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Pathophys > Primary (Essential) Hypertension & Overview of Renal Disease > Flashcards

Primary (Essential) Hypertension & Overview of Renal Disease Flashcards

1
Q

Describe the comparison between benign & malignant HTN?

  • Etiology
  • Age
  • Incidence
  • Course
  • Diastolic - BP
  • Change in BP
A
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2
Q

HTN is defined as _____.

  • Stage I
  • Stage II
A
  • >140/90
  • Staging
    • Stage I
      • 140-159 / 90-99
    • Stage II
      • >160 / >100
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3
Q

Describe the demographics of benign (essential) primary HTN in white & black adults?

A
  • White adults in US: 20% hypertensive
  • Black adults in US: 30% are hypertensive and have 2x the frequency of hypertensive retinopathy than whites
  • of all hypertensives, >50% are over age 65 years
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4
Q
A
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5
Q

Describe the demographics in Canda vs US.

A
  • Prevalence of HTN in US & Canada: 21.1% of all canadians age 18 and older, vs. 20.1% in the US
  • Study found that higher percentage of canadians w/ HTN go untreated for the condition, and that more candians are unaware of their HTN than their US counterparts (at 30%)
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6
Q

Describe the relative risks for cerebrovascular accident & alzheimer’s disease

A
  • Cerebrovascular Accident
    • ​Relative risk increases 1.84 for each 10mmHg DBP
    • Midlife hypertension raises longterm CVA risk
  • Alzheimer’s Disease
    • Increased SBP in middle age is predisposing factor
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7
Q

What are the Pre-Disposing Risks Factors for HTN?

A
  • Age
  • Smoking
  • Alcohol beyond 1-2 drinks/day
  • Inactivity
  • Obesity
  • Diet - especially salt
  • Genetics
  • Stress/increased sympathetic tone
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8
Q

What is the equation for mean arterial pressure?

A
  • MAP = (CO x PR) + CVP
    • Because CVP is usually at or near 0 mmHg, we can simplify to:
    • MAP = (CO x PR)
    • Therefore, changes in CO or PR will affect MAP
    • CO = HR (beats/min) x SV (ml expelled/beat)
    • MAP = SBP + 2 (DBP)/3
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9
Q

At constant pressure, flow increases proportional to the diameter of the _____ to the ____ power. Thus small reductions in diameter produce significant reductions in flow. Thus to maintain flow, pressure has to ____.

A
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10
Q

What are the factors affecting cardiac output (CO) and Peripheral Resistance (PR)? Define Autoregulation?

A

CO

  • Heart rate
  • Stroke volume
  • Contractility

Perpheral Resistance

  • Include constricting & dilating humoral & neural factors
    • Humoral constrictors - angiotensin II, catecholamines, thromboxane
    • Humoral dilators - prostaglandins, kinins, nitric oxide
    • Neural constrictors - alpha adrenergic
    • Neural dilators - beta adrenergic
  • Autoregulation: also influences local resistance; this is property of local vasoconstriction to reduce flow presumably to protect from hyperfusion
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11
Q

Describe the Histology of Glomerulus

A
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12
Q

In the renin-angiotensin system, a drop in BP causes what?

A
  • renin release and angiotensin II production and therefore vasconstriction
  • Sodium homeostasis and therefore blood volume is controlled by the kidney
  • Aldosterone (secreted by the adrenal in response to angiotensin II). And thus indirect result of renin release
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13
Q

Describe the Renin-Angiotensin System?

A
  • Renin is proteolytic enzyme produced by the juxtaglomerular cells in the kidney
    • ​Catalizes conversion of circulating protein angiotensinogen to angiotensin I (a physiologically inactive substance)
  • Angiotensin I is rapidly converted to angiotensin II in lungs by ACE (Angiotensin converting enzyme)
    • Angiotensin II also stimulats release of aldosterone from the zona glomerulosa of the adrenal gland, which results in a further rise in blood pressure related to sodium and water retention
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14
Q

Renin secretion is controlled by what 4 main factors?

A
  • A renal vascular receptor responds to changes in tension in the afferent arteriolar wall
  • A macula densa receptor detects changes in the delivery rate or concentration of NaCL in the distal tubule
  • Circulating angiotensin has a negative feedback effect on renin secretion
  • Sympathetic nervous system stimulates renin secretion via the renal nerve mediated by receptors
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15
Q

Inhibition of _____ is effective against lower blood pressure.

A
  • ACE
  • The circulating renin-angiotensin system is not thought to be directly responsible for the rise in BP in essential hypertension. In particular many hypertensive pt have low levels of renin & angiotensin II (especially elderly & black people) , and drugs that block renin are not particularly effect. But inhibition of the enzyme ACE is effective
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16
Q

overall _____ activity is elevated in HTN.

A
  • Sympathetic activity
  • Young hypertensives have increased levels of catecholamines in circulation, faster heart rate and an increased vascular reactivity to norepinephrine.
    *

Pathophys (9 decks)

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