Wk 2: HTN & HLD

Question 1

RASS System

Answer 1

hormones regulating longterm BP through sympathetic nervous system
-angiotensionogen released by liver (response to low BP)
-low fluid volume -> kidneys release renin
-liver converts angiotensinogen to Angiotensin I
-Angiotensin I travels to lung and is converted to Angiotensin II by ACE
-Angiotensin II acts on adrenal glands to release aldosterone
-Angiotensin II is vasoconstrictor
**ultimately causes nephron to retain fluid and BP increases*

Question 2

Arterial Baroreceptors

Answer 2

-alter BP by altering HR
-receptors in the carotid sinus, aorta, and left ventricle
-impact vasodilation/ constriction

Question 3

Vascular Autoregulation

Answer 3

-maintains tissue perfusion
-regulates based on MAP
-alters resistance in arterioles
-keeps CONSISTENT BP at tissue level

Question 4

Blood pressure ranges
1. normal
2. elevated
3. stage 1 HTN
4. stage 2 HTN
5. hypertensive crisis

Answer 4

1. systolic <120; diastolic less than 80
2. systolic 120-129; diastolic less than 80
3. systolic 130-139; diastolic 80-89
4. systolic 140 or >; diastolic > 90
5. systolic > 180; diastolic >120

Question 5

Primary HTN
“essential hypertension”

Answer 5

-usually idiopathic
-can occur d/t interactions of genetic, environment, and neurohormonal effects

Question 6

Risk factors for primary HTN

Answer 6

smoking, excess sodium intake, HLD, sedentary lifestyle, stress, family Hx and genetics, obesity, age >60, African Americans, high alcohol consumption, insulin resistant pre-DM

Question 7

Secondary HTN

Answer 7

-KNOWN cause related to underlying Dz
-treatment includes treating underlying cause

Question 8

Risk factors for secondary HTN

Answer 8

renal disorder/Dz
adrenocortical tumors
adrenomedullary tumors
drugs

Question 9

Signs of end organ damage

Answer 9

chest pain (heart)
headache (brain)
visual changes (eyes)
weakness/pain in extremities (brain/stroke)

Question 10

longterm outcomes of HTN on the heart

Answer 10

-increased left ventricle work
-hypertrophy of left ventricle
-accelerated progression of atherosclerosis
-increased risk for aortic aneurysm

Question 11

longterm outcomes of HTN on kidneys

Answer 11

primary cause of end-stage renal disease

Question 12

longterm outcomes of HTN on the brain

Answer 12

higher risk for stroke, aneurysm, hemorrhage

Question 13

longterm outcomes of HTN on eyes

Answer 13

retinopathy and blindness

Question 14

longterm outcomes of HTN on lower extremities

Answer 14

gangrene, intermittent claudication

Question 15

HTN crisis

Answer 15

systolic >180 AND/OR diastolic >120
-acute condition
-two types: urgency and emergency
-most common in ppl with primary HTN
-rapidly progressive HTN

Question 16

Hypertensive Urgency

Answer 16

-no S/Sx of end organ damage
-BP > 180/120
-Treat with oral agents and GRADUALLY reduce BP
-causes: anxiety, pain, abrupt withdrawal

Question 17

Hypertensive Emergency

Answer 17

-uncontrolled BP leading to end organ damage
-BP >180/120
-Can lead to: stroke, brain hemorrhage, acute coronary syndrome, heart dysfunction
-Aggressively lower BP in minutes to hours with IV meds

Question 18

Classes of medications to treat HTN

Answer 18

Diuretics
Sympathetic nervous system blockers
Beta Blockers
Calcium Channel blockers
Vasodilators

Question 19

Three types of Diuretics

Answer 19

1. Potassium-Sparing (mild)
2. Thiazide (mild)
3. Loop (moderate to profound)

Question 20

MOA of general diuretics

Answer 20

-increased urine output
-decreased circulating volume
-decreased arterial resistance

Question 21

Thiazaide Diuretics
(Hydrochlorothiazide)

Answer 21

1st line of management of mild HTN
-can be used alone or with other anti-hypertensives

Question 22

MOA of Thiazaide Diuretics