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Flashcards in L11- Primary HTN Deck (12):
1

How do both SBP and DBP change with age? Mechanism for age-related changes?

 

Effect on Pulse Pressure?

SBP - Increases with age up until death bc blood vessels get stiffer 

 

DBP - rises until age 50 and then starts to decline bc blood vessels lose elasticity and canno longer maintain pressures

 

Pulse Pressure Widens!

2

Name the 4 predictors of mortality in HTN and which one is most significant?

1) Elevated systolic pressure

2) elevated diastolic

3) Wide Pulse Pressure* most significant 

4) Loss of Nocturnal Dip (normally BP goes down at night but if it doesn't anymore then bad HTN)

3

What is the numerical definition of Isolated Systolic HTN?

SBP >140 and DBP <90

 

occurs predominantly in older people and indicates underlying stiffness of vessels 

4

How does AG2 contribute to primary HTN?

AG2 acts on receptors in vessels and leads to 1) Vasoconstriction and 2) Fibrosis and 3) Thrombosis 

5

What are the target organ sequelae of HTN in the eyes?

Retinal vein and artery thrombosis 

*Papilledema - PATHOPNEUMONIC!!! 

Other Findings on fundoscopic exam evidence of Eye damage:

AV Nicking - arteries in retina thickened and intent onto veins there they cross

Copper Wiring - arteries look thick and prominent

Flame Hemorrhage, Hard exudates, Cotton wool spot, Papilledema 

6

How does HTN lead to target organ damage in the heart and cardiac failure...Then walk through an example of the progression 

Coronary Artery Disease decreases luminal caliber leading to Hypertrophy of LV

LV Hypertrophy becomes so thick that heart has hard time relaxing so has to contract more frequently to maintain CO (bc less filling) 

LV Hypertrophy also leads to stretching of myocytes and changes electricity in heart - Arrhythmias 

WALK THROUGH EXAMPLE

Early - ventricle thickened and Diastolic heart failure so blood backs up into periphery and lungs

Later - ventricle gives out bc cant pump against increased pressure and get dilated Systolic Heart Failure 

7

What is a Clinical Presentation clue to Peripheral Vascular Disease?

Claudification of feet and legs - get sore with exertion 

8

What are the CNS organ damage effects from HTN?

Strokes - 

Hemorrhagic - shear force of high BP on tiny vessels that burst

Ischemic - Atheroma and plaque dislodges distally to get ischemic area - LACUNAR CAVITY FORMS = Pathopneumonic for HTN

Vascular Dimentia 

9

What are the 4 classes of drugs to treat primary HTN and how do they work?

diuretics - Lower CO by reducing salt and water load

Sympatholytics - act centrally or peripherally 

Vasodilators - Dilate vessels for less TPR

RAS Antagonists - block effects of Renin and AG2

10

Which anti-HTN durgs should NOT be used in pregnancy?

ACE-Inhibitors and ARB

11

What is the rule of tens? to what does it apply?

Rule of Tens for SYSTOLIC pressure only

 

add 1 additional drug to treat HTN for every additional 10 mmHG reduction that needs to be made 

12