Lecture 5 - Hypertension

Question 1

What are the major determinants for blood pressure?

Answer 1

cardiac output and peripheral resistance

Question 2

What are the regulation systems for blood pressure?

Answer 2

baroreceptor reflex
renin-angiotensin system
aldosterone

Question 3

What minute-minute regulates blood pressure?

Answer 3

baroreceptors

Question 4

What long term regulates blood pressure?

Answer 4

RAAS

Question 5

How does RAAS regulate blood pressure?

Answer 5

hypovolemia –> renin from kidney goes to liver and activates angiotensinogen into angiotensin 1 –> ACE converting enzyme from lungs converts angiotensin 1 to angiotensin 2 –> potent vasoconstrictor and potent aldosterone stimulator –> improve blood volume and pressure

Question 6

Constriction of efferent arteriole (increases/decreases) glomerular capillary pressure.

Answer 6

increases

Question 7

Angiotensin 2 vasoconstricts….

Answer 7

efferent arteriole

Question 8

What do ACE inhibitors do?

Answer 8

block ACE converting enzyme from converting angiotensin 1 to angiotension 2

Question 9

What do ARBs do?

Answer 9

blocks angiotensin 2 from stimulating aldosterone or vasocontricting

Question 10

Examples of ACE inhibitors

Answer 10

enalapril
benazepril

Question 11

Examples of ARBs

Answer 11

telmisartan

Question 12

Aldosterone is a?

Answer 12

mineralocorticoid

Question 13

Where is aldosterone produced?

Answer 13

zona glomerulosa

Question 14

What is the stimuli for release?

Answer 14

angiotension 2
hyperkalemia

Question 15

Aldosterone effects on kidneys

Answer 15

potassium excretion and sodium retention

Question 16

Hyperaldosteronism does what to Na and K?

Answer 16

high Na
low K

Question 17

Addison’s, with a mineralocorticoid deficiency, does what to K and Na?

Answer 17

high K
low Na

Question 18

How do you choose appropriate cuff size?

Answer 18

choose cuff width of 30-40% leg circumference

Question 19

If your BP cuff is too narrow, what will you see?

Answer 19

overestimation of

Question 20

4 reasons for chronic activation of RAAS

Answer 20

1. endothelial dysfunction
2. tissue fibrosis
3. cellular remodeling
4. proteinuria

Question 21

How many measurements should you take for BP?

Answer 21

5-7

Question 22

Gold standard for direct BP measurement?

Answer 22

arterial cath

Question 23

Most common causes of secondary hypertension

Answer 23

D - diabetes mellitus
P - pheochromoctyoma
A - hyperAldosteronism
C - cushing’s
T - hyperThyroidism

Question 24

What are the indirect, non-invasive measurement techniques for BP?

Answer 24

doppler
oscillometric

Question 25

Doppler reads what arterial BP?

Answer 25

systolic

Question 26

Doppler reads what BP in cats?

Answer 26

mean

Question 27

What is the most accurate BP reading?

Answer 27

mean arterial BP

Question 28

Types of Hypertension

Answer 28

white coat hypertension secondary hypertension idiopathic/primary hypertension

Question 29

Describe white coat hypertension.

Answer 29

consequence of anxiety or stress!!!

Question 30

Tx for White Coat Hypertension

Answer 30

none

Question 31

Most common type of hypertension

Answer 31

secondary

Question 32

Describe secondary hypertension

Answer 32

persistent, pathologic increase in BP concurrent with disease, drugs, toxins

Question 33

Describe idiopathic or primary hypertension

Answer 33

persistent in the absence of an underlying identifiable cause usually multifactorial: genetics, lifestyle, environment

Question 34

Which type of hypertension is difficult to prove in dogs and cats because of subclinical renal disease?

Answer 34

idiopathic or primary hypertension

Question 35

Target organ damage from hypertension?

Answer 35

B - brain (encephalopathy) A - arteries R - retina (detachment) K - kidney (proteinuria) H - heart (failure)

Question 36

When should you measure BP?

Answer 36

If there are clinical abnormalities consistent with target organ damage, if there is a disease present that's associated with secondary hypertension annual screening

Question 37

How would you classify a BP of <140mmHg and what's the risk of end organ damage?

Answer 37

normotensive

Question 38

How would you classify a BP of 141-159mmHg and what's the risk of end organ damage? When should you recheck?

Answer 38

pre-hypertensive; low risk; monitor and recheck in 6mo

Question 39

How would you classify a BP of 160-179mmHg and what's the risk of end organ damage? When should you recheck?

Answer 39

hypertensive, moderate risk; recheck in 4-8wks

Question 40

How would you classify a BP of >180mmHg and what's the risk of end organ damage? When should you recheck?

Answer 40

severely hypertensive, high risk, recheck in 1-2wks

Question 41

What is considered hypotensive?

Answer 41

<90mmHg

Question 42

Tx of Hypertension

Answer 42

reduce BP over weeks RAAS inhibitors ARBs

Question 43

What's the frontline for mild to moderate hypertension in dogs?

Answer 43

ACE inhibitors, only reduces 10-15mmHg

Question 44

Side effects of ACE inhibitors

Answer 44

GI, hyponatremia, hyperkalemia, worsening azotemia

Question 45

What is the frontline for severe hypertension in cats?

Answer 45

CCB BID

Question 46

Side effects of calcium channel blockers

Answer 46

hypotension gingival hyperplasia peripheral edema

Question 47

Tx for Severe Hypertension in dogs

Answer 47

ACE inhibitor or ARB + CCB

Question 48

Mild Hypertension Tx in cats

Answer 48

CCB SID

Question 49

If a cat has hypertension and proteinuria, what should you add into tx plan?

Answer 49

ARB