Hypertension

Question 1

is systolic or diastolic pressure more important?

Answer 1

systolic associated w/ mortality

Question 2

risk factors for hypertension

Answer 2

african americans, age, low SES,

Question 3

diagram the RAAS system

Answer 3

see notes

Question 4

what stimuli activate the juxtaglomerular apparatus

Answer 4

1 decreased stretch in the wall

2 reduced Na concentration

3 sympathetic stimulation

Question 5

3 hemodynamic patterns of hypertension

Answer 5

1 increased total blood volume

2 increased CO

3 increased PVT

Question 6

describe increased BV hypertension

Answer 6

increased BV = increased preload = increased CO = increased BP

causes- excessive Na intake, cushings, renal disease, hyperaldosteronism

low renin

therapy- diuretics

Question 7

describe increased CO hypertension

Answer 7

caused by: hyperthyroidism, hyperkinetic heart syndrome

therapy: beta blockers

Question 8

describe increased TPR hypertension

Answer 8

renovascular hypertension, hyperthyroidism, hypothyroidism, malignant hypertension

high renin

therapy: vasodilators

Question 9

essential hypertension

Answer 9

not secondary to another disease

Question 10

primary aldosteronism

Answer 10

hyperplasia/adenoma of adrenal cortex causes excess aldosterone.

causes Na retention and hypokalemia

treated w/: aldosterone antagonists

Question 11

pheochromocytoma

Answer 11

tumor on chromaffin cells (usually adrenal medulla). excrete catecholamines.

norepinephrine- hypertension, vasoconstriction, pallor, bradycardia

epinephrine- tachycardia, orthostatic hypotension

dx- measure metabolites

treatment- surgery

Question 12

renal artery stenosis

Answer 12

two causes: atherosclerosis or fibromuscular dysplasia

stenosis causes fall in afferent arteriolar pressure, activates RAAS

may have audible bruit or hypokalemia d/t aldosterone

dx- sample renin in renal veins

Question 13

renal parenchymal disease

Answer 13

can’t secrete volume or increased renin secretion

Question 14

coarctation of aorta

Answer 14

congenital narrowing of aorta puts all pressure into arms and none into kidneys

dx- comparing upper and lower BPs. murmur of flow through coarctation

Question 15

cushings

Answer 15

cortisol is similar to aldosterone

Question 16

thyroid disease

Answer 16

hyper- pts are hypertensive b/c thyroid stimulation of heart

hypo- pts are hypertenisve b/c of increased PVR

Question 17

sleep apnea

Answer 17

elevation of sympathetic tone associated w/ apneic episodes

Question 18

alcohol

Answer 18

unknown- sympathetics?

Question 19

oral contraceptives

Answer 19

estrogens increase angiotensinogen, activating RAS

Question 20

pregnancy induced

Answer 20

normal during 3rd trimester

Question 21

essential hypertension causes

Answer 21

genetics
hyperactive sympathetic nervous system
hyperactive renin
increased intracellular Na
vascular hypertrophy

Question 22

2 phases of essential hypertension

Answer 22

hyperkinetic- early
excessive CO and increased BV
labile BP
renin low

established- late
increased PVR, BP is fixed
renin is high

Question 23

consequences of hypertension

Answer 23

1. risk factor for atherosclerosis via endothelial injury
2. heart disease- coronary disease (atherosclerosis), hypertensive heart disease (concentric LV hypertrophy
3. brain- cerebrovascular atherosclerosis, aneurysms

4 kidney- nephrosclerosis narrows lumens d/t increased BP

5 aortic dissection- splits intima from adventitia

6 hypertensive retinopathy- arterioles narrow in retina

7 malignant hypertension- renal arterioles develop hyperplastic arteriolar sclerosis w/ fibrinoid necrosis of arterioles and glomeruli- thickening of intima and narrowing of lumen

Question 24

lifestyle modications

Answer 24

diet- weight loss, salt intake, alcohol decrease

excercise-

relaxation therapy- less stress

Question 25

categories of hypertensive drugs

Answer 25

diuretics- decrease BV

beta-blockers- decrease sympathetic activation

agents that block CNS activation- decreased sympathetic activation

calcium channel blocker- reduction of CO and TPR

vasodilators- decrease TPR

alpha-blocking agents- decrease TPR

ACE-I

ARBs