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House AMP > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Maintenance of a normal blood pressure is dependent on the balance between the _________ and ________

A

cardiac output and peripheral vascular resistance.

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2
Q

Most patients with essential hypertension have a normal (CO or PR?) but a raised (CO or PR?)

A

CO

PR

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3
Q

Hypertension

__________________ is thought to induce structural changes with _______ of the arteriolar vessel walls possibly mediated by _______, leading to an irreversible rise in ________

A

Prolonged smooth muscle constriction

thickening

angiotensin

peripheral resistance.

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4
Q

Hypertension affects up to ___ % of the population of the world

A

20

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5
Q

(Blacks or Whites?) particularly suffer the ravages of hypertension and are more likely than (Blacks or Whites?) to experience serious complications

A

Blacks

Whites

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6
Q

Hypertension is Defined as a blood pressure level below which ___________

A

the patient can benefit from its reduction

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7
Q

Hypertension is Usually taken as a sustained diastolic BP>___mmHg or systolic BP>____mmHg, or ____.

A

90

160

both

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8
Q

According to WHO

OPTIMAL =SP<____; DP<___

NORMAL= SP<____ ; DP<____

HIGH NORMAL= SP__-___ ; DP__-___

A

120; 80

130;85

130-139; 85-89

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9
Q

Hypertension

Grade 1- SP__-___ and/or DP__-___
Grade 2 -SP__-___ and/or DP__-___
Grade 3-SP__-___ and/or DP__-___
Isolata ed SHT-SP__-___ and/or DP__-___
Grade4-SP__-___ and/or DP__-___

A

140-159; 90-99

160-179; 100-109

Greater or equal to 180; greater or equal to 110

Greater or equal to 140; less than 90

Greater than 210; greater than 120

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10
Q

PREVALANCE of hypertension

__-__% in unacculturated societies such as _____ Indians,_______ and ____ people in Nigeria

___% in Black Americans.

(Male or female?) > (Male or female?) below 50yrs

(Male or female?) > (Male or female?) after 50 yrs

A

0-2; Yanomami; Papua New Guinea; koma

40

Male; female; female; male

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11
Q

PREVALENCE IN NIGERIA

•_____%(greater than or equal to 140/90)
• approximately ___%(greater than or equal to 160/95).

NCD Committee, Hypertension Project.
• Prevalance ___ in M; ___% in F (160/95)

Urban/rural gradient
• In rural areas,lowest in ______.

A

17-20

10

11.1; 11.2

Savannah

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12
Q

RATE OF PROGRESSION

BENIGN HT

•(Acute or Chronic?) hypertension occuring over _____ which may be either ______ or ______
• The clinical presentation is ( benign or malignant?) but may eventually have serious effects (eg ______, brain, blood vessels)

A

Chronic ; many years

mild or moderate.

Benign ; organ damage

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13
Q

RATE OF PROGRESSION

MALIGNANT HT

• A (slowly or rapidly?) increasing BP over a period of _____ or ________
• The BP is usually very ___ and (slowly or rapidly?) increasing (eg diastolic >___mmHg)
• The clinical effects are serious, damaging many organs

A

Rapidly

few months or 1 or 2 years

high; rapidly

120

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14
Q

_____ HT is common in young HTensives

A

Malignant

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15
Q

ESSENTIAL HT

•Seen in ___-__% of cases
•A diagnosis of ____, i.e. _______

A

90-95; exclusion; no cause is found

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16
Q

ESSENTIAL HT

A number of aetiological factors may be implicated including
•_____ predisposition ( ________ inheritance)
• -racial, (black or whites?) >(black or whites?)
•___ homeostasis: increased _____
• Stress-nervous reactivity
• Lackofexercise.

A

genetic; polygenic

Black; whites

Na; salt intake

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17
Q

SECONDARY HT

• Occurs in __-___%
• It is a ______ of other disease

A

5-10; complication

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18
Q

Causes of secondary HT

• - RENAL: ____, ____,____,_____ stenosis, renal _______, ______ tumour, and very importantly __________

• NEUROGENIC: ______, raised ___, sleep apnoea, acute ____

A

AGN; CGN; CRF; renal artery; vasculitis; renin producing; diabetic nephropathy

psychogenic; ICP; stress

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19
Q

Causes of secondary HT

•- DRUGS: eg ______ and _____

• - ENDOCRINE, ______, ____ syndrome, phaechromocytomas, exogenous hormones, acromegaly, hyper______, ______ induced

• - CVS, ______ of the aorta, increased CO, increased intravascular volume, _____

A

steroids and contraceptives

aldosterone; cushing; thyroidism

pregnancy

coarctation; PAN

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20
Q

NORMAL REGULATION OF BP
• Depends on the ______ and ——-

A

CO and PR

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21
Q

Normal regulation of BP

CO is influenced by the ____ which is in turn dependent on the body’s _____

• Total PR is determined at the level of _____ and it depends on the ______ which is dependent on the arteriolar wall and the effects on the ____ and ——- factors that either constricts or dilate the arterioles (endothelin, NO, cathecolamines, angiothensin)

A

Blood volume
sodium
arterioles
caliber of the lumen
neural and hormonal

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22
Q

The kidneys play an important role in the control of BP thru its influence on the ______ and ————

A

PR & sodium homeostasis

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23
Q

Kidney’s role in maintaining BP

By:
• The ______ System

A

Renin-Angiotensin

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24
Q

The renin angiotensin system

Renal artery _____/_____ restriction/
reduction in _____ Leads to reduced ___ and stimulation of ____ from the JGA

A

stenosis
dietary salt
CO
GFR
RENIN

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25
Q

Renin is a protease that acts on ______ (an ________)
• It splits it into a _____ (_____) which is in turn converted into ____ by ____ ( a protein found on the ___________ )

A

angiotensinogen
alpha globulin
decapeptide
Ang I
Ang II
ACE
surface of endothelial cells

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26
Q

Ang II is a powerful vaso______ that also acts centrally and stimulates _____ release from the ______.

A

constrictor
aldosterone
adrenal gland

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27
Q

The net effect of the RAAS is __________ and ________

A

an increase in total body fluid volume and increased PR

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28
Q

GFR INDEPENDENT NATRIURETIC FACTOR
• ATRIAL NATRIURETIC FACTOR (ANF)
• A hormone secreted by the specialized cells of the ______ in response to _____ that accompanies ____________.

A

cardiac atria; distension; expansion of the blood volume

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29
Q

ANF binds to specific receptors in the ______
• Causes increased urinary ________

A

kidneys; sodium excretion

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30
Q

ANF (antagonizes or aids?) the RAS(Renin-Ang)

A

Antagonizes

31
Q

GFR INDEPENDENT NATRIURETIC FACTOR
• Na+ HOMEOSTASIS
• Important for the control of BP
• Increase in Na in the body is accompanied by an ______ and (expansion on constriction?)of the _____
• This acts on the _____ resulting in an increased _____ of salt and water

A

Increase in water; expansion; blood volume

kidney; excretion

32
Q

EFFECT OF ORAL CONTRACEPTIVES ON BP

• Acts by activating the ____ pathway
• Most OCPs contain ________
• They stimulate the liver to produce the ________ which is _______
• Why do some women develop HBP with OCP and others do not?

A

RA ; progesterone-estrogens; renin substrate ; angiotensinogen

33
Q

EFFECT OF ORAL CONTRACEPTIVES ON BP
• Increased _______ to _____
• Presence of (mild or severe?) renal disease
• Familial factors((positive or negative ?) family history >50%)
• Age>_____years
• _______ content of the contraceptive
• Obesity

A

vascular sensitivity to AngII; mild ; positive

35; Oestrogen

34
Q

The oral contraceptives are thus thought to be simply __________________

A

unmasking women with essential hypertension

35
Q

PHAEOCHROMOCYTOMA
• Increased secretion of ______ and ______
• Which results in ___________ and ———
• Diagnosed by ______________________

A

epinephrine and norepinephrine

peripheral vasoconstriction and cardiac stimulation

increased urinary secretion of adrenalin, noradrenalin and their metabolites

36
Q

Accelerated/malignant HT
• –Seen in about ___% of hypertensives
• Usually ________ on _____ HT.

A

5; super imposed; preexisting

37
Q

Malignant HT
The clinical syndrome is characterized by:
•Severe hypertension (i.e., systolic pressure over ____ Hg, diastolic pressure over ____ Hg)
• If untreated leads to death in ___ years.

•

A

200 mm; 120 mm; 1 or 2

38
Q

Malignant HT

•Causes ____ failure and
• Retinopathy: _______ ,_____ and presence or absence of ______
• Brain – _____ microaneurysms, Intraparenchymal haemorrhages, hypertensive _________.

A

renal; Retinal haemorrhages and exudates ; papilloedema

Charcot Bouchard; encephalopathy

39
Q

EFFECT OF HT on the HEART

Hypertensive heart disease:
• Systemic= ___ sided; pulmonary=___- sided

A

left; right

40
Q

EFFECT OF HT on the HEART

Hypertensive heart disease:

Systemic: diagnostic criteria –
• (i) ______
• (ii) A ______ or ________ of hypertension.

A

Left ventricular hypertrophy; history or pathologic evidence

41
Q

EFFECT OF HT on the HEART

Hypertensive heart disease:

Systemic: diagnostic criteria –

LVH(_______) – usually _____ in the absence of any cardiovascular pathology that might have induced it and

This Left ventricular hypertrophy is an adaptive response to _______ which can lead to myocardial _____, cardiac ____, _______ failure and sudden _____.

A

Left ventricular hypertrophy; concentric

pressure over load; dysfunction; dilation; congestive heart ; death

42
Q

Hypertensive heart disease:
• Increased work load causes concentric LV hypertrophy
• characterized by an increase in the left ventricular free wall ______
• Ventricular free wall is measured ___ cm (below or above?) the AV orifice

A

thickness; 2.5; below

43
Q

In hypertensive heart disease, The heart (can or can not?) cope with excessive work load
• This leads to ______ and _____, eventually

•

A

can not; hypertrophy and dilatation

44
Q

The best assessment of cardiomegaly is ____ and not _____

A

weight; ventricular thickness

45
Q

In hypertensive heart disease, ANGINA PECTORIS may occur because ____ and ______ is decreased with decreased coronary bld flow

A

CO and bld flow

46
Q

artherosclerosis is a complication of hypertension
T/F

A

T

47
Q

coronary vessels are rarely affected in artherosclerosis.

T/F

A

F(commonly)

48
Q

Morphology of Heart
•______ hypertrophy without _____ of the ventricle
• Increase LV wall ______
• Cardiomegally with increased heart weight leads to impaired _______ which leads to _______ enlargement with presence or absence of atrial fibrillation
,
•

A

Circumferential

dilatation; thickness

diastolic filling

Left atrial

49
Q

Morphology of the heart

Microscopically: _____ myocyte diameter that is later _____ with interstitial fibrosis.
•(presence or absence ?) of hyperplasia.
• Other possible complications include:
• ischemic heart disease from the potentiating effect of HT on coronary artherosclerosis, comgestive heart failure and sudden cardiac death as above.

A

Increase ; irregular; absence

50
Q

Vascular pathology
• Affects _____________ sized vessels:

A

both small & large

51
Q

Vascular pathology

Two main forms of small blood vessels diseases:
1. Hyaline arteriolosclerosis:
• Encountered generally in ____ and _____ but more generalized and more severe in _____.
• Vascular lesions consists of __genous, _____ color , hyaline thickening of the walls of arterioles and with _____ of the lumen.

A

elderly and diabetics; hypertensives

homo; pink; narrowing;

52
Q

Hyaline arteriolosclerosis

Pathogenesis
•Presumably the chronic hemodynamic stress of hypertension accentuates endothelial injury → ________ and ________ deposition with narrowing and
• Consequent ischaemia and organ shrinkage as in ______________.
• The hyaline appearance of the protein gives it its name

A

leakage of plasma proteins and hyaline

benign nephrosclerosis

53
Q

Hyperplastic Arteriolosclerosis
• Related to more (acute or chronic ?) and (mild or severe?) elevations of BP,
• Therefore characteristic of _____ HT (diastolic press > 110 mmHg)

A

Acute ; severe; malignant

54
Q

Hyperplastic Arteriolosclerosis

• Proliferation of _____ manifests as ______,_______,______ thickening of the walls of arterioles with progressive narrowing of lumina

• This proliferation is thought to be a response to _______ derived from _____
• There is also loss of endothelial integrity often accompanied by deposits of ____ material (______ necrosis) and
• Acute necrosis of the vessels walls – ____________
• All tissues throughout the body may be affected but the favoured site is the _____.

A

smooth muscle ; onion –skin, concentric , laminated

growth factors; platelets

fibrinoid; fibrinoid necrosis

necrotizing arterolitis.; kidney

55
Q

Pulmonary HT
• Pulmonary vasculature
1. Primary pulmonary hypertension
2. Secondary causes:
•_________ disease,
• Pneumoconiosis;
• Recurrent _________
• Marked obesity and
•_______ sickness.

A

Chronic obstructive pulmonary

pulmonary thrombo-embolism

Chronic altitude

56
Q

Secondary causes of pulmonary hypertension:

It can be acute or chronic:
• Acute-massive pulm. thromboembolism → marked ____________

Chronic → ______,_______ and potentially failure (__________) + pulmonary vascular sclerosis

A

Rt ventricular dilation without hypertrophy

right vent. Hypertrophy, dilatation ; Cor pulmonale

57
Q

BRAIN
• The most important effects of hypertension on the brain include:
1. Massive ___________, with the presence or absence of ______
2.______ infarcts and ____ hemorrhages,
3. Hypertensive _______. Atherosclerosis and diabetes are frequently associated diseases

A

hypertensive intracerebral hemorrhage; berry aneurysms

Lacunar; slit

encephalopathy

58
Q

BRAIN-2
• Hypertension affects the (shallow or deep ?) penetrating arteries and arterioles that supply the:
* _______,______,__________
• These cerebral vessels develop arteriolar sclerosis and may become occluded -_____________

A

Deep; Basal ganglia, hemispheric white matter & the brainstem.

Transient ischemic atrophy

59
Q

Effect of Hypertension on the brain

Ischaemic strokes ____%; hemorrhagic -____%; subarachnoid hemorrhage - ___ %

A

75-80; 15; 5

60
Q

Effect of Hypertension on the brain

• Development of single or multiple, small, cavitary infarcts-_____ , or lacunar state (________)
• Less than _____ wide, & occur in the ________, thalamus, internal capsule, deep white matter, caudate nucleus, and pons, in descending order of frequency.
• Lacunes can either be ______ or cause _____.
• Widening of the perivascular spaces around affected vessels - (_______).

A

lacunes; état lacunaire

15 mm

lenticular nucleus

clinically silent ; severe neurologic impairment; état criblé

61
Q

BRAIN-3
Slit hemorrhages
• Rupture of the (small or large?) -caliber penetrating vessels and the development of small hemorrhages. Which resorbs, slitlike cavity (slit hemorrhage) surrounded by ______ discoloration;
• Hypertensive _________
• Clinicopathologic syndrome arising in a hypertensive patient characterized by diffuse cerebral dysfunction, including headaches, confusion, vomiting, and convulsions, sometimes leading to coma.
• Edematous brain with or without __________ or _______ . Petechiae and fibrinoid necrosis of arterioles in the gray and white matter may be seen microscopically.

A

Small ; brownish; Encephalopathy

transtentorial or tonsillar herniation.

62
Q

BRAIN-4
Vascular (multi-infarct) dementia –
• Multiple, bilateral, gray matter (cortex, thalamus, basal ganglia) and white matter (centrum semiovale) infarcts caused by multifocal vascular disease, consisting largely of
• (1) cerebral _______,
• (2) vessel thrombosis or embolization from ______ vessels or from the ______ , or
• (3) cerebral _______ from chronic hypertension.

A

atherosclerosis; carotid; heart; arteriolar sclerosis

63
Q

Effect of hypertension on the brain

Binswanger disease

• Pattern of injury preferentially involves (small or large?) areas of the ____________ with myelin and axon loss,

A

Large

subcortical white matter

64
Q

EYE

RETINAL VASCULAR DISEASE
• A- ‘Non Malignant’ Hypertensive retinopathy
1.________ arteriolar wall -generalized arteriolar (narrowing or widening?)
2.____ and ___ wiring. Vessels may appear (narrowed or widened?) , and the color of the blood column may change from ___ to _____ and to _______ depending on the degree of ________
3. Arteriovenous _____: Retinal arterioles and veins share a common _______.
Therefore, in pronounced retinal arteriolosclerosis, the arteriole may ______ at points where ______
4. Venous ____ distal to arteriolar-venous crossing may precipitate ____ of the _______ branches.

A

Thickened; narrowing

Copper & Silver; narrowed; bright red to copper and to silver ; vascular wall thickness

nipping; adventitial sheath; compress the vein ; both vessels cross

stasis; occlusions; retinal vein

65
Q

EYE-2
• B Malignant Hypertensive Retinopathy,
• Vessels in the ____ and ——— may be damaged.
•it is characterized by – _____,______, and presence or absence of _______

A

retina and choroid

hemorrhages, hard exudates; Optic disc oedema

66
Q

EYE-2
• B Malignant Hypertensive Retinopathy,

• Elschnig’s spots -Damage to ______ vessels may produce ____________

A

choroidal; focal choroidal infarcts

67
Q

EYE-2
• B Malignant Hypertensive Retinopathy,

• Retinal detachment -Damage to the ______, the ______ layer of the choroidal vasculature, may, in turn, damage the _________________ epithelium and permit exudate to accumulate in the potential space between the _______ and the ________

A

choriocapillaris; internal

overlying retinal pigment

neurosensory retina and the retinal pigment epithelium.

68
Q

EYE-3
• Occlusion of retinal arterioles may produce infarcts of the nerve fiber layer of the retina

• Axoplasmic transport in the nerve fiber layer is interrupted at the point of axonal damage, and accumulation of _______ at the swollen ends of damaged axons creates the__________ (_____bodies).Collections of those bodies populate the nerve fiber layer infarct, seen ophthalmoscopically as “__________”.

A

mitochondria

histologic illusion of cells

cytoid

cotton-wool spots

69
Q

Renal Changes
• Benign Nephrosclerosis: Sclerosis of ______ and ________ with resultant parenchymal ischaemia.
• Morphology – ___________ and ______
• (N) or ______ kidneys + fine ________.

A

renal arterioles and small arteries

Hyaline arteriolosclerosis & fibroelastic hyperplasia. ; shrunken; granularity

70
Q

Malignant nephrosclerosis – occurs in 1-5% of hypertensives. Morphology –
1. “______” appearance.
2._______ necrosis of arterioles;
3. Hyperplastic _____
4. Necrotizing _____
• BP usually >____ mmHg diastolic →

A

flea bitten

Fibrinoid

arteriolitis

glomerulitis

130

71
Q

_______________ - ACC

________________ - AHA

JNC-______________

A

American College of Cardiology

AmericanHeartAssociation

Joint national committee

72
Q

Causes of secondary HT; - #_________!

A

RNDEC

Renal
Neurogenic
Drugs
Endocrine
CVS

73
Q

EYES

Fundoscopic examination:

_______ spots (___ _____)

Retinal hemorrhages (i.e.,_____-shaped hemorrhages)
Microaneurysms

____________(results from exudation into the macula)
Arteriovenous ______: _______ shape on fundoscopic exam Associated with advanced hypertensive retinopathy.

Marked swelling and prominence of the ______ with ______ borders due to papilledema and optic ____ (end-stage disease)

A

Cotton-wool ; hard exudates

flame

Macular star; nicking

optic disk; indistinct; atrophy

74
Q

Left ventricular free wall thickness (Normal : ___-___cm)

Normal weight of heart: Males – ___-____ g, Females – ____-____ g)

A

1.3 – 1.5

300 to 350

250 to 300

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