systemic hypertension Flashcards
what is stage 1 hypertension
> 130/80
How is MAP derived
TRP x CO
how is CO derived
HR x SV
how is SV derived
diastolic - systolic
Volume of blood ejected from each ventricle per beat
what are the structural causes that induce sustained elevation of BP in essential hypertension
endothelial dysfunction (NO, endothelial) vdmc constriction (calcium)
what are the functional causes that induce sustained elevation of BP in essential hypertension
increased wall mass (hypertrophy and hyperplasia)
wall remodeling with no increase in mass
describe functional and structural rarefaction
Rarefaction Decrease of number of vessels in parallel with increase resistance
In functional rarefaction the vessels are there but not being perfused this can then turn into structural rarefaction where then the vessels degrade
what does a decrease in the number of
vessels in parallel do to the network
vascular resistance
increases the resistance
what happens to the chamber size in hypertension
decreases since the wall thickens
what happens to the diastolic filling in hypertension
decreases due to decreased ventricular compliance (stiffness)
define after load
Resistance that the left ventricle has to overcome to eject blood
what impact does insulin resistance have on the pathophysiology of hypertension
VSMC hypertrophy and increased resistance
what impact does obesity have on the development of hypertension
increases angiotensinogen, increased blood viscosity, augments blood volume
when do you assess for secondary hypertension
- Age ( before 20 or after 50)
- Severity – dramatic
- Onset- acute
- Associated symptoms – ie renal artery bruit
- Family history – not common
is Reduced nephron number a risk factor for hypertension
yes
how does an Abdominal aortic aneurysm occur in hypertension
Usually below the renal artery so high perfusion leads to Prominent dialation then weakened by the high flow and atherosclerosis
how does an aortic dissection occur in hypertension
weakened intima media is then collapsed by high pressures
what are two pathologies of the kidney that develop with hypertension
renal failure
Hyaline arteriolosclerosis
Fibrinoid necrosis (SM hypertrophy and necrosis of cap walls)
what does ischemia in the optic nerve result in
blurred vision
what is a sign of acute hypertension
hemorrages, exudates
what is a sign of very high BP with high ICP
Pailledema
what is a sign of chronic hypertension
Increased light reflection- arterial sclerosis
ID some things that can lead to increased BP
estrogens can lead to increased angiotensinogen glucocorticoids epo cyclosporine sympathetic activity NSAids Ang II
how does renal parenchymal disease lead to hypertension without impacting GFR
excessive renin elaboration
often causes fibromuscular lesions in the media of the vessel
how can you ID renovascular hypertension
renal artery bruit or unexplained hypokalemia
can you treat renovascular hypertension with ACEi
yes IF its not bilateral and they don’t have an already reduced GFR
what are some symptoms of pheochromocytoma
NE secreting tumor resulting in
headaches, sweating, palpitations and tachycardia
what is cushings syndrome
excessive glucocorticoid secretion central obesity round face proximal muscle weakness hirsutism
what are Cotton Wool Spots on retina exam
Accumulations of debris within bundles of unmyelinated ganglion cell axons due to focal ischemia
what are some ways that Hyperinsulinemia / Insulin resistance can cause hypertension
Increased sympathetic activity, volume expansion from increased renal sodium reabsorption,
upregulation of angiotensin II receptors, and decreased cardiac natriuretic peptide (protein released by heart to reduce arterial pressure)
