L11

Question 1

1ary vs 2ary HTN vs hypertensive crisis

Answer 1

1ary = HTN w/o identifiable cause
2ary = HTN due to some other disease process
HTN crisis = target organs in danger of damage

Question 2

Does moderate or high BP correlated to increased CV mortality?

Answer 2

Moderate - you don’t need crazy high BP

Question 3

What are the 4 predictors of CV mortality?

Answer 3

1 = widened PP

• ↑S + ↓D
  Loss of nocturnal dip

Question 4

What is the nocturnal dip of BP?

Answer 4

Lower BP at night

Question 5

MAP equation

Answer 5

MAP = 1/3 S + 2/3 D

Remember this doesn’t give you info about widened PP

Question 6

What does ↑SBP w/o changes to D indicate?

Answer 6

= isolated systolic HTN

Indicates underlying stiff vessels

Question 7

Equations for BP and CO

Answer 7

BP = CO x TPR
CO = HR x SV

Question 8

What is the hemodynamic progression of HTN?

Answer 8

If see HTN in young people
- Due to CO as ↑% of BP
If see HTN in older people
- Due to TPR as ↑% of BP
Old people have weak hearts (↓CO) and stiff vessels

Question 9

Describe the pathway to make AGT2

Answer 9

Angiotensinogen –> AGT1
- Renin
AGT 1 –> AGT2
- ACE

Question 10

What are the chronic outcomes of elevated AGT2?

Answer 10

RAAS goal = ↑BP
Vasoconstriction
Fibrosis
Thrombosis

Question 11

What are the 4 associations between ↑insulin and HTN?

Answer 11

Stimulate sympa
Na retained @ kidney
Vascular muscle hypertrophy
Changes Ca2+

Question 12

Chronic HTN effects on CNS

Answer 12

Hemorrhage
Ischemic stroke
Dementia

Question 13

What is the patho mneumo sign for HTN related cerebral damage?

Answer 13

Lacunae in brain tissue - due to macrophages entering dead tisse

Question 14

HTN ocular effects

Answer 14

Retinopathy
Vascular thrombosis
See
- Cotton wool spots = ischemic areas
- Flame hemorrhages
- Papiledema

Question 15

HTN cardiac effects

Answer 15

LV hypertrophy
CHD
CHF
Arrhythmia

Question 16

HTN vascular effects

Answer 16

↑Shear force –> endo damage
Atherosclerosis
Peripheral vascular disease

Question 17

Clinical symptoms of HTN

Answer 17

THERE ARE NONE

Question 18

What is important about measuring BP

Answer 18

Do it on both arms

Wait 5 mins after they get to office and in between readings

Question 19

Every 2mmHG increase in SBP = x increase in ischemic heart disease mortality

Answer 19

7%

10% increase stroke mortality

Question 20

First line drugs for uncomplicated HTN

Answer 20

ACE inhibitors
Angiotensin receptor blockers
BBs
Ca2+ channel blockers
Diuretics

Question 21

Which drugs to caucasians respond to better?

Answer 21

ACE
Angiotensin receptor blockers
BBs

Question 22

Which drugs to African Americans respond to better?

Answer 22

Ca2+ channel blockers

Diuretics

Question 23

Which drugs do you use for HTN pts with proteinuria?

Answer 23

RAS inhibitors!!

Question 24

What is the rule of 10s

Answer 24

Need to add 1 drug from a different class to see additional 10 mmHG ↓BP