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Pathophysiology > Adult Cardio 4 (Hypertension) > Flashcards

Adult Cardio 4 (Hypertension) Flashcards

1
Q

____ is sustained elevation of systemic arterial blood pressure

A

Hypertension

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2
Q

Hypertension may also be explained as a state of abnormal ___ function and structure associated with endothelial dysfunction, vascular smooth muscle constriction or remodeling, increased impedance to left ventricle ejection, and propensity for atherosclerosis, often but not always manifested by elevated blood pressure

A

Arterial

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3
Q

Is systolic BP on the top or bottom of the BP reading?

A

Top (systolic/diastolic)

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4
Q

Normal blood pressure is…

A

<120/<80

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5
Q

Elevated blood pressure is…

A

120-129 systolic AND <80 diastolic

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6
Q

Stage 1 hypertension is…

A

130-139 systolic OR 80-89 diastolic

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7
Q

Stage 2 hypertension is…

A

140+ systolic OR 90+ diastolic

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8
Q

A hypertensive crisis would indicate what BP readings?

A

180+ systolic OR 120+ diastolic

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9
Q

Before menopause, women tend to have ____ blood pressure than men but its flips after menopause

A

Lower

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10
Q

Blood pressure relationship to the risk of ___ ___ is continuous, consistent, and independent of risk factors

A

Cardiovascular disease

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11
Q

Each increment of __/__ mmHg doubles the risk of cardiovascular disease across entire blood pressure range starting from 115/75 mmHg

A

20/10

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12
Q

At early stages of hypertension, there are no manifestations, therefore it is difficult to achieve treatment ____

A

Compliance

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13
Q

AT early stages, the inconvenience of ___ ___ or side effects of the medication may be worse than nonexistent symptoms

A

Lifestyle modifications

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14
Q

What can happen if elevated blood pressure is not detected?

A

-Hypertension becomes established
-It promotes accelerated atherosclerosis and CVD beginning at age 30
-End organ damage

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15
Q

Lowering blood pressure can reduce risk of stroke by ___-___%

A

35-40

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16
Q

Lowering blood pressure can reduce the risk of MI by ___-___%

A

20-25

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17
Q

Lowering blood pressure can reduce the risk of heart failure by ___%

A

50%

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18
Q

The etiology of hypertension is unknown, but seems to result from a complicated interaction between ___ and the ___

A

Genetics, environment

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19
Q

An increase in __ __ and __ __ causes sustained increases in blood pressure

A

Vascular tone, blood volume

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20
Q

What environmental factors can increase risk of hypertension?

A

-Inactivity
-Stress
-Obesity
-Tobacco
-Age
-Salt
-Alcohol

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21
Q

Blood pressure is equal to ___ x ___

A

Cardiac output x peripheral resistance

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22
Q

Hypertension means ____ cardiac output and/or ___ peripheral resistance

A

Increased, increased

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23
Q

Cardiac output is equal to ___ x ___

A

Heart rate x stroke volume

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24
Q

A small change in diameter (vasoconstriction) results in large changes in ___

A

Resistance

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25
Q

Increased vasoconstriction=increased resistance–> major factor in generating increased pressure leading to ____

A

Hypertension

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26
Q

The kidneys release renin which leads to the creation of ____ and ____ which both lead to vasoconstriction

A

Angiotensin I and Angiotensin 2

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27
Q

What type of drug prohibits the formation of angiotensin II, leading to decreased vasoconstriction?

A

ACE inhibitors

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28
Q

A shift in the ___-____ relationship can influence total plasma volume

A

Pressure-natriuresis (sodium excretion)

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29
Q

For a given blood pressure, patients with hypertension tend to secrete ___ salt in their urine

A

Less

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30
Q

The pressure-natriuresis relationship is believed to be a central process in the pathogenesis of ____

A

Hypertension

31
Q

There “sensor” in the kidney can sense blood flow because it is the ___ organ to receive blood flow; so, if the kidney is getting enough blood, every other organ should also be getting enough (if it is not, that means other organs are likely not getting enough)

A

Last

32
Q

What things can lead to decreased renal salt excretion (indicative of hypertension)?

A

-Genetics
-Increased sympathetic nervous system response
-Increased renin, angiotensin, aldosterone (especially aldosterone)
-Endothelial dysfunction
-Dysfunction of the natriuretic hormones
-Renal glomerular and tubular inflammation
-Obesity
-Insulin resistance
-Increased dietary sodium intake
-Decreased dietary potassium, magnesium, and calcium

33
Q

What genetic/environmental factors contribute to sustained hypertension?

A

-Insulin resistance
-Dysfunction of the SNS, RAA, adducin, and natriuretic hormones
-Inflammation
-Vasoconstriction
-Renal salt and water retention
-Increased peripheral resistance
-Increased blood volume

34
Q

Black people have variations of the ____ ___ gene associated with hypertension and renal disease

A

Apolipoprotein L1

35
Q

What genetic factors can lead to higher risk of hypertension?

A

-Family history
-Age
-Gender
-Black race
-High dietary sodium intake
-Glucose intolerance
-Cigarette smoking
-Obesity
-Heavy alcohol consumption
-Low dietary intake of K+, Ca++, and Mg++

36
Q

Increased sympathetic nervous system activity can cause…

A

-Increased heart rate and peripheral resistance
-Increased insulin resistance
-Vascular remodeling
-Procoagulant effects
-Endothelial dysfunction
-Narrowing of vessels and vasospasm
-Hypertension

37
Q

The renin-aldosterone-angiotensin system causes persistent increases in ___ ___ __ and __ ___ __

A

Peripheral vascular resistance; renal salt retention

38
Q

Angiotensin II is responsible for…

A

-Remodeling
-Endothelial dysfunction
-Platelet aggregation
-Myocardial hypertrophy

39
Q

Aldosterone leads to…

A

-Sodium retention
-Toxic to the cardiovascular system

40
Q

Endothelial injury/tissues ischemia leads to ____ release

A

Cytokine

41
Q

The release of cytokines leads to…

A

-Vascular remodeling
-Smooth muscle contraction
-Decreased production of vasodilators (nitric oxide)
-Increased production of vasoconstrictor (endothelin)

42
Q

Decreased renal perfusion leads to ___ ___ and ___ ___

A

Tubular ischemia and preglomerular arteriopathy

43
Q

Decreased renal perfusion caused decreased sodium ___ and increased sodium ___

A

Filtration, retention

44
Q

Membrane-bound ____ located on the endothelium converts angiotensin I to angiotensin II locally, and metabolizes the endogenous vasodilator, bradykinin

A

ACE

45
Q

Powerful vasoconstrictors that act on vessel smooth muscle include proteins known as ____ and the local action of ACE on the endothelium

A

Endothelins

46
Q

Endothelins are ___ times more potent than angiotensin

A

10

47
Q

Endothelins (ET-1, ET-2, and ET-3) are extremely powerful ____

A

Vasoconstrictors

48
Q

ET-1 is produced in a variety of tissues including…

A

-Endothelial cells
-Vascular smooth muscle cells
-Neurons
-Astrocytes
-Endometrial cells

49
Q

ET-2 and ET-3 are produced within the ___ and ____

A

Kidney and intestines

50
Q

There are ___ receptors for the ET isoforms

A

3

51
Q

Endothelin-A receptor is found largely in ___ ___ ___ and ___ and is responsible for mediating vasoconstriction

A

Vascular smooth muscle and myocardium

52
Q

Endothelins are hightly active, potent, pleiotropic protein molecules that are involved in…

A

-Vasoconstriction
-Platelet aggregation
-Neutrophil adhesion
-Development of atherosclerosis
-Pulmonary hypertension
-Mediation of vascular and cardiac remodeling

53
Q

Vasoactive substances that cause constriction tend to induce ___ ___

A

Cell growth

54
Q

Substances that cause ___ tend to inhibit cell growth

A

Dilation

55
Q

If the homeostasis between substances that cause constriction vs dilation is not maintained, ___ ____ develops

A

Endothelial dysfunction

56
Q

Endothelial cells produces ___ ___

A

Nitric oxide

57
Q

Endothelial dysfunction means that endothelial cell layers lose their ability to balance ____ vs ___ ___ (leads to focus on endothelin which causes prolonged vasoconstriction)

A

Endothelin vs nitric oxide

58
Q

What things modulate renal sodium excretion?

A

-Atrial natriuretic peptide
-B-type Atrial natriuretic peptide
-Urodilanton

59
Q

What can cause dysfunction of natriuretic peptides?

A

-Increased vascular tone
-Shift in pressure of natriuresis curve

60
Q

Leptin and adiponectin together result in…

A

-Vasoconstriction
-Salt and water retention
-Renal dysfunction

61
Q

Obesity increases ___ and ___

A

Leptin and adiponectin

62
Q

Functions of leptin:

A

-Increases SNS activity
-Decreases renal sodium excretion
-Promotes inflammation
-Stimulates myocyte hypertrophy

63
Q

Functions of adiponectin:

A

-Insulin resistance
-Decreased nitric oxide
-Activation of SNS and renal angiotensin aldosterone system

64
Q

___% of patients with hypertension are insulin resistant

A

50

65
Q

Insulin leads to increased endothelial cell production of ___ ___

A

Nitric oxide

66
Q

Insulin resistance leads to ____ and endothelial dysfunction

A

Hyperinsulinemia

67
Q

Insulin resistance causes…

A

-Activation of noreppy and angiotensin II (myocardial toxins)
-Increased blood pressure
-Increased dyslipidemia

68
Q

Insulin resistance contributes to target ___ damage

A

Organ

69
Q

If sodium and chloride concentrations in the blood are decreased, there is a decrease in secretion of ___ ___ which leads to decreased water intake, increased salt intake, and diluted urine

A

Antidiuretic hormone

70
Q

If sodium and chloride concentrations are increased, there is an ___ in the secretion of antidiuretic hormone which leads to concentrated urine, thirst, and increased water intake

A

Increase

71
Q

Sodium intake of more than ___ meq/day (2.3 grams) contributes to hypertension

A

100

72
Q

Hypertension is rare when sodium intake is less than ___ meq/day (1.2 g)

A

50

73
Q

Reducing sodium intake from ___ to ___ meq/day can reduce normotensive BP 2/1 mmHg and hypertensive BP 5/3 mmHg

A

170 to 100

74
Q

What types of lifestyle modifications may slow down endothelial dysfunction and possibly reverse it?

A

-Physical activity
-Stopping smoking
-Weight reduction
-Reducing alcohol consumption
-DASH diet
-Low salt diet
-Adequate intake of potassium, calcium, and magnesium
-Stress management

Pathophysiology (18 decks)

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