Hypertension

Question 1

Hypertension doubles the risk of

Answer 1

CHD, CHF, stroke

Question 2

Primary determinant of extracellullar fluid

Answer 2

Sodium

Question 3

Modulate blood pressure over the short term

Answer 3

Adrenergic reflexes
(Norepinephrine, epinephrine, dopamine)

Question 4

Adrenergic reflexes are mediated by

Answer 4

G proteins and

Intracellular conc of second messengers

Question 5

Alpha receptors are activated more by

Answer 5

Norepnephrine

Question 6

Beta receptors are activated more by

Answer 6

Epinephrine

Question 7

Located on postsynaptic cells in smooth muscle

Answer 7

Alpha 1 receptors

Question 8

Causes vasoconstriction

➢ Increases renal tubular reabsorption of sodium

Answer 8

•α1 Receptors

Question 9

Located on presynaptic membranes of postganglionic nerve terminals

Answer 9

α2 Receptors

Question 10

Stimulates the rate and strength of cardiac contraction

Answer 10

Beta 1

Question 11

By activation of epinephrine, it relax vascular smooth muscle

➢ Causes vasodilation

Answer 11

Beta 2

Question 12

Mediated by stretch-sensitive sensory nerve endings in the carotid sinuses and the aortic arch

Answer 12

Arterial baroreflex

Question 13

3 primary stimuli for renin secretion

Answer 13

1. Decreased NaCl transport in the distal portion of the thick ascending limb of the loop of Henle
2. Decreased pressure or stretch within the renal afferent arteriole (baroreceptor mechanism)
3. Sympathetic nervous system stimulation of renin-secreting cells via β1 adrenoreceptors

Question 14

Primary factor in regulating the synthesis and secretion of aldosterone

Answer 14

Angiotensin II

Question 15

Mineralocorticoid
➢ Increases sodium reabsorption by amiloride-sensitive epithelial sodium channels (ENaC) on the apical surface of the principal cells of the renal cortical collecting duct

Answer 15

Aldosterone

Question 16

Diagnosis of htn

Answer 16

Average of two or more seated blood pressure readings during each of two or more outpatient visits

Question 17

the cardiovascular disease risk is doubled

Answer 17

For every 20mmHg increase in systolic and 10mmHg increase in diastolic,

Question 18

Consequences of Hypertension

Answer 18

Cardiovascular disease
•Stroke
•Renal disease
•Peripheral or vascular disease

Question 19

JNC 8 GUIDELINE

Answer 19

Normal <120 < 80
Pre 120-139/ 80-89
Stage 1 140-159/90-99
Stage 2 >/= 160/>/= 100

Question 20

Isolated systolic htn

Answer 20

> /= 140/ <90

Question 21

AHA HTN CATEGORIES

Answer 21

NORMAL
<120/<80
ELEVATED
120-129/<80
HTN STAGE 1
130-139/80-89
HTN STAGE 2
140 OR HIGHER/ 90 OR HIGHER
HTN CRISIS
>180/ >120

Question 22

AKA essential hypertension

Answer 22

Primary hypertension

Question 23

80-95% of htn

Answer 23

Primary htn

Question 24

Consequence of interaction between environmental and genetic factors

Answer 24

Primary hypertension

Question 25

A specific, remediable cause of hypertension can be identified

Answer 25

Secondary hypertension

Question 26

Clues for suspecting secondary HTN:

Answer 26

1. Abrupt onset of htn 2. Age of onset <20 or >50 y/o 3. No family hx of htn 4. Sudden inc in BP with stable stage 1 htn 5. Poor bp control 6. Systemic findings 7. Disproporionate target organ damage

Question 27

Secondary causes of htn

Answer 27

``` Renaal Primary aldosteronismm Cushing's syndrome 17 alpha hydroxylase deficiency Pheochromocytoma Aortic coarctation Obstructive sleep apnea Peeclampsia/eclampsia Hypothyroidism Hyperthyroidism Hypercalcemia Acromegaly ```

Question 28

atleast three separate clinic-based measurements >140/90 mmHg •At least two non-clinic-based measurements <140/90 mmHg in the absence of any evidence of target organ damage.

Answer 28

White coat htn

Question 29

Normal BP in the office or clinic, but experiences episodes of INCREASED BP OUT OF THE OFFICE

Answer 29

Masked Hypertension

Question 30

Office BP ≥ 140/90 and with ≥ 3 drugs at optimal doses •Office BP <140/00 but requires ≥ 4 drugs

Answer 30

Resistant Hypertension

Question 31

Dipping pattern

Answer 31

Nocturnal decrease in BP by 15% to 25% compared with awake values

Question 32

Non dipping pattern

Answer 32

BP dec during sleep by 10% compared with awake

Question 33

Increased BP during sleep, in a supine position | •A.K.A Rise Pattern

Answer 33

Reverse Dipping Pattern

Question 34

A syndrome associated with an abrupt increase of blood pressure in a patient with underlying hypertension

Answer 34

Malignant Hypertension

Question 35

Markedly elevated BP with target organ damage

Answer 35

Hypertensive emergency