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Flashcards in Hypertension Deck (31):
1

Which organ is essential in the maintenance of chronic hypertensive states?

Kidney

2

Bp determined by

CO*SVR

3

CO determined by

HR*SV

4

Pressure natriuresis

Increasing BP causes excretion of Na and H2O due to baroreceptors at kidney. Then BP decreases

5

Hypertension effect of pressure natriuresis

Respnse in blunted. Normal intake of sodium doesn't increase output

6

Where does pressure natriuresis occur?

In the proximal nephron

7

How does hypertension affect the baroreceptors in the carotid sinus?

Stimulates them (this is acute regulation), to cause decreased cardiac output and vasodilation. These effects cause blood pressure reduction

8

Essential hypertension

Essential hypertension is hypertension without an identifiable cause. Its the most common form of hypertension (90%) and is a diagnosis of exclusion. Multifactorial cause likely.

9

Potential causes of essential hypertension

Genetics- hereditary component exists.

Systemic abnormalities -- cardiac sympathetic overactivity, abnormal regulation of vascular tone

Renal abnormalities-- excess sodium/water retention.

10

What is more common at what stage in life?
Isolated diastolic hypertension or isolated systolic hypertension?

Isolated diastolic hypertension common earlier in life. Becomes less common because arteries harden due to increased pressure. Loss of elastic recoil. So isolated systolic hypertension becomes more common.

11

Secondary hypertension

Presence of hypertension in the setting of clear structural/hormonal cause.

12

Clues of secondary hypertension

Young age (<20 years)
New onset over 50.
More severe with rapid onset

13

Causes of secondary hypertension

Chronic kidney disease (impaired ability of kidney to excrete sodium and water so rise in blood volume, elevation of CO.)

Renovascular (Renal artery stenosis due to atherosclerosis or fibromuscular dysplasia (young women)) Causes reduced renal blood flow and as a result, activation of the RAAS.

Aortic Coarctation -- congenital narrowing of the aorta causes reduced blood flow to kidney

14

Hypertension with high creatinine or abnormal urinalysis suggestive of

Secondary hypertension due to chronic kidney disease

15

Hypertension with abdominal bruit, unexplained hypokalemia suggestive of

Renal artery stenosis. Treat with ace inhibitors

16

Hypertension with higher BP in arms than legs, or higher BP in right arm than left arm, and rib notching suggestive of

Aortic coarctation

17

Endocrine causes of secondary hypertension

Pheochromocytoma
Primary aldosteronism (Conn Syndrome, decreases renin from negative feedback)
Secondary aldosteronism (renin secreting tumor)
Excess glucocorticoids (expand blood volume and stimulate RAAS)

18

How does pheochromocytoma present?

With paroxysms of palpitations/tachycardia/headaches

19

How does thyroid dysfunction cause hypertension

Both hyper and hypothyroid patients can develop HT

Hyper: Cardiac hyperactivity, increase in blood volume
Hypo: Diastolic hypertension, increase in PVR.

20

Some other causes of secondary hypertension

Cocaine, alcohol, cold remedies, EPO, oral contraceptives

21

Consequences of hypertension

Arterial damage -- smooth muscle hypertrophy, endothelial dysfunction, loss of elasticity.

Organ damage - brain, heart, aorta, kidney, retina.

22

Consequences of increasing BP 20/10?

CV disease risk doubles with each increment

23

Cardiac effects of hypertension

LV hypertrophy due to increased afterload. This leads to increased ventricular stiffness and diastolic dysfunction.

Systolic dysfunction due to hypertension and myocardial ischemia

Coronary artery disease- development of atherosclerosis which increases cardiac work and myocardial oxygen demand.

24

Most common form of heart failure in elderly?

Diastolic

25

Effect of hypertension on brain

Causes stroke! Both ischemic and hemorrhagic. Effective BP treatment has led to 50% reduction in stroke deaths

26

Effect of HTN on aorta?

Aneurysm of the abdominal aorta (can burst causing death)
Aortic dissection (can occur at ascending and descending aorta) intima tears

27

Hypertensive Urgency

SBP >180 or DBP >110 without evidence of end-organ damage. Requires immediate evaluation but not admission to ED

28

Hypertensive Emergency

BP >180 or DBP > 100 with signs/symptoms of end organ damage including headache/blurred vision (encephalopathy), SOB (pulmonary edema due to LV hypertrophy), papilledema/retinal exudate.

Immediate hospitalization with rapid control of BP.

29

Nonpharmacologic treatment for HTN

Weight reduction (each 10kg = 5-20 decrease in BP)
Exercise
Diet
Salt restriction
Decrease EtOH, stop smoking

30

Pharmacologic treatment

Diuretics (best for mild-moderate HTN with normal renal function)

Beta Blockers -- reduce CO, reduce renin secretion
REDUCE MORTALITY after MI/CHF

Alpha 2 agonists - decrease sympathetic outflow

Alpha 1 antagonists - relax smooth muscle

CCB- reduce influx of calcium necessary for cardiac/vascular smooth muscle contraction

Direct vasodilators - relax smooth muscle cells

ACE inhibitors-- REDUCE MORTALITY

ARBs -- REDUCE MORTALITY.

31

First line for uncomplicated HTN

Thiazide diuretic