Flashcards in HTN Pathophysiology and Lifestyle Management Deck (21):
1. What condition is the most common primary diagnosis in the U.S. as well as the most common reason for use of prescription medication?
1. Describe the relationship between blood pressure and age regarding both systolic and diastolic.
as patients age:
systolic pressure shows linear increase
diastolic increases until then 5th decade then decreases (due to increasing vascular stiffness as elastin is replaced by collagen, less blood volume during diastole- diastole run-off)
1. Describe the relationship between aging men and women and the prevalence of HTN.
men have a higher prevalence until 45yo
after age 64yo women have a higher prevalence
(change attributed to hormonal changes of menopause
1. What percent of the people without HTN at age 50yo will develop HTN before the age of 90?
1. Describe the relationship between increased systolic and diastolic pressures with mortality due to ischemic heart disease?
for every 20 mm Hg systolic and 10mm Hg diastolic, the risk of death due to IHD doubles
1. Define normal, prehypertensive, stage 1 and stage 2 hypertension using blood pressure.
normal 160 or >100
hypertension is defined as the level of pressure associated with doubling of long-term CV risk
1. Contrast primary and secondary hypertension.
essential or primary hypertension (95% HTN) is not cause specifically by another condition while secondary causes of HTN are specific disease processes that cause HTN (sleep apnea, thyroid disease etc.) ; patients with primary hypertension may still have co-morbidities that may be related to their HTN
1. Name some of the contributing systems/factors that regulate blood pressure
goal: tissue perfusion
blood volume and viscosity
vessel elasticity and neural input
kidney function (long term control)
all controls occur on differing time scales
3. Persistent hypertension develops in response to an increase in ____ ____ or a ___ ____ ___
cardiac output (more common cause in young patients)
systemic vascular resistance (more common cause in older patients)
2. Does the heart spend more time in diastole or systole
diastole, remember MAP is not calculated as a simple average (= DBP + ⅓ (SBP-DBP))
2. Name 9 risk factor for developing elevated blood pressure.
dietary factors (primarily Na intake)
2. Describe how HTN and endothelial damage are related. Also, why is leptin important?
endothelial dysfunction causes less release of NO a natural vasodilator
leptin is considered important in understanding the relationship between obesity and HTN
2. What action does sodium have on the body that supports the development of HTN.
renal sodium retention > extra-cellular-fluid volume expansion
vascular smooth muscle contraction> increased systemic vascular resistance
2. What is the major chemical mediator of the sympathetic nervous system's control on blood pressure?
norepinephrine (activity increases with age, weight, and SVR to cause vasoconstriction, tachycardia, renin release, vascular remodeling and renal sodium retention)
CNS receives feedback as well as exerting systemic control
4. What stimulates renin release, and what is renin's consequent action?
renin release is a response to hypoperfusion or the activation of the SNS; it's action is to convert angiotensinogen to angiotensin I
4. What chemical metabolism does ACE complete and what is it's (metabolite's) associated receptor?
ACE converts angiotensin I to angiotensin II and angiotensin II binds to the AT1 receptor to trigger aldosterone release
ACE also metabolizes bradykinin (which can eventually effect NO release and vasodilation
4. AT1 receptors can be found on what types of tissues? (5)
kidney, adrenal gland, vascular smooth muscle, CNS and myocardium; excess can cause heart failure, myocardial ischemia, stroke, nephrosclerosis and retinopathy
5. Describe some of the benefits of lowering blood pressure on CV outcomes.
reducing blood pressure lowers CVD risk:
35-40% reduction in myocardial infarction
20-25% reduction in myocardial infarction
>50% reduction in heart failure
6. Name 6 life style interventions that can be used in treatment of hypertension.
weight reduction (linear relationship, even small reduction important)
adopt DASH diet
dietary sodium reduction
moderation of alcohol consumption
6. What are the components of the DASH diet?
(dietary approaches to stop hypertension)
low saturated fat and cholesterol
emphasizes fruits, veggies and low fat diary products
reduces red meat, sweets and sugar containing beverages
(can decrease BP in 2 weeks)