Hypertension

Question 1

Hypertension definition

Answer 1

Pressure on arterial walls exceeding a defined threshold

Question 2

What does isolated hypertension mean?

Answer 2

Just one particular artery or vein/region, i.e. renovascular, portal

Question 3

Normotension, according to the slide, is what range

Answer 3

<120 over <80

Question 4

Pre-hypertension is what range

Answer 4

120-139 / 80-89

Question 5

Stage I HTN range

Answer 5

140-159 / 90-99

Question 6

Stage II HTN range

Answer 6

sys > 160 / dia > 100

Question 7

Isolated systolic HTN range

Answer 7

sys >140 and dia < 90

Question 8

When in the day is blood pressure normally higher?

Answer 8

Morning

Question 9

What happens to the systolic vs diastolic value with age?

Answer 9

Systolic increases with age, diastolic decreases with age

Question 10

At what age do women meet or surpass the systolic blood pressure of men? (before this age, women have lower BP than men)

Answer 10

60-70 years old

Question 11

What percentage of all death is related to HTN?

Answer 11

13-15%

Question 12

What does essential HTN mean?

Answer 12

no clear etiological factor, and describes 80-90% of all HTN patients. all others are “secondary” and have a clear cause

Question 13

Two things that affect peripheral resistance (from slide)

Answer 13

Vessel wall function

Vessel wall structure

Question 14

Two things that affect cardiac output (again just from slide, not the formula or whatever)

Answer 14

Intravascular volume

Contractility

Question 15

How does increased NaCl intake lead to increased BP?

Answer 15

“In order to increase Na+ excretion, BP must increase some too”
Increases glomerular filtration, decreases renal tubule Na+ absorption

Also ANF
(one single mech not clear, but effects of high NaCl uptake are very clear)

Question 16

What is the guideline for sodium intake in the average population?

Answer 16

2300 mg sodium (5.8g NaCl)

Question 17

What is the guideline for sodium intake in the >51 y/o, diabetic, or hypertensive population?

Answer 17

1500 mg sodium (3.8g NaCl)

Question 18

Main effects of Angiotensin:

Answer 18

vasoconstriction, stimulation of aldosterone secretion, stimulation of vessel wall smooth muscle proliferation

Question 19

Main effects of aldosterone (relevant to this lecture anyway)

Answer 19

Stimulation of Na reabsorption

Question 20

How do alterations in RAS relate to essential and secondary hypertension?

Answer 20

Essential hypertension: RAS is a consequence, not a cause

Secondary htn: may be from renin-secreting tumors, renovascular HTN, primary or secondary aldosteronism

Question 21

In sustained HTN, what may happen to the baroreceptor set-point?

Answer 21

It may be altered, and symp activity is too high. Increased symp tone is related to obesity, sleeping disorders etc. May be more of a “permissive effect” than a cause of hypertension

Question 22

What is arteriosclerosis?

Answer 22

Decreasing in elasticity of vessel walls

Question 23

How do ion transport changes in smooth muscle cells lead to HTN?

Answer 23

Intracellular Ca2+ increases, causing increased contractile activity in arterioles and vasoconstriction

Question 24

How does endothelin affect vascular compliance?

Answer 24

It’s a vasoconstrictor

Question 25

HTN causes weakened vessel walls. What are 3 possible pathologies resulting from this?

Answer 25

1. Cerebral vessel weakening -> hemorrhagic stroke 2. Renal vessel weakening -> nephrosclerosis and renal failure 3. Opthalmic vessel weakening -> retinopathy

Question 26

HTN causes accelerated atherosclerosis. What are 3 major risks from this?

Answer 26

AMI, ischemic stroke, and aneurysms/dissections

Question 27

HTN causes an increase in afterload. What are 2 major risks from this?

Answer 27

Heart failure and AMI due to increased myocardial O2 demand

Question 28

What are two cerebral problems from hypertension that are not a form of stroke?

Answer 28

Hypertensive encephalopathy: loss of cerebral autoregulation, etc.. Hypertension-associated Dementia

Question 29

What are 3 manifestations of hypertension in the heart?

Answer 29

LVH, CHF, and coronary artery disease

Question 30

What is the most frequent cause of secondary hypertension?

Answer 30

Kidney disease

Question 31

What part of the kidney is primarily affected by HTN?

Answer 31

Glomeruli primarily affected. Tubular damage develops at a later stage Combined glomerular and tubular damage makes the vessels leaky (?)

Question 32

What is the threshold for microalbuminuria vs clinical albuminuria? (check this when suspecting kidney damage from HTN)

Answer 32

Micro: 30-300 mg/24 hours Clinical: >300 mg/24 hours

Question 33

What's a good early, non-invasive diagnostic of peripheral vascular disease?

Answer 33

Dilated fundoscopic examination

Question 34

What are the two kidney secondary hypertension entities?

Answer 34

Parenchymal and Renovascular

Question 35

What are some endocrine causes of HTN?

Answer 35

Primary aldosteronism, Cushing's syndrome, Pheochromocytoma, Hyperthyroidism, Acromegaly

Question 36

What are some drugs that may cause secondary HTN?

Answer 36

Estrogen/androgen hormone supplements, NSAIDS, chronic alcohol intake, antidepressants, immunosupressive agents

Question 37

How do you test kidney function in diagnostic laboratory test of HTN?

Answer 37

Urine sediment, albumin, potassium Serum creatinin

Question 38

How do you test endocrine function in diagnostic laboratory test of HTN?

Answer 38

Serum sodium, potassium, calcium, TSH

Question 39

What are 3 ways to reduce intravascular volume by medication?

Answer 39

Diuretics ACE inhibitors Aldosterone antagonists