Hypertension

Question 1

What is systemic circulation?

Answer 1

provides nutrients and blood to entire body + removes waste products

Question 2

Circulatory System

Answer 2

regulates body temperature and hormone/immune system components in body

Question 3

Arterial BP

Answer 3

Normal: 120 mmHg (Systolic Pressure: maximum pressure when heart contracts) / 80mmHg (Diastolic Pressure: minimum pressure when heart relaxes)

Question 4

How does arterial BP change at night?

Answer 4

diurnal variation (highest in the afternoon and lowers at night

Question 5

How is arterial BP controlled?

Answer 5

Cardiac Output + Peripheral Resistance

Question 6

What controls CO?

Answer 6

HR + SV

Question 7

What controls SV?

Answer 7

myocardial contractility + size of vascular compartment (the more fluid = the higher the BP)

Question 8

What controls peripheral resistance?

Answer 8

vascular structure / supply / function

Question 9

What are the ranges for normal HR?

Answer 9

Adult: 60-80bpm
Child: 80-100bpm
Infant: 100-120bpm
it gets lower with age !

Question 10

What is HTN?

Answer 10

More than 120/80mmHg on an average of 2+ visits

Usually asymptomatic

Question 11

What are the risk factors of HTN?

Answer 11

Stroke + MI, HF, Kidney Damage, Retinopathy, Peripheral Arterial Disease

Question 12

What are the categories for arterial BP?

Answer 12

Normal: <120 and <80
Elevated: 120-129 and <80 
Pre-HTN: 130-139 and 80-89
HTN Stage 1: >140 and >90
HTN Stage 2: >180 and >120

Question 13

What is primary HTN and how it affects autonomic NS, RAAS, and salt?

Answer 13

90-95% of cases; no underlying cause or disease
Heterogenous etiology and gradual development

Autonomic NS: increased sympathetic stimulation and increased resting pulse rate

RAAS: regulates blood volume via renin (kidney and adipose tissue)

Abnormal Salt Handling (35%): increased intracellular sodium and increased sensitivity to sympathetic NS

Question 14

How do you treat primary HTN?

Answer 14

Lifestyle modifications and Meds

Goal: <130/80

Question 15

What is secondary HTN?

Answer 15

5-10% of cases but is more severe and etiology can be determined

it is secondary to other cause like renal disease, pheochromocytoma, primary aldosteronism, CS, Hyperthryoid + pre-eclampsia

Question 16

What is a HTN crisis - urgency and its symptoms?

Answer 16

> 180/120 with NO end-organ damage

severe HA/anxiety and SOB + nosebleed

Recommend: immediate PCP evaluation

Question 17

What is a HTN crisis - emergency and its symptoms?

Answer 17

> 180/120 WITH end-organ damage

Chest pain, SOB, back pain, weak, change in vision*, difficulty speaking

Recommend: IMMEDIATE hospitalization (GO TO ER)

79% mortality rate without treatment

Complications: stroke, pulmonary edema, lose consciousness/memory, MI, eye/kidney damage, angina, eclampsia, and aortic dissection

Question 18

Arteriosclerosis

Answer 18

narrowing or thickening of arteries

Question 19

Arteriolosclerosis

Answer 19

narrowing or thickening of hardened arterioles

Question 20

Atherosclerosis

Answer 20

Arteriosclerosis + cholesterol deposits

Question 21

What is HTN retinopathy?

Answer 21

most common ocular manifestation of HTN (50-80%)

usually asymptomatic or may lose vision

Grade 1-2: 35% increase risk of stroke
Grade 3-4: 137% increase risk of stroke

Question 22

what is the 1st sign of HTN retinopathy

Answer 22

retinal microvasculature changes and gradual decrease in blood flow in retina

Question 23

What is grade 1 HTN retinopathy

Answer 23

Attenuation of retinal arterioles, decreased A/V ratio, and increased ALR

Question 24

what is grade 2 HTN retinopathy

Answer 24

grade 1 + tortuosity of veins + A/V crossings

Question 25

what is grade 3 HTN retinopathy

Answer 25

grade 2 + flame-shaped hemorrhages + cotton wool spots

Question 26

What is grade 4 HTN retinopathy

Answer 26

grade 3 + swollen optic disc, retinal edema, and macular star