7-8. Hypertension

Question 1

What part of the brain controls blood pressure?

Answer 1

Brainstem

Question 2

What is the primary cause of hypertension? 2 mechanisms by which this occurs?

Answer 2

Imbalance b/t cardiac output and arterial resistance:

• increased afterload (heart pumping too hard for vessels)
• arterial damage (vessels too small to handle blood pumped out)

Question 3

What is hypertension?

Answer 3

Excessive tension in the arterial tree

Question 4

Which BP is observed when the aortic valves is open? Closed?

Answer 4

• Open = SBP

- Closed = DBP

Question 5

What factors affect SBP?

Answer 5

• HR
• Contractility
• Aortic elasticity

Question 6

What factors affect DBP?

Answer 6

Things that affect the arterioles

Question 7

How many BP readings are needed in order to make a clinical diagnosis?

Answer 7

3 sets of readings at least 1 week apart, unless severe

Question 8

What is the drainage rate when taking a BP?

Answer 8

2-3 mmHg/sec

Question 9

What is the range of normal BP?

Answer 9

• SBP less than 120

- DBP less than 80

Question 10

What is the range for prehypertension?

Answer 10

120-139/80-89

Question 11

What is the range for stage 1 hypertension?

Answer 11

140-159/90-99

Question 12

What is the range for stage 2 hypertension?

Answer 12

160+/100+

Question 13

How is a person w/ hypertension categorized?

Answer 13

The higher of SBP or DBP

Question 14

Which CVD is known as “the silent killer”? Why?

Answer 14

Hypertension b/c asymptomatic for years to decades

Question 15

What is the prevalence of hypertension in U.S. adults?

Answer 15

60 million

Question 16

What fraction of U.S. adults under age 65 have hypertension?

Answer 16

1/4 - 1/3

Question 17

What fraction of U.S. adults over age 65 have hypertension?

Answer 17

1/2

Question 18

What is the leading reason in the U.S. for physicians visits and prescriptive meds?

Answer 18

Hypertension

Question 19

What are the end organ consequences of hypertension?

Answer 19

• Heart: LV hypertrophy, congestive heart failure, MI, ischemia
• Stroke
• Aortic aneurysm or dissection
• Renal failure
• Retina: hemorrhage, blindness

Question 20

1° vs. 2° hypertension? What % of hypertension does each account for?

Answer 20

PRIMARY:
-90-95% of all cases
-unknown or multiple causes
SECONDARY:
-5-10% of all cases
-hypertension caused by another pathology

Question 21

Which type of hypertension (1° or 2°) is more common in younger peeps?

Answer 21

2°

Question 22

What are the causes of 2° hypertension?

Answer 22

• Renal disease
• Coarctation of the aorta
• Endocrine abnormalities (hyper or hypothyroidism)
• Meds (estrogens, androgens, cocaine)

Question 23

What is aortic coarctation? Where does it occur? Effect?

Answer 23

• Aorta is pinched and narrow
• Often @ the site of the now-closed ductus arteriosus
• BP above coarctation is elevated while BP below is lowered

Question 24

What is Poiseuille’s Law?

Answer 24

Q = ∆P/R

Question 25

How does insulin effect hypertension?

Answer 25

Hyperinsulinemia (elevated insulin in blood) may be a unifying factor in many cases of essential hypertension

Question 26

What are the mechanisms by which hyperinsulinemia may increase BP?

Answer 26

Increased: - renal sodium reabsorption - sympathetic activation - arterial smooth muscle cell hypertrophy - intracellular calcium and vascular tone

Question 27

What are the lifestyle interventions used to treat hypertension?

Answer 27

- Weight loss - Diet (sodium and alcohol restriction) - Exercise

Question 28

What are the pharmacological interventions used to treat hypertension?

Answer 28

- Diuretics - Beta blockers - Vasodilators - Calcium channel blockers - RAS blockers (ACE inhibitors, Angiotensin receptor blockers)

Question 29

Which lifestyle intervention usually produces the best outcomes for lowering BP?

Answer 29

Weight loss (5-20 mmHg for every 22 lbs lost)

Question 30

What are the mechanisms by which exercise improves hypertension?

Answer 30

- Decreased blood viscosity - Increased arterial elasticity - Decreased sympathetic nervous activity - Lower insulin levels - Preservation of endothelial function - Reduced vascular resistance - Altered baroreceptor sensitivity or CNS regulation of BP - Weight management

Question 31

How do ACE inhibitors manage hypertension?

Answer 31

Inhibit angiotensin converting enzyme --> angiontensin I doesn't convert to angiotensin II --> no vasoconstriction --> no increase in BP

Question 32

How do angiotensin II blockers manage hypertension?

Answer 32

Inhibit angiotensin II from vasoconstricting --> no increase in BP

Question 33

What is the recommended frequency, intensity, duration and mode of exercise for patients w/ hypertension?

Answer 33

- Frequency = 3 days/week - Intensity = 50-65% HRmax - Duration = 30+ mins - Mode: aerobic, circuit weight training @ less than 60% 1RM

Question 34

What types of exercise create the greatest dangers for a poorly controlled hypertensive?

Answer 34

Weight lifting greater than 60% 1RM