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Flashcards in Reading Assignment Deck (32):
1

What is the clinical standard of chronic arterial hypertension?

Greater than or equal to 140/90 over several weeks or months

2

What is hypertension a leading risk factor for?

What is hypertension a major contributor to?

stroke

morbidity and mortality associated with heart failure, coronary artery disease, atherosclerosis, and renal insufficiency

3

What occurs if hypertension is left untreated?

It gets worse over time and must be treated with medication

4

More attention is now being paid to reduction of high systolic or pulse pressures: why?

Because of the effect of these variables on myocardial afterload and oxygen demand

5

Several causes of secondary hypertension are? (6)

Renal artery stenosis, renal parenchymal disease, primary aldosteronism, pheochromocytoma, aortic coarctation, and thyrotoxicosis

6

Renal artery stenosis:

1. What occurs to the renal arteries?

2. Causes what down stream from the stenosis?

3. How does the body counteract?

1. atherosclerotic plaques in one or both

2. reduced arterial pressure --> reduced water and sodium excretion

3. Activation of the renin-angiotensin system and elevated plasma A II

7

Renal parenchymal disease

Impairs kidney's ability to do what?

To excrete sodium and water 

8

Primary Aldosteronism

Hypersecretion of aldosterone results in?

Abnormal retention of salt and water

9

Pheochromocytoma

What does the tumor secrete? What is the result?

Epinepherine and norepinepherine result in elevated peripheral resistance

10

Aortic coarctation

1. What is CO like?

2. Where is there going to be elevated arterial pressure?

3. Where is the blood pressure normal?

1. Normal

2. Because CO is normal, there will be increased pressure upstream from the coarctation - will read a higher BP in the brachial arteries

3. Normal after the coarctation - will read normal BP in the lower extremities

11

Thyrotoxicosis

1. What is this?

2. Result?

3. ONLY form of chronic arterial hypertension caused by elevated ____ with essentially normal ____ ____.

1. Excessive production of thyroid hormone with resultant increase in metabolic activity of all tissues including the heart

2. Increased CO and HR

3. CO; vascular resistance

12

Prehypertension range?

120/80-135/85

13

Mild hypertension

130/85 - 139/89

14

Stage one hypertension range?

140/90 - 159/99

15

Stage two hypertension range?

160/100 - 179/109

16

Stage three hypertension range?

180/110 - 209/119

17

Stage four hypertension range?

GREATER than or equal to 210/120

18

Stages 1-4 required pharmacological intervention. What level is considered a serious threat to the patients immediate well being? 

Greater than or equal to 160/100 (Beginning of stage 2)

19

What are some initiating factors?

Genetics, renal, CNS, sodium

20

Salt dependent hypertension has been associated with an especially high incidence of ____. 

How can this be attenuated?

Stroke

Increase in dietary K+ consumption

21

What occurs to the baroreceptors in hypertensive individuals?

They are both re-set to a higher mean arterial pressure reference point AND de-sensitized to any increases in mean arterial pressure

22

Normal plasma renin levels when arterial pressure goes up in normotensive individuals?

What happenes with hypertensive individuals?

The renin levels should reflexively decrease

Plasma renin levels are not decreased in patients so their "normal" value for plasma renin activity is actually unacceptably high and suggest there must be a defect in the regulatory mechanism involving the renin-angiotensin system

23

Mean arterial pressure = ______ x _____

Cardiac output X vascular resistance

24

What are the three ways to sustain an elevation of mean arterial pressure? 

However - it has been known that ___ is normal in patients with essential hypertension (except in ____)

1. Increased CO

2. Increased vascular resistance

3. Increase CO and increased vascular resistance

 

CO; thyrotoxicosis

25

Because there is normal CO (except for thyrotoxicosis) there must be an ____ ____ ___ ___. And thus hypertension is classified as a ____ disease.

Elevated peripheral vascular resistance; vascular

26

Two major types of vascular change that contribute to increased resistance?

1. Changes in the structure of the arterial wall

2. Functional changes in the responsiveness of arteries to vasoactive agents

27

What can occur to the structure of the arterial wall?

Thicken and thus narrow the lumens

28

How do vascular walls thicken?

Smooth muscle hypertrophy and hyperplasia as well as increased accumulation of water and connective tissue in the arterial wall

29

For the same degree of muscle shortening, an artery with a thickened wall will exhibit a greater increase in ___ as compared to a thinner walled artery.

resistance

30

What mitogens can lead to vascular wall thickening in the absence of an elevation in arterial pressure?

Norepinepherine, Angiotensin II and endothelin

31

Arteries from hypertensive individuals and animals exhibit excess production of ____ ___ ____ such as ____ ____.

Reactive oxygen species; superoxide anion

32

ROS are _____ and _____. In addition they damage the arterial endothelium and ______ chemically quenches ___.

mitogenic; vasoconstrictive; superoxide; NO