Hypertension Flashcards
(25 cards)
is systolic or diastolic pressure more important?
systolic associated w/ mortality
risk factors for hypertension
african americans, age, low SES,
diagram the RAAS system
see notes
what stimuli activate the juxtaglomerular apparatus
1 decreased stretch in the wall
2 reduced Na concentration
3 sympathetic stimulation
3 hemodynamic patterns of hypertension
1 increased total blood volume
2 increased CO
3 increased PVT
describe increased BV hypertension
increased BV = increased preload = increased CO = increased BP
causes- excessive Na intake, cushings, renal disease, hyperaldosteronism
low renin
therapy- diuretics
describe increased CO hypertension
caused by: hyperthyroidism, hyperkinetic heart syndrome
therapy: beta blockers
describe increased TPR hypertension
renovascular hypertension, hyperthyroidism, hypothyroidism, malignant hypertension
high renin
therapy: vasodilators
essential hypertension
not secondary to another disease
primary aldosteronism
hyperplasia/adenoma of adrenal cortex causes excess aldosterone.
causes Na retention and hypokalemia
treated w/: aldosterone antagonists
pheochromocytoma
tumor on chromaffin cells (usually adrenal medulla). excrete catecholamines.
norepinephrine- hypertension, vasoconstriction, pallor, bradycardia
epinephrine- tachycardia, orthostatic hypotension
dx- measure metabolites
treatment- surgery
renal artery stenosis
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
renal parenchymal disease
can’t secrete volume or increased renin secretion
coarctation of aorta
congenital narrowing of aorta puts all pressure into arms and none into kidneys
dx- comparing upper and lower BPs. murmur of flow through coarctation
cushings
cortisol is similar to aldosterone
thyroid disease
hyper- pts are hypertensive b/c thyroid stimulation of heart
hypo- pts are hypertenisve b/c of increased PVR
sleep apnea
elevation of sympathetic tone associated w/ apneic episodes
alcohol
unknown- sympathetics?
oral contraceptives
estrogens increase angiotensinogen, activating RAS
pregnancy induced
normal during 3rd trimester
essential hypertension causes
genetics hyperactive sympathetic nervous system hyperactive renin increased intracellular Na vascular hypertrophy
2 phases of essential hypertension
hyperkinetic- early
excessive CO and increased BV
labile BP
renin low
established- late
increased PVR, BP is fixed
renin is high
consequences of hypertension
- risk factor for atherosclerosis via endothelial injury
- heart disease- coronary disease (atherosclerosis), hypertensive heart disease (concentric LV hypertrophy
- 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
lifestyle modications
diet- weight loss, salt intake, alcohol decrease
excercise-
relaxation therapy- less stress
