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Physiology Test Two > hypertension > Flashcards

hypertension Flashcards

1
Q

what is a normal blood pressure?

A

less than 120/80

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2
Q

what is an elevated blood pressure?

A

120-129 and less than 80

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3
Q

stage 1 hypertension is?

A

130-139 or 80-89

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4
Q

hypertension stage 2 is?

A

140 or higher or 90 or higher

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5
Q

hypertensive crisis is?

A

systolic: 180 or higher

and/or

120 and higher

meaning you usually have both but you could just have one

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6
Q
A
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7
Q

what is the most common primary diagnosis in the United States?

A

hypertension

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8
Q

in individuals younger than 45 years old the prevalence of hypertension is higher in men or women?

A

men

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9
Q

after 65 years old the prevalence of hypertension is higher in men or women?

A

women

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10
Q

the prevalence of hypertension increases with ______.

A

age

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11
Q

the prevalence of hypertension is higher in _____ _____ who suffer from diabetes.

A

aftrican americans

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12
Q

what is isolated systolic hypertension?

A

an elevated systolic blood pressure accompanied by a normal diastolic blood pressure

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13
Q

isolated systolic hypertension is commonly abbreviated?

A

ISH

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14
Q

ISH is becoming mrore prevalent in all _____ ______ and is strongly assciated with what kind of events?

A

all age groups

cardiovascular and cerebrovascular events

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15
Q

95% of hypertension cases are diagnosed as?

A

primary hypertension

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16
Q

primary hypertension means what?

A

no known cause

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17
Q

primary hypertension is also called?

A

essential hypertension

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18
Q

what is secondary hypertension?

A

associated with an underlying primary disorder like renal disease

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19
Q

hypertension is a complex disorder that affects the entire ______ system.

A

cardiovascular

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20
Q

All types and stages of hypertension are associated with increased risk for target organ disease events such as?

A

myocardial infarction

kidney disease

stroke

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21
Q

Risk factors for primary hypertension include (5)

A

age

obesity

smoking

stress

high alcohol intake

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22
Q

secondary hypertension is caused by an underlying disease process that raises what two things?

A

peripheral vascular resistance or cardiac output

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23
Q

what drugs can cause secondary hypertension?

A

oral contraceptives

corticosteroids

antihistamines

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24
Q

what happens to the blood pressure in secondary hypertension is the cause is identified and removed before permanent structural changes occur?

A

blood pressure returns to normal

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25
Q

cardiac output is increased by any condition that increase the ____ ____ or _____ _____.

A

heart rate

or

stroke volume

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26
Q

peripheral resistance is increased by any factor that increases blood _____ or reduced _____ ____.

A

viscosity

vessel diameter

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27
Q

primary hypertension is the result of a complicated interaction between genetics and the environment that increases what two things

A

peripheral vascular resistance and blood volume

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28
Q

increased vascular volume is related to a decrese in renal exretion of _____, often referred to as a shift in the pressure natriuresis relationship

A

salt

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29
Q

what does pressure natriuresis relationship mean?

A

this means that for a given blood pressure, individuals with hypertension tend to secrete less salt in their urine

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30
Q

name pathophysiologic mechanisms that can cause primary hypertension (7).

A

SNS

RAAS

BNP

inflammation

endothelial dysfunction

obesity related hormones

insulin resistance

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31
Q

in patients with hypertension, the SNS can cause hypertension by two mechanisms?

A

increase production of catecholamines (ephinephrine or norepinephrine)

increased receptor reactivity involving the neurotransmitters (norepi or epi)

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32
Q

increased SNS activity = ______ heart rate and systemic _______.

A

increased

vasoconstriction

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33
Q

increased SNS causes what effects affecting blood pressure?

A

increased HR and PVR

increased insulin resistance

vascular remodeling

procoagulant effects

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34
Q

increased SNS activity increases insulin resistance which causes __________dysfunction, leading to what?

A

endothelial dysfunction

narrowing of the vessels and vasospasms causing hypertension

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35
Q

describe the RAAS system

A

Baroreceptors trigger the release of renin from the kidneys, and angiotensinogen from the liver, which combined make angiotensin 1 and then the ace enzyme from the lungs converts this into angiotensin II.

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36
Q

List the effects of angiotensin II (5 things)

A

constrict glomerular efferent arteriole

Posterior pituitary-ADH secretion-increased kidney water reabsorption

vascular smooth muscle - constriction

hypothalamus-stimulates thirst

adrenal cortex-adosterone secretion-increased sodium retention in the kidneys

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37
Q

in the brain angiotensin 2 enhances sympathetic neural outflow, altering the release of hormones that contribute to what four things?

A

endothelial dysfunction

insulin resistance

dyslipidemia

platelet aggregration

38
Q

angiotensin 2 can cause _______ remodeling, which is a structural change in the vessel wall that results in permanent increases in peripheral resistance.

A

arterial

39
Q

angiotensin 2 is associated with end organ damage due to hypertension such as (3 things)

A

atherosclerosis

renal disease

cardiac hypertrophy

40
Q

why is angiotensin 2 a potent vasocontrictor?

A

because it destroys the potent vasodilator bradykinin

41
Q

name the organs affected by angiotensin 2?

A

brain

heart

adrenals

kidney

and kidney efferent arterioles

42
Q

angiotensin II can be further modified into?

A

angiotensin III and IV

43
Q

describe the effects angiotensin II has on blood vessel structure and function leading to aterosclerosis?

A

increased thrombosis

increased platelet aggregation

increased smooth muscle cell growth and migration

increase growth

decreased apoptosis

increased endothelial dysfunction

44
Q

Populations with high dietary ______ intake have long been shown to have an increased of hypertension.

A

sodium

45
Q

sodium is retained when there is low dietary intake of which three electrolytes?

A

potassium

calcium

magnesium

46
Q

Why does the sodium retention occur with decreased potassium, calcium, and magnesium intake?

A

Natriretic hormones modulate renal sodium excretion and require adequate potassium, calcium, and magnesium in order to function properly.

47
Q

Natriuretic hormones include what?

A

atrial natriuretic peptide (ANP) or B type natriuretic peptide or BNP.

48
Q

Natriuretic hormones does what functions?

A

increase natriuresis

decrease blood volume

decrease aldosterone secretion

vasodilate

decrease blood pressure

increase endothelial permeability

49
Q

Dysfunction in the natriuretic hormone can cause what two things to happen?

A

increase in vascular tone

shift in the pressure natriuresis relationship

50
Q

when there is inadequate natriuretic function, serum levels of ______ _____ rise in an attempt to compensate

A

natriuretic peptides

51
Q

In hypertension, increased ANP and BNP are linked to an increased in what disease processes?

A

ventricular hypertrophy

atherosclerosis

heart failure

52
Q

in addition to the shift in the pressure natruresis relationship why does the dysfunction in natriuretic hormones cause more rethention of sodium?

A

because of vasoconstriction decreasing blood flow to the kidneys causing ischemia causing inflamation causing dysfunction of the glomeruli and tubules and promote additional sodium retention.

53
Q

how can you increase or enhance natriuretic peptide function with diet?

A

potassium

calcium

magnesium

54
Q

what two molecules stimulate ANP and BNP?

A

renin and angiotensin II

55
Q

what inhibites the NP system?

A

SNS system

56
Q

inflammation place a role in ____ dysfunction of hypertension

A

vascular

57
Q

endothelial injury and tissue ischemia can result in the release of ?

A

vasoactive inflammatory cytokines

58
Q

endothelial injury and tissue ischemia release what cytokines in acute inflammatory injury?

A

histamine and protoglandins which vasodilate

59
Q

with chronic inflammation vascular _____ and smooth muscle _____ occurs

A

remodeling

contraction

60
Q

endothelial injury and dysfunction in primary hypertension are characterized by decreased production of ______ such as _____ ____ and increased production of ________ such as _______.

A

vasodilators such as nitrous oxide

vasoconstrictors such as intodetlin

61
Q

obesity causes changes in ______. Name three.

A

adipokines

  1. leptin
  2. resistan
  3. adipoq nectin
62
Q

obesity does was to the SNS and RAAS

A

increases their activity

63
Q

adipokine dysregulation causes what effects (6)

A

increased vascular tone and arterial stiffness (remodeling)

increased RAAS system

Increased liver inflammation

decreased metabolic rate

insulin resistance

decreased muscle perfusion

64
Q

Patients with diabetes are treated with medications to improve insulin resistance, what can happen to the blood pressure?

A

decrease

65
Q

insulin resistance is associated with ____ injury and affects the ____ function, causing ____ and _____ retention.

A

endothelial

renal

salt and water retention

66
Q

insulin resistance is associated with overactivity of what two systems

A

SNS and RAAS

67
Q

now for a summary name the factors leading to primary hypertension which will be cause by increased blood volume and increased peripheral resistance.

A

genetics

increased SNS

Increased RAAS (especially aldosterone)

endothelial dysfunction

dysfunction of natiruetic hormones

decreased dietary potassium, magnesium, and calcium

increased dietary sodium intake

insulin resistance

obesity

renal glomerular and tubular inflammation

68
Q

what is complication hypertension?

A

hypertension that damages the walls of systemic blood vessels, leading to dysfunction of the organs perfused by the affected vessels.

69
Q

another name for complicated hypertension is?

A

chronic hypertension

70
Q

chronic hypertension affects which organs?

A

kidney

brain

heart

extremities

and eyes

71
Q

a hypertensive crisis is also called

A

malignant hypertension

72
Q

hypertensive crisis is when the the blood pressure is

A

systolic higher 180

diastolic higher than 120

73
Q

hypertensive crisis can occur as an uncommon complication of _____ hypertension.

A

primary

74
Q

other causes of hypertensive crisis would be?

A

pregnancy

cocaine or amphetamine use

reaction to certain medications

adrenal tumors

alcohol withdrawal syndrome

75
Q

high arterial pressure renders the cerebral arteries incapable of doing what?

A

regulating blood flow to the cerebral capillary beds.

76
Q

high hydrostatic pressures in the cerebral capillaries causes vascular fluid to ____ into the interstitial space

A

leak out

77
Q

if hypertensive crisis blood pressure is not reduced, ______ edema and _____ dysfunction increase until death finally occurs

A

cerebral

cerebral

78
Q

hypertensive crisis can also cause other symptoms such as (4)

A

heart failure

uremia

retinopathy

cerebrovascular accident

79
Q

hypertensive crisis must be treated rapidly why?

A

to avoid serious complications

80
Q

the early stages of hypertension have _____ clinical manifestations

A

none except elevated blood pressure

81
Q

because early stages of hypertension does not have clinical manifestations other than elevated bp it is also called the

A

silent disease

82
Q

most clinical manifestation of hypertensive disease are caused by complication affecting _____ _____.

A

target organs

83
Q

Diagnosis of hypertension requires are high reading on how many occasions?

A

on at least two seperate occasions

84
Q

describe how to take the blood pressure readings and special considerations when testing for hypertension?

A

average 2 readings at least two minutes apart with the individual seated, the arm supported at the level of the heart after five minutes at rest with no smoking or caffeine intake in the past 30 minutes.

85
Q

why would some individuals benefit from a 24 hour ambulatory blood pressure monitoring?

A

better correlation with end organ damage and the ability to screen out for white coat hypertension and mask hypertension

to monitor for patients who fail to have a nocturnal decrease in blood pressure who may be at higher cardiovascular risk

86
Q

evaluation of a hypertensive individual should include what?

A

complete medical history

assessment of lifestyle and other risk factors for hypertension and cardiovascular disease and secondary causes of hypertension.

87
Q

what is mask hypertension?

A

when blood pressure is normal in the clinic setting but elevated everywhere else.

88
Q

what is white coat syndrome?

A

where blood pressure is elevated in the clinic setting but not everywhere else

89
Q

physical exam should include what for a hypertensive patient?

A

optic fundi

calculation of BMI

examination of heart and lungs

palpation of the abdomen

assessment of lower extremity pulses and edema

neurologic examination

90
Q

diagonstic test of a hypertensive patient include?

A

CBC

urinalysis

BMP (glucose, sodium, potassium, calcium, magnesium, creatinine, cholesterol, and triglycerides)

EKG

91
Q

Individuals who have elevated blood pressure are assumed to have ______ ______ unless their history, physical examination, or initial diagnostic screening indicates _______ hypertension.

A

primary hypertension

secondary hypertension

92
Q

once the diagnosis is made for hypertension, a careful evaluation for other ______ risk factors and for ______ organ damage should be done.

A

cardiovascular risk factors

target organ damage

Physiology Test Two (3 decks)

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