W.5: Hypertension Flashcards
Definition of hypertension
Pressure on arterial walls exceeding a defined threshold
Values normotension
Less than 120/80
Values pre-hypertension
Sys: 120-139 or dia: 80-89
Values stage I hypertension
Sys: 140-159 or dia: 90-99
Values stage II hypertension
Sys: above 160, or dia: above 100
Isolated systolic hypertension
Sys: above 140 AND dia: up to 90
Cause of essential (idiopathic) hypertension, % of all patients with hypertension?
No clear etiological factor (cause) can be identified, 80-90% of all hypertensive patients.
Cause of secondary hypertension, % of all patients with hypertension?
Clear etiological factor, 10-20% of all hypertensive patients.
How can we get increased intravascular volume? Response?
Eg. from eating lots of NaCl - Response will be increased sodium excretion (and increased BP)
Main effects of angiotensin II
Vasoconstriction, stimulation of aldosterone secretion, stimulation of vessel wall smooth muscle proliferation
Effect of aldosterone
Stimulation of Na-reabsorption
RAS pathway
Angiotensinogen (+renin)-> Angiotensin I (+ ACE-kinase II) -> Angiotensin II -> AT1 and AT2 receptor -> Aldosterone
What is the function of the baroreflex?
To smoothen the fluctuations in arterial pressure
alpha1 receptor
smooth muscle contraction, vasoconstriction
alpha2 receptor
presynaptic membrane, negative fb
beta1 receptor
heart, increases frequency and contractility
beta2 receptor
smooth muscle, vasodilation
Alteration in compliance when atherosclerosis is present?
Decreases the elasticity of the vessel wall, narrowing
One vasodilator
Nitric oxide
One vasoconstrictor
Endothelin
Manifestations of hypertrophy on the heart
- LVH
- Congestive heart failure (CHF)
- Coronary heart disease (CHD)
Disease of what organ is the most frequent causative factor in secondary hypertension?
Kidney disease
Important early detection laboratory test of kidney disease
Albuminuria
Causes of renal hypertension
- Parenchymal (chronic kidney disease)
- Renovascular (atherosclerosis)
Causes of endocrine hypertension
- Primary aldosteronism
- Cushing syndrome
- Pheochromocytoma
- Hyperthyroidism
- Acromegalia
Causes of drug induced hypertension (what drugs)
- Estrogen/androgen hormone supplementation
- NSAIDS
- Chronic alcohol intake
- Antidepressants
- Immunosupressive agents (cyclosporins, tacrolimus)
Selected laboratory tests upon initial diagnosis of hypertension: Kidney function
- Urine sediment
- Urine albumin
- Urine sodium/potassium ratio
- Serum creatinin
Selected laboratory tests upon initial diagnosis of hypertension: Endocrine
- Serum sodium
- Potassium
- Calcium
- TSH
Selected laboratory tests upon initial diagnosis of hypertension: Metabolism
- Fasting blood glucose
- Total cholesterol
- HDL
- LDL-cholesterol
- Triglyceride
Therapy for essential hypertension
Target:
- Intravascular volume: Diuretics, ACE-inhib., aldosterone antagonists
- Contractility: beta-blocker
- Vessel wall function: Alpha1-blocker, alpha2-agonist, calcium-channel inhib.
- Vessel wall structure: Cholesterol lowering agents
