Hypertension

Question 1

Systemic blood pressure is regulated by what two systems of the body? Be specific.

Answer 1

(Sympathetic nervous system and the renin-angiotensin-aldosterone system)

Question 2

Explain the mechanism by which the sympathetic nervous system controls blood pressure.

Answer 2

(When baroreceptors in blood vessels sense there is a decrease in blood pressure, catecholamines are released from the adrenals and those increased cardiac output and peripheral vascular resistance resulting in increased blood pressure)

Question 3

What is released from the kidneys when there is decreased renal perfusion say in a case of CKD?

Answer 3

(Renin)

Question 4

What other organ needs to be working in addition to the kidneys to produce angiotensin I?

Answer 4

(The liver, it needs to produce angiotensinogen which is then converted to angiotensin I by the renin produced by the kidneys)

Question 5

What converts angiotensin I to angiotensin II and where is it produced?

Answer 5

(ACE and the lungs)

Question 6

What effect does angiotensin II have on systemic vascular resistance and how does it produce that effect?

Answer 6

(It increases systemic vascular resistance by causing contraction of the smooth muscle in vasculature throughout the body)

Question 7

How is angiotensin II related to an increase in blood volume and therefore cardiac output that is associated with the RAAS system and hypertension?

Answer 7

(Angiotensin II triggers the release of aldosterone from the adrenal glands which then triggers the kidneys to reabsorb sodium and water)

Question 8

You’re presented with a cute little kitty that you want to get a blood pressure reading on, what method would you choose and how would you determine the appropriate cuff size?

Answer 8

(Doppler is preferred method in cats and small dogs, the width of your cuff should be 30-40% the circumference of the site you are choosing to use)

Question 9

If you were taking the BP on a cat and you for some reason only had a size 5 cuff, you would expect the BP to be falsely high/low (choose).

Answer 9

(Low, cuff too big = falsely low, cuff too small = falsely high)

Question 10

What are the most common causes of hypertension in cats?

Answer 10

(CKD and hyperthyroidism)

Question 11

What are the more common causes of hypertension in dogs?

Answer 11

(Kidney dz (can be acute or chronic unlike cats which is typically CKD) and hyperadrenocorticism)

Question 12

Older/younger (choose) animals physiologically have a higher blood pressure.

Answer 12

(Older)

Question 13

Give an example of a dog breed with a physiologically higher blood pressure compared to other breeds.

Answer 13

(Sighthounds)

Question 14

What is the drug class and action of amlodipine?

Answer 14

(Calcium channel blocker which relaxes vascular smooth muscle causing vasodilation and decreased systemic vascular resistance)

Question 15

Amlodipine is the first line treatment for hypertension in dogs/cats (choose).

Answer 15

(Cats)

Question 16

What is the drug class and action of benazepril/enalapril?

Answer 16

(ACE inhibitor, inhibits RAAS by blocking the action of ACE)

Question 17

How do ACE inhibitors and angiotensin II receptor blockers decrease proteinuria?

Answer 17

(By causing dilation of the efferent arteriole of the glomerulus and reducing pressure within the glomerulus)

Question 18

What can be a downside to the glomerular effects of ACE inhibitors and angiotensin II blockers?

Answer 18

(Azotemia d/t decreased GFR, should check patient for renal function prior to using these and recheck after 7-10 days)

Question 19

If you overdose a patient with ACE inhibitors and angiotensin II blockers, what electrolyte abnormalities should you expect to see?

Answer 19

(Hyponatremia and hyperkalemia)

Question 20

What is the drug class and action of telmisartan?

Answer 20

(Angiotensin II receptor blocker, inhibits RAAS by blocking action of angiotensin II)

Question 21

What are the emergency drug options that should only be used with severe life-threatening hypertension?

Answer 21

(Direct arterial vasodilators such as hydralazine and sodium nitroprusside)

Question 22

What type of drugs are typically used when pheochromocytomas are involved in hypertension cases?

Answer 22

(Alpha adrenergic antagonists such as phenoxybenzamine and prazosin)

Question 23

What drug is typically used when hyperaldosteronism is involved in hypertension cases?

Answer 23

(Spironolactone → diuretic that acts as an aldosterone antagonist)

Question 24

What signs should you warn an owner of when placing a patient on an antihypertensive drug to monitor for hypotension?

Answer 24

(Weakness or syncope, will find tachycardia on initial examine and hypotension with BP measurement)

Question 25

What are the possible areas of target organ damage associated with hypertension?

Answer 25

(Eyes, kidneys, brain, and heart/vasculature)