treatment of hyperntesion

Question 1

bood pressue as a preictor of risk?

Answer 1

1905 ­ DBP - Convention
1971 ­ SBP - Framingham (Cohort)
1993 ­ DBP- SHEP MRC ( Committee)
& or ­ SBP -STOP

Question 2

what does elastic arteries do?

Answer 2

Reduces peak pressure
Maintains diastolic pressure
Smoothes blood flow
Improves efficiency

Question 3

diastolic blood pressue and risk?

Answer 3

Diastolic BP Risk
> 90 2.7
80-89 3.9
70-79 6.4

Question 4

PW velocites?

Answer 4

Young compliant arteries : Normal PW velocity (8 m/sec)

diastole - (1) Ventricular-Vascular coupling
(2) increase coronary blood flow

Elderly stiff arteries with ISH : Increased PW velocity (12 m/sec)

sytole - (1) Ventricular-vascular mismatch

(2) The reflected wave increases or “augments” central SBP during late systole:

 Increases vascular afterload with a propensity to develop LVH
 Decreases coronary perfusion pressure
 Increases myocardial oxygen demand and subendocardial ischemia
 Increases flow turbulence, endothelial dysfunction and atherogenesis
 Increases in pulsatile strain and chance of plaque rupture
All recognized by a wide brachial artery pulse pressure in the elderly

Question 5

non-invasive methods of assessing arterial stiffness?

Answer 5

Direct
Ultrasound
MRI

Indirect
Pulse pressure
Pulse wave velocity
Windkessel
Pulse wave analysis
Photoplethysmography

Question 6

windkessel?

Answer 6

Windkessel effect is a term used in medicine to account for the shape of the arterial blood pressure waveform in terms of the interaction between the stroke volume and the compliance of the aorta and large elastic arteries (Windkessel vessels). Windkessel when loosely translated from German to English means ‘air chamber’,[1][2] but is generally taken to imply an elastic reservoir.[3] The walls of large elastic arteries (e.g. aorta, common carotid, subclavian, and pulmonary arteries and their larger branches) contain elastic fibers, formed of elastin. These arteries distend when the blood pressure rises during systole and recoil when the blood pressure falls during diastole. Since the rate of blood entering these elastic arteries exceeds that leaving them due to the peripheral resistance there is a net storage of blood during systole which discharges during diastole. The distensibility of the large elastic arteries is therefore analogous to a capacitor.

Question 7

photoplethysmography?

Answer 7

A photoplethysmograph is a device used to optically obtain a volumetric measurement of an organ. The trace generated by the device is called photoplethysmogram.

Question 8

augmentation indx?

Answer 8

A measure of the contribution that wave reflection makes to the central pressure waveform
Depends on
Wave velocity
Magnitude of reflected wave
Site of wave reflection
An indirect measure of systemic stiffness and of wave reflection
Confounding factors

Question 9

physiology of pulse pressue

Answer 9

Question 10

essential hypertension?

Answer 10

dependent on cardiac output and peripheral resistance

Question 11

isolated systolic hypertension?

Answer 11

dependent on chage in arterial volume and arterial compliance

Question 12

isolated systolic hypertension?

Answer 12

‘A wide pulse pressure’

BHS
>160/<90 mmHg

JNC VI
140/<90 mmHg

Question 13

difference betweenisolated and essential hypertension?

Answer 13

Question 14

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Answer 14

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