CVS + GIT?? Flashcards
(84 cards)
Define hypertension.
A sustained and elevated BP above 140 systolic and 90 diastolic.
Identify the classification categories of hypertension.
Normal <120 S <80 D
High normal 120 - 139 S 80 - 89 D
Grade 1 (mild) 140 - 159 S 90 - 99 D
Grade 2 (moderate) 160 - 179 S 100 - 109 D
Grade 3 (severe) > 180 S >110 D
Identify the risk factors associated with hypertension.
Family history
Race
Age (DBP increases 50- then decreases 60+, SBP
increases throughout life)
Salt (Na+) intake
Smoking
Obesity (central adiposity -> hypertension)
Alcohol (3+ drinks/day increases risk)
Low dietary K+ (increased Na+ elimination)
Distinguish between primary and secondary hypertension.
PRIMARY
90% cases have no clear aetiology
Disruption of complex interactions of mechanisms that regulate BP
SECONDARY
10% cases
Results from other disorders – e.g. drugs, renal disease, adrenal issues, congenital inheritance, metabolic disorders
Describe the pathophysiological processes possibly involved in the development of primary hypertension.
Sympathetic Nervous System
Increased SNS activity -> Increased HR and systemic vasoconstriction -> Increased BP
RAAS
Moderates vascular tone, influences sodium (Na) and H2O retention
Summarise nonpharmacological treatment strategies for hypertension.
↓ Weight
↓saturated and total fats, eat more
vegetables and fruit
5 – 20 mm Hg/10 kg lost
↓ Na+
≤ 6 g Sodium Chloride per day
2 – 8 mm Hg
↑ Exercise
Regular aerobic activity (brisk walking) 30 min per day
4 – 9 mm Hg
↓ Alcohol
≤ 2 drinks/day for men ≤ 1 drink/day for women
2 – 4 mm Hg
Summarise pharmacological treatment strategies for hypertension.
ACEIs (inhibits formation of Angiotensin II)
ARBs (block angiotensin receptors)
Alpha (α) Blockers (arterial vasodilators)
Beta (β) Blockers
Calcium (Ca++) Channel Blockers
Diuretics (↓ Na+ reabsorption)
Discuss why adhering hypertension medications is
important.
With proper therapy, the risks of long-term complications can be minimized, resulting in a longer and healthier life.
Medications don’t cure only control symptoms.
Identify the impact of chronic hypertension on the heart.
Can result in heart disease Increased afterload Accelerates atherosclerosis of coronary arteries Left ventricular hypertrophy Systolic dysfunction Coronary artery disease Arrhythmia
Identify the impact of chronic hypertension on the kidneys.
Hyaline accumulates in the wall of small BV narrowing the lumens which causes ischemia leading to tubular atrophy, internal fibrosis and glomerular alterations.
Identify the impact of chronic hypertension on the brain.
Risk factor of stroke
Hemorrhagic CVA : rupture of intracerebral vessels
Atherothrombotic CVA : due to atherosclerotic plaque
Lacunar infarcts
Slit haemorrhage
Identify the impact of chronic hypertension on the retinas.
Hypertensive retinopathy Vision problems Rupture of retinal vessels Haemorrhage Exudation of plasma lipids Papilledema Copper wiring
Identify the impact of chronic hypertension on the arteries.
Atherogenesis -> degeneration of walls
Hyaline arteriosclerosis
Hyperplastic arteriosclerosis
4 common drug groups of hypertension treatment
A - angiotensin converting enzyme inhibitors
(ACEI), angiotensin receptor blockers (ARB),
alpha blockers (A1B)
B - beta blockers (BB)
C - calcium channel blockers (CCB)
D - diuretics (D)
Outline the method used to determine what medication to use when treating hypertension.
First choice
- ACE inhibitor
- Calcium channel blocker
- Low dose thiazide diuretic
Second choice
- ACE inhibitor + calcium channel blocker
- ACE inhibitor + low dose thiazide diuretic
Third choice
- ACE inhibitor + calcium channel blocker + low dose thiazide diuretic
Explain the mode of action of ACEIs
Inhibits formation of Angiotensin II
↓ Angiotensin II-mediated vasoconstriction and aldosterone mediated volume expansion → ↓BP
Explain the mode of action of ARBs
Block angiotensin receptors
Similar to ACEI’s
Explain the mode of action of Alpha (α) Blockers
Arterial vasodilators
Not first line drugs for hypertension due to risk of hypotension and cardiac problems.
Explain the mode of action of Beta (β) Blockers
Blocks action of SNS on β1 receptors of heart
• ↓HR, ↓contractility→↓CO
• Suppresses reflex tachycardia
• Blocks β1 receptors in kidney→ ↓renin (RAAS)→
↓vasoconstriction→ ↓resistance
Explain the mode of action of Calcium Channel Blockers
Disrupts movement of Ca++ ions through membrane
channels of smooth/cardiac muscle cells
• ↓intracellular calcium, ↓cardiac contractility
• ↓ Ca++ results in ↓contraction of vascular smooth
muscle→ ↑vasodilation, ↓PVR, ↓BP
Explain the mode of action of Diuretics
↓ Na+ reabsorption
Thiazides:
• Produce moderate diuresis and ↓ vascular resistance
High Ceiling Loop (potent) :
• Large diuresis generally for conditions such as pulmonary oedema rather than hypertension
K+ Sparing:
• Mild diuresis
Define primary hypertension
Primary hypertension is the result of complex interaction of genetic and environmental factors which disrupt normal BP regulating mechanisms leading to increased blood volume, SNS activity, activity of the RAA system, and renal Na+ retention.
Regulation of blood pressure
BP = Cardiac output (CO) * Peripheral Resistance
Neural Control (Rapid acting short duration)- - Baro-receptors → ANS → regulation of CO and vasoconstriction
Hormonal Control (slow acting long duration)-
• Renin-Angiotensin → vasoconstriction
• Aldosterone → Na+ and water retention → increased blood volume → increased CO
• Catecholamine (adrenaline) → vasoconstriction
• Prostaglandins and Nitric oxide (NO) → vasodilation
• Atrial Natriuretic hormone → vasodilation
Define atherosclerosis
A common form of arteriosclerosis which arises due to a thickening and hardening (loss of elasticity) of the arterial wall.