Hypertension

Question 1

How do you calculate blood pressure and cardiac output?

Answer 1

BP = cardiac output x total peripheral resistance
CO = stroke volume x heart rate

Question 2

What are the current joint national committee levels for hypertension?

Answer 2

Normal: 120/80
Pre HTN: 120/80 - 139/89
HTN 1: 140/90 - 160/100
HTN 2: >160/100

Question 3

What has control over blood pressure regardless of how high cardiac output and total peripheral resistance are?

Answer 3

Renal Excretion

Question 4

How does the carotid sinus regulate blood pressure?

Answer 4

• High blood pressure stretches the carotid sinus.
• The stretch in the vessel wall sends a signal up CN IX to the nucleus tractus solitaries in the brainstem medulla
• sympathetic stimulation is inhibited and parasympathetic stimulation occurs

Question 5

How does the aortic arch regulate blood pressure?

Answer 5

• High blood pressure stretches the carotid sinus.
• The stretch in the vessel wall sends a signal up CN X to the nucleus tractus solitaries in the brainstem medulla
• sympathetic stimulation is inhibited and parasympathetic stimulation occurs

Question 6

How is essential hypertension diagnosed?

Answer 6

It is diagnosed by exclusion. When all other etiologies are ruled out you are left with primary or essential hypertension.

Question 7

What are the 4 theoretical mechanisms explaining how hyperinsulinemia may cause essential HTN?

Answer 7

1. Stimulates Renal absorption increasing volume
2. Increases SANS activity increasing circulating catecholamines
3. Mitogen that stimulates vascular smooth muscle hypertrophy
4. Alters membrane transport increasing intracellular calcium and vascular tone

-a mitogen is a chemical substance (like insulin) that encourages mitosis

Question 8

What is the theory behind leptin contributing to essential hypertension?

Answer 8

Leptin activates the SANS

Question 9

What is the difference in the proposed cause of essential hypertension in younger patients vs. older patients? What would the treatments then be?

Answer 9

Younger: due to elevated CO
-Tx: beta blockers

Older: due to elevated TPR
-Tx: vasodilators

Question 10

Top two most common causes of Renovascular HTN (a type of secondary HTN) and treatments for each.

Answer 10

Men: atherosclerosis
-Tx: stent

Women: fibromuscular dysplasia
-Tx: angioplastic balloon

Question 11

Treatment for a unilateral Renal artery stenosis leading to Renovascular HTN.

Answer 11

ACE-Is

Question 12

What is the mechanism that leads to secondary HTN in a patient with aortic coarctation?

Answer 12

1. Coarctation causes low renal blood flow (RBF)
2. Kidneys respond to low RBF with Renin-Ag-Ald system
3. Atherosclerosis also occurs proximal to the stenosis and baroceptor’s neural regulation is less sensitive

Question 13

Radiography clue to aortic coarctation and treatment.

Answer 13

Dx: notched ribs on chest X-ray

Tx: angioplasty

Question 14

Tx. for pheochromocytoma.

Answer 14

Phenoxybenzamine

Question 15

Etiology and diagnosis of primary vs. secondary aldosteronism.

Answer 15

Primary
Cause: aldosterone-secreting adenoma in adrenal glands
Dx: high aldosterone levels and low renin levels

Secondary
Cause: renin-secreting tumor
Dx: high renin levels, high Ag II levels, low aldosterone levels

Question 16

What changes to the heart can occur with chronic HTN that is a huge indicator for morbidity?

Answer 16

Left Ventricular Hypertrophy

Question 17

What is noticed on ophthalmoscopy exam that would indicate need for neurosurgery consult?

Answer 17

Papilledema