Hypertensive Vascular Disease

Question 1

What is essential/primary HTN?

Answer 1

HTN occuring without an identifiable cause

Question 2

What are the three mechanisms by which RAAS elevates BP?

Answer 2

1. Increased sympathetic output
2. Increased mineralocorticoid secretion
3. Direct vasoconstriction

Question 3

What role does Atrial Naturietic Factor play in regulating BP?

Answer 3

ANF increases when BP is high and causes an increased secretion of Na

Question 4

In the case of HTN, what is the end result of autoregulation?

Answer 4

Always increased peripheral resistance

Question 5

What is the prothrombotic paradox associated with HTN?

Answer 5

Patients with HTN often experience thrombotic events such as stroke/MI and show Virchow’s triad:

1. BF abnormalities
2. Endothelial Damage
3. Hypercoagulable state

Question 6

WHat is GLucocorticoid-remediable Aldosteronism and how does it contribute to HTN?

Answer 6

Autosomal DOMINANT trait that causes excess aldosterone production, increased Na retention, and increased BP

Question 7

What is the Syndrome of Apparent Mineralocortoid?

Answer 7

Autsomal RECESSIVE form of early-onset HTN in which cortisol is allowed to accumulate and stimulate mineralocorticoid receptors

Question 8

What is Liddle Syndrome?

Answer 8

Autsomal dominant gain of function mutation in chromosome 16 that codes for amiloride-sensitive epithelial sodium channels. Channels are constitutively active in the renal tubules despite low levels of mineralocorticoid

Question 9

By what mechanism do all mutations that cause hereditary HTN work?

Answer 9

By increasing renal Na reabsorption

Question 10

What vessels typically contribute most to the amount of blood flow thru capillary beds of the kidney?

Answer 10

Resistance vessels (arterioles)

Question 11

A patient has benign arteriosclerois. A cross section of a renal intralobular artery shows irregular thickening of the intima. What is this indicative of?

Answer 11

Mild chronic HTN

Question 12

What is benign arteriolosclerosis typically associated with?

Answer 12

Benign Nephrosclerosis

Question 13

What is malignant HTN?

Answer 13

Elevated BP that causes rapidly progressive vascular compromise with the onset of Syx disease of the brain, heart, or kidney

Question 14

What examination allows for the visualization of malignant HTN on vasculature? What type of changes are seen?

Answer 14

Opthalmoscopic exam; Ischemic necrosis (“cotton wool spots”)

Question 15

Describe the pathogenesis of vascular damage in malignant HTN

Answer 15

Segmental dilation due to necrosis of smooth muscle cells. Endothelial integrity is lost resulting in leakage of plasma proteins into the vessel wall (fibrinoid necrosis)

Question 16

What is the vascular response to acute injury?

Answer 16

“Onion-skin” appearance - proliferation of smooth muscle cell proliferation