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Flashcards in 38 Hypertension Deck (27)
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1

What is hypertension level? symptomatic or asymptomatic?

sustained 140/90 mmHg, asymptomatic

2

What is the JNC7 classification of hypertension for
Normal?
Prehypertension?
Stage1?
Stage2?

High= 160 or >100

3

Do systolic or diastolic BP tend to decrease after 50 years old?

Diastolic--systolic seems to just keep increasing

4

What is 90-95 % of all hypertension and has an unknown etiology? What does the unknown etiology arise from?

1. Essential hypertension
2. Polygenetics and altered regulation of arterial pressure

5

How does a tumor of the adrenal cortex cause hypertension? Adrenal medulla?

1. increase mineral corticoids--> increase blood volume
2. increase epinephrine--> vasoconstriction

6

What does renal artery stenosis do to cause hypertension?

Increase renin release--increase angiotensin II Also other kidney will eventually hold off its higher volume because of TGF

7

What is the definition of MAP?

Cardiac output x total peripheral resistance

8

What are the 2 major determinants of stroke volume?

Ventricular filling pressure and myocardial contractility

9

What is the most important neural sensory mechanism for blood pressure?

Arterial baroreceptors (also chemoreceptors and muscle metaboreceptrs

10

What are the two main outputs from neural control on BP?

ParaSNA=Heart
Sympathetics= heart vessels and kidney

11

What is the neuronal route from the carotid sinus to the SNA input to the kidney?

carotid sinus-->NTS--->RVLM-->SNA IML etc.

12

What are the 2 underlying causes of abnormal baroreceptor function?

loss of afferent function=oxygen radicals, atherosclerosis, less distensible
central defect= angiotensin II, loss of baroreceptor pathways, emotional or reactive stress

13

What does normal fluid regulation look like in the kidney?

up arterial pressure--> up renal perfusion--> down Na and H2O reabsorption and down renin release

14

What percentages of people have high, low and normal renin but have hypertension?

15% high, 25% low, 60% normal, but drugs attacking the renin are still very effective

15

Vasopressin, aldosterone, catecholamines have what general effect on BP?

Increase CO and peripheral vascular resistance

16

What does angiotensin II feedback inhibit?

Renin- at renal B1 receptors [blocks angiotensinogen from becoming angiotensin II]

17

Which angiotensin II receptor leads to increased aldosterone? Is this a slow or fast pressor response?

AT1 [this is a slow pressor response]

18

How does ACE inhibitor modulate the bradykinin system?

Blocks kininase II from degraded bradykinin which leads to B2 effects of vasodilation and B1 effects of inflammation

19

What are the 3 endothelial-derived vasodilators? how do each lead to vasodilation

1.PGI2- up adenylyl cyclase-->incr. cAMP-->SM relax
2. NO- up guanylyl cyclase--> incr. cGMP--> SM relax
3. EDHF--> k channels and SM hyperpolarization effect

20

Does abnormal vascular function in CV disease arise from abnormal endothelial function or abnormal smooth muscle function?

Both

21

What is smooth muscle function determined by?

Intracellular calcium concentration and calcium sensitivity of contractile proteins

22

What are the 3 endothelial-derived vasoconstrictors? What happens in the smooth muscle cell?

1. endothelin-1
TXA2
AngII

2. Increase Ca2 concentration

23

Does NE cause vasodilation?

Vasoconstriction

24

Does endothelin-1 on ETa or ETb lead to constriction?

ETa…ETb does dilation

25

What 4 things are in the diet modification or initial strategy for decreasing BP?

Body weight reduction
Restrict sodium intake
restrict fat intake
decrease alcohol

[also want physical activity, but is not diet]

26

Does excess sodium effect vascular resistance at all?

Yes- it increases it.
[promotes intracellular Ca, increased basal tone of VSM, increases response of NE and ANGII, Increase vessel stiffness, increase fluid retention, increase NE and EPI release]

27

What is the mechanism of obesity leading to hypertension?

insulin dependent increase in Na+ reabsorption or increase in central-mediated vasoconstriction