11/8 Hypertension - Kostis

Question 1

classification of HTN

essential HTN

Answer 1

essential HTN (90-95%)

thought to be related to one or more of following:

• changes in SNS and RAAS
• renal dysfx
• genetic/environmental factors

Question 2

classification of HTN

secondary HTN

Answer 2

secondary HTN (10-5%)

• acute or chronic kidney disease
• renovasc HTN (RAS)
• primary aldosteronism
• thyroid disease (hyper/hypo)
• Cushing Syndrome
• pheochromocytoma
• aortic coarctation
• obstructive sleep apnea
• drug-induced

Question 3

determinants of bp

Answer 3

1. cardiac output
   
   • heart rate
   • stroke volume
     
     • contractility
     • venous return
       
       • venous tone
       • blood volume
         
         • thirst
         • renal retention
2. peripheral resistance
   
   • circulating regulators
   • direct innervation
   • local regulators
   • blood viscosity

Question 4

primary abnormalities in essential HTN

(potential)

Answer 4

1. blood vessels
2. CNS
3. pressure/volume receptors
4. adrenal
5. kidney

Question 5

what tends to cause essential HTN in…

• younger people?
• older people?

Answer 5

younger people → cardiac output

older people → total peripheral resistance

• decr in vascular compliance!
• atherosclerosis!

Question 6

difference between high compliance and low compliance vasculature (ex. young vs old)

Answer 6

the same change in stroke volume will result in diff changes in pressure depending on the compliance of vessels involved

• high compliance? → relatively small change in pressure
• low compliance? → relatively large change in pressure!
  
  • sys bp, pulse pressure, and pulse wave velocity all increase

Question 7

consequence of pulse wave pressure increase

Answer 7

if you have compliant arteries, the pulse wave is relatively slow → followed by a reflected wave that is relatively slow/arrives relatively late

if you have noncompliant arteries, the pulse wave is faster → reflected wave arrives faster (fast enough to augment systolic bp!)

Question 8

freq of untreated HTN

Answer 8

younger individuals: mostly isolated diastolic elevation

older individuals: mostly isolated systolic elevation

Question 9

major consequences

• heart failure
• MI/infarction
• aortic aneurysm/dissection
• stroke
• nephrosclerosis & renal failure
• retinopathy

Answer 9

Question 10

risk and tx of HTN

Answer 10

relationship of bp to risk of CVD is continuous and consistent; also interacts with other risk factors

• every 20/10mmHg increment = 2x risk CVD (starting 115/75)
• preHTN signals need for incr education! → reduce bp → prevent HTN

bp medication lowers incidence of

• stroke
• MI
• heart failure

Question 11

algorithm for HTN tx

Answer 11

1. lifestyle modification!

• failure to meet goal → move on to drugs
  
  • goal: <140/90 (<130/80 for diabetic/chronic kidney disease)

2. initial drug choices

• compelling indications : specific drugs for those indications
• no compelling indications
  
  • Stage 1 HTN (140-159/90-99) : thiazide type diuretics for most
  • Stage 2 HTN (>160/>100) : 2 drug combo (thiazide diuretics + other)

what if still not at goal bp?

• optimize dosages or add addtl drugs
• consider consult with HTN specialist

Question 12

compelling indications and clinical trial/guideline basis

Answer 12