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Physiology Hypertension > Physiology Hypertension > Flashcards

Physiology Hypertension Flashcards

1
Q

What does AMA recommend diagnosis of hypertienion is systolic or diastolic pressures were meausred to greater than….

A

140/90

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2
Q

How many Americans are hypertensive?

A

50 million

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3
Q

What is the optimal/NOrmal BP according to JNC 7

What is BP that is considered to be hypertenstive

A

140/90

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4
Q

What is Secondary Hypertension

A

Patents in whom a cause can be determined

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5
Q

What is primary hypertension

A

When a cause cannot be determined

we can essentially have no idea what’s causing it

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6
Q

What are some examples of secondary Hypertension (5)

A

Pheochromocytoma

Renal artery Constirction

Primary hyperaldosteronism (Conn’s syndrome)

Aortic Coarctation

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7
Q

Pehochromocytoma- what is it?

Tx?

A

Non-malignant tumor of chromaffin tissue which produces and releases catechoalmines

Tx: cut it out when possible

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8
Q

Renal artery constriction

A

Diagnosed by renal arteriogram

Reduces renal artery pressure and increases renin relase

Tx: Resect or dialte the constrction

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9
Q

Pirmary hyperalodsteronisn (Conn’s Syndrome)

A

excess productino f the mineralcorticoid causes retention of salt and water

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10
Q

Aortic Coarctation

A

produces upper body hypertension with lower body being normotenxive

Rx: Surgical Correction

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11
Q

What are risk factors for Essential Hypertension (95-99% of people)
(6)

A
  1. GEnetic
  2. Race
  3. Aging
  4. Salt Intake
  5. Obesity
  6. Psychological Stress
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12
Q

Race as a factor for hypertentions

African Americans vs whites

Chinese peple vs Chinese Americans

A

African Americans have 2-3x greater risk

Yet, not tentire

Chinese peopel have low insidence of hypertension, while Chinese Americans suffer the same high incidence as teh American national average

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13
Q

Aging. Wha tis risk of having hypertension if 55-65 year olds live up to be 80

A

90%

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14
Q

How does increasein BP with age affect systolic and diastolic presures

A

Systolic pressures continously increase with age

Diastolic pressure rises with age until late 50s then actually declines!

This means Pulse Pressure increases with age

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15
Q

What diseases does Hypertensino put you at risk for? (4)

A

Coronary disease

Stroke

Peripheral Artery Disease

Cardiac Failure

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16
Q

What is the minimum daily intake of sodium of “average American”

A

10-15

while minimum dialy intake of sodium is about 0.5 gm/day

17
Q

Equation for CHange in Pressure

A

Change in Pressure = Flow x Resistance

Arterial P could be increased by either incrase in CO or TPR

18
Q

How does CO elevate? What becomes more sensitive

A

Increase in cardiac puping secondary to increased beta adrenoreceptor sensitivity

no evidence that cardiac sensitiivyt is increased in chronic hypertensino, but increased beta 1 adrenoceptor numbers can be seen durign onset of hypertension

19
Q

How else could CO be incrased

A

by increased Venous return via a preload effect

20
Q

How does positive fluid balance affect CO

A

Positive fluid balance (input-output > 0) could produce retention of fluid, overinflation of vascular system and increased venous return

21
Q

What does positive fluid balance imply

A

there must be inappropriate renal functioning to retain fluid in spite of elevated arterial pressure

22
Q

ECF and plasma volumes of chronic hypertensive patients

A

generally within the nomral range

however, proponesents argue that hypertension could be intitaitoed by sustaned increase in BV of as alittle as 5% change that is too small to be meausred

23
Q

what are two ways of periphearl resistance changing

A

Intrinsic arteriolar changes (arteriol narrowing)

Extrinsic

24
Q

Intrinsic arteriolar changes

A

Arteriole media is thickened in hypertensive patients and

encroaches on the lumen,

tehreby reducing its diamter and increaseing its resistance

This ia SEONCDARY of high pressure and not the cause of hypertension, but may aid in progression and maintenance of the probelm

25
Q

Vascular sooth uscles of muslce of hypertenisve peopel

A

hypersenstive to wide variety of agonsists

these changes occur before hypertensino, and perist in vacular beds of hypertenisve indicual which hve een protected agaisnt high pressure

Hypersensitivey is NOT a seconary effect, and may result in increased resistance to flow

26
Q

Extrinsic influences on arteries

A

Even if peripheral vascuularture is normal in sturcture and funciton it may be abnormally constricted by increased levels of stimulation, eitehr neural or humoral

A tthis point we have moved teh intiating event away from teh vasculature to other areas

27
Q

What is nerual influence of arteries and resistance

A

presence f elevated sympathetic nerve activity in hypertenstive rat have been well esatlbished

BaroR may laterd in hpertenives

28
Q

What CNS areas are improtant for CV regulation (3)

A
  1. Nucleus solitarius- major synapse point for BaroR input
  2. Hypothalamus- has major effect on thurs, ADH, fluid balnace, temp regulation
  3. Cerebral cortex- has multiple connectiosn with the hypothalamus and thus NTS
29
Q

What is teh CNS transmitter that is related to BP control

A

NE

Alternation in NE levels, alpha 1 adrenoceptor number and NE turnover are all seen in vairous CNS areas of expereimentally hypertenstive animals

30
Q

What aother HUMORAL influences have been nomianted a role in hypertension

A

Renin-angiotesin sstem- most popular humoral system

  1. Ang II has a direct constirctor effect on vascular SM
  2. Angi II and Ang III situalte relaese of aldosterone –> increase BV by its renal effects
  3. Ang II has effects in hypothalamus and other CNS areas that affect thirs, ADH and symp nerve activity
31
Q

How mnay hyeprtensive pateints have elevated renin

A

only 1/3 hypertensive patients

1/3 are normal

1/3 have nomral renin levels

32
Q

What are other humor agents in hypertension

A

Bardykinin
PG
Natriuretic homrone
Antihypertensive nueutral renal lipid

33
Q

What is the ajor treatmetn probem

A

patient complieance!

34
Q

What are CO changes

A

Sympathetic stimulation

Beta 1 hypersensitivity

Increased vascular volume, Preload

35
Q

What are periphearl resistance changes

A

Arteriole changes: hypersensitivity, wall thickening

Elevated sympathetic stimualtion SH Rat

Humoral stimulation

Renin-angio

Mosaic theory

36
Q

Hypertenstive Treatmetn

A

Lifestyle Modification

Drugs

37
Q

What kind of dugs

A 
Diurectics
Beta blockers
Ace inhibitors
A2 inhibitors
Ca ch blockers
alpha 1 blockers
central alpah 2 blockers
direct vasodilators

Physiology Hypertension (2 decks)

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