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CVS > 5. Hypertension > Flashcards

5. Hypertension Flashcards

1
Q

How is BP calculated?

A

Flow x Resistance

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2
Q

How is mean arterial blood pressure calculated?

A

CO x TPR

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3
Q

What response is relevant to acute changes in blood pressure?

A

Baroreceptor reflex

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4
Q

How does the baroreceptor reflex respond to increases in blood pressure?

A

Nerve endings in the carotid sinus and aortic arch which are sensitive to stretch.
Signals to medulla oblongata which reduces sympathetic NS to case bradycardia and vasodilation.

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5
Q

Why is the baroreceptor reflex only effect at regulating short-term, acute changes in blood pressure?

A

The threshold resets after around 15 minutes

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6
Q

What are the 4 neurohormonal pathways that control blood volume and pressure over medium and longer term?

A
  1. RAAS
  2. SNS
  3. ADH
  4. ANP
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7
Q

Where is renin released from?

A

Granular cells of juxtaglomerular apparatus (JGA)

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8
Q

What 3 factors stimulate renin release?

A
  1. Reduced NaCl delivery to distal tubule
  2. Reduced perfusion pressure in the kidney
  3. Sympathetic stimulation
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9
Q

Where is renal perfusion detected?

A

Macula densa - baroreceptors in afferent arteriole

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10
Q

What are the major functions of angiotensin II?

A
  1. Aldosterone release
  2. Na+ reabsorption in kidney
  3. Vasoconstriction
  4. Increase NA release
  5. Thirst sensation in hypothalamus
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11
Q

The main actions of aldosterone act via which receptor?

A

AT1 - GPCR

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12
Q

What are the main actions of aldosterone?

A

Stimulates Na+ reabsorption in the kidney:

  • Activates apical Na+ channel (ENaC)
  • Na+/K+ ATPase
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13
Q

Other than catalysing Angiotensin conversion, what other reaction does ACE catalyse?

A

Bradykinin (vasodilator) breakdown into peptide fragments, contributing to further vasoconstriction.

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14
Q

What is the most common side effect of ACE inhibitors?

A

Dry cough due to bradykinin accumulation

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15
Q

How does SNS affect renal blood flow?

A

High levels of sympathetic stimulation reduces renal blood flow by vasoconstriction of arterioles.

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16
Q

How does decreased renal blood flow alter GFR blood pressure?

A

Decrease GFR which decreases excretion of Na+ and increase retention of Na+ and water, raising blood pressure in short term.

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17
Q

How does SNS alter renin release from JG cells?

A

Stimulates renin release which increases Ang II levels and increase Na+ reabsorption.

18
Q

How does the SNS alter expression of transporters in the kidney?

A

Activates apical Na+/K+ exchanger and basolateral Na+/K+ ATPase in PCT to increase Na+ absorption.

19
Q

In what conditions is ADH secretion stimulated?

A

Dehydration

Severe hypovolaemia

20
Q

What is the function of ADH?

A

Increase water absorption in distal tubule
Stimulates Na+ reabsorption in thick ascending limb
Vasoconstriction

21
Q

Where is ANP synthesised and stored?

A

Atrial myocytes

22
Q

What stimulates ANP release?

A

Stretch - low pressure sensors in atria reduce ANP secretion when there is decreased filling and pressure is low

23
Q

What are the actions of ANP?

A

Tries to decrease blood pressure:
Vasodilation of afferent arteriole to kidney
Increased BF increases GFR
Inhibits Na+ reabsorption in the kidney

24
Q

What effect do prostaglandins have on blood vessels?

A

Cause vasodilation

25
Q

Why is decreased blood pressure a common complication of Parkinson’s treatment?

A

Dopamine is a vasodilator:

Inhibits reabsorption of NaCl

26
Q

What is classified as stage 1 hypertension?

A

140/90 mmHg

27
Q

What is classified as stage 2 hypertension?

A

160/100 mmHg

28
Q

What is classified as severe hypertension?

A

> 180 systolic or >110 diastolic

29
Q

What is primary or “essential” hypertension?

A

Cause is unknown or multifactorial

95% of cases

30
Q

What is secondary hypertension?

A

Cause can be identified

31
Q

What are some common causes of secondary hypertension?

A

Reno vascular disease
Chronic renal disease
Hyperaldosteronism
Cushing’s syndrome

32
Q

What factors might contribute to primary hypertension?

A
  • Genetic factors

- Environmental factors

33
Q

How is hypertension diagnosed?

A

Sustained elevation of BP on 3 different occasions.

Systolic > 140 or diastolic > 90 mmHg

34
Q

How does renovascular disease lead to hypertension?

A

Occlusion in renal artery causes a fall in perfusion and increased renin production and RAAS activation.

35
Q

What are some adrenal causes of secondary hypertension?

A

Conn’s syndrome - aldosterone secreting adenoma
Cushing’s syndrome - cortisol has mineralocorticoid actions at high conc
Pheochromocytoma

36
Q

What non-pharmacological methods can be used to manage hypertension?

A 
Exercise
Diet
Reduce Na+ intake
Reduce alcohol intake 
Lifestyle changes have a limited effect.
37
Q

Which anti-hypertensive drugs target RAAS?

A

ACE inhibitors

Ang II receptor antagonists

38
Q

Which antihypertensive drug decreases blood volume as well as causing vasodilation?

A

Ang II receptor antagonist

39
Q

What anti-hypertensive drugs target the blood vessels?

A

L-type Ca2+ channel blockers - reduce entry into VSMC’s

40
Q

What anti-hypertensive drugs target the kidney?

A

Diuretics -
Thiazide - inhibit Na/Cl so-transporter on apical membrane of distal tubule
Spironolactone and amiloride are potassium sparing

41
Q

When are beta blockers used to treat hypertension?

A

Never hypertension alone - only if other indications such as previous MI or angina.

CVS (16 decks)

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