Hypertension

Question 1

RAAS: what does it stand for

Answer 1

renin angiotensin aldosteron system
- regulates longterm bp and extracellular fluid
- activated when loss of blood volume ot drop in bp

Question 2

RAAS explained

Answer 2

1) angiotensinogen is released from liver which stimulates the release of renin from kidneys
2) angiotensinogen + renin = angiotensin I
3) angiotensin I causes ACE to be released from lungs
4) angiotensin I + ACE = angiotensin II
5) angiotensin II causes adrenal gland to release aldosterone, adrenal gland also causes vasoconstriction

Question 3

what does aldosterone do

Answer 3

• increase the reabsorption of Na, water sucks so bp inc

Question 4

when is angiotensinogen released

Answer 4

low bp and changes in blood volume (usually response to changes in Na levels)

Question 5

what stimulates the kidneys to release renin

Answer 5

low fluid volume

Question 6

what does the release of renin cause

Answer 6

the liver to convert angiotensinogen to angiotensin I

Question 7

what does angiotensin I do

Answer 7

travels to lung where its converted into angiotensin II by ace

Question 8

what converts angiotensin I to II

Answer 8

ACE: angiotensin converting enzyme

Question 9

what does angiotensin II act on

Answer 9

the adrenal gland which will release aldosterone

Question 10

angiotensin II is a _____ ____

Answer 10

potent vasoconstrictor

Question 11

RAAS can also be activated by…

Answer 11

• decreased renal perfusion
• pathologic ways
• some have hypersensitivity to angiotensin II or high secretors of renin
• stress can elevate angiotensin II, stimulates renin

Question 12

other mechanisms that stimulate bp

Answer 12

• baroreceptors: found in the carotid sinus, aorta and LV that sense BP and will alter HR accordingly; can also impact vasocon/dil
• vascular auto regulation: helps maintain consistent levels of tissue perfusion, regulates mean arterial pressure, alters resistance, helps keep consistent BP at tissue level

Question 13

primary HTN

Answer 13

• aka essential HTN
• occurs when there is no known cause (no underlying disease)
• occurs due to complicated interactions of genetics and env, involving neurohormonal effects

Question 14

risk factors for primary HTN

Answer 14

• smoking
• excessive Na intake
• sedentary lifestyle
• hyperlipidemia
• stress
• fam history/genetics
• obesity / insulin resistance
• over the age of 60
• blacks
• high alc consumption
• men more likely before age 55

Question 15

secondary HTN

Answer 15

known cause of HTN, known underlying disease
- treatment = treat underlying disease like
– renal disorders, adrencortical tumors, adrenomedullary tumors, drugs (oral contraceptives, corticosteroid, cocaine)

Question 16

causes of primary vs secondary HTN

Answer 16

• primary: excess salt, abnormal arteries, inc blood vol, genetic disorder, stressful life
• secondary: health conditions, certain meds, recreational drugs, pregnancy, hormonal therapy

Question 17

s/s of HTN

Answer 17

none, it is a silent killer
- can do screenings for it
- might see signs of end organ damage like
– chest pain, headache, weakness/pain in extremeties

Question 18

long term outcomes of HTN (cardiac)

Answer 18

inc LV work
- hypertrophy of LV due to excess pressure it has exerted to pump blood
- accelerated progression of atherosclerosis
- increased risk for aortic aneurysm (weakened vessel walls)

Question 19

long term outcomes of HTN (kidney)

Answer 19

primary cause of end stage renal disease

Question 20

long term outcomes of HTN (brain)

Answer 20

higher risk for stroke, aneurysm, hemorrage

Question 21

long term outcomes of HTN (eye)

Answer 21

retinopathy, blindness

Question 22

long term outcomes of HTN (lower extremeties)

Answer 22

gangrene, intermittent claudication

Question 23

hypertensive crisis

Answer 23

rapidly progressive HTN
- sbp over 180 and/or dbp over 120
- occurs more often in primary HTN
- types: urgency vs crisis

Question 24

HTN urgency

Answer 24

• no s/s of end organ damage (pt feels normal)
• BP over 180/120
• treated w oral agents to gradually bring BP down in usually hrs
• often caused by anxiety, pain, abrupt w/drawl

Question 25

HTN emergency

Answer 25

- s/s of end organ damage like headache, blurred vision, stroke, brain hemorrhage, chest pain, etc> - BP greater than 180/120 - treated aggressively w IV meds to bring down in mins to hrs