HTN Roles of Genetics and Lifestyle Flashcards
6 lifestyle factors for uncomplicated HTN
Aging Obesity and Insulin Resistance High salt diet Low K diet Sedentariness Stress
How does aging affect HTN?
With aging, the elastin in the aorta is replaced by collagen, which leads to arterial stiffness
Increased arterial stiffness can be seen with widened pulse pressure
Diastolic vs Systolic HTN and aging
Around ages 10-20 people have diastolic HTN from high CO
After the mid-50s, SBP increases and DBP plateaus, causing isolated systolic hypertension
Retrograde wave
When blood hits bifurcations it goes backwards and feeds the coronary arteries
If you have a stuff aorta, the reflective wave comes back during systole (less blood supply = more problems)
Most common cause of adolescent HTN is…
Obesity and insulin resistance
Obesity and insulin resistance cause HTN by this mechanism of action
Increase in plasma volume and CO
Hyperinsulinemia may cause salt sensitivity by inhibiting the breakdown of ENaC
Hyperinsulinemia, obesity and hyperleptinemia activate the SNS and RAAS
Shifting of pressure natriuresis to a higher BP threshold in obesity
How does dietary K affect BP
BP is inversely related to K intake
Food processing reduces the K content of food
MOA for how K affects BP
Sodium excretion is decreased by hypokalemia or a low K diet through increases in Na reabsorption in the proximal tubule/LoH
Masked HTN
When you have HTN at work, but coming in to the doctors office is relaxing so your BP seems normal
Good at home
Associated with higher mortality
Alcohol intake and BP
Excess alcohol intake is associated with the development of HTN
MOA: stimulation of the SNS, RAAS, raised cortisol levels, inhibitions of NO
Non-pharmacologic interventions for high BP
Physical exercise Weight reduction Alcohol consumption Diet (DASH diet) Na reduction Stress management
Exercise for BP
Increase endothelial production of NO synthase, decreases aortic stiffness, and increases whole-body insulin sensitivity
Reduces circulating NA and decreases vascular resistance
Reduces hyperinsulinemia
DASH diet
High in Ca, Mg, and K Fruit and veggies Low intake of red meat Low fat dairy products Plant protein High fiber
How does sleep apnea cause high BP
SNS is firing all night long
