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What is the clinical standard of chronic arterial hypertension?

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


What is hypertension a leading risk factor for?

What is hypertension a major contributor to?


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


What occurs if hypertension is left untreated?

It gets worse over time and must be treated with medication


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


Several causes of secondary hypertension are? (6)

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


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


Renal parenchymal disease

Impairs kidney's ability to do what?

To excrete sodium and water 


Primary Aldosteronism

Hypersecretion of aldosterone results in?

Abnormal retention of salt and water



What does the tumor secrete? What is the result?

Epinepherine and norepinepherine result in elevated peripheral resistance


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



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


Prehypertension range?



Mild hypertension

130/85 - 139/89


Stage one hypertension range?

140/90 - 159/99


Stage two hypertension range?

160/100 - 179/109


Stage three hypertension range?

180/110 - 209/119


Stage four hypertension range?

GREATER than or equal to 210/120


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)


What are some initiating factors?

Genetics, renal, CNS, sodium


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

How can this be attenuated?


Increase in dietary K+ consumption


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


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


Mean arterial pressure = ______ x _____

Cardiac output X vascular resistance


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


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


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


What can occur to the structure of the arterial wall?

Thicken and thus narrow the lumens


How do vascular walls thicken?

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


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.



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

Norepinepherine, Angiotensin II and endothelin


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

Reactive oxygen species; superoxide anion


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

mitogenic; vasoconstrictive; superoxide; NO