Systemic Hypertension and the Eye

Question 1

Prehypertension is defined as what?

Answer 1

120/80 to 139/89

Question 2

Stage 1 HTN is defined as ?

Answer 2

140/90 to 159/99

Question 3

Stage 2 HTN is defined as ?

Answer 3

> 160/100

Question 4

How many adults in the US have HTN? What percentage is this?

Answer 4

67 million people

30% of adults

Question 5

How many adults are aware that they have hypertension?

Answer 5

53 million

Question 6

How many adults are treated for HTN?

Answer 6

47 million

Question 7

How many adults have controlled HTN?

Answer 7

31 million

Only 47% of ppl w/ HTN

Question 8

What percentage of adults have pre-HTN?

Answer 8

30%

Question 9

What ethnicity has the highest rate of HTN? What percentage per gender group?

Answer 9

African Americans

43% men, 45.7% women

Question 10

What is the second race to have the highest rate of HTN?

Answer 10

Mexican Americans

Question 11

What is the name of the specialized cell in the distal convoluted tubule that senses sodium concentration in the blood?

Answer 11

Macula Densa

Question 12

If the macula densa cell senses low sodium, it will send what to the juxtaglomerular cell?

Answer 12

Prostaglandin – tells juxtaglomerular cells to release renin

Question 13

The juxtaglomerular cell is found in what part of the kidney

Answer 13

Afferent arteriole (or juxtaglomerular apparatus)… secretes renin

Question 14

What stimulates renin?

Answer 14

i. Prostaglandin released by Macula Densa Cells

ii. Sympathetic nervous system via Medulla signal via the baroreceptors:

Question 15

Where are the baroreceptors found? Which CN is associated with each?

Answer 15

Aortic Arch - CN X (vagus nerve)

Carotid - CN IX (glossopharyngeal)

Question 16

Renin will cause what?

Answer 16

Reacts w/ Angiotensinogen to become angiotensin I

Question 17

Angiotensin I reacts with ACE to become what? What does this signal cause?

Answer 17

Angiotensin II - power vasoconstrictor to increase BP

Question 18

Does A-II go to pituitary? What does it do?

Answer 18

Yes, it tells the pituitary to secrete an antidiuretic hormone

Question 19

Does A-II go to the hypothalamus? What does it do?

Answer 19

Yes, stimulates the thirst center to make us drink water

Question 20

Where are the 4 locations that A-II goes?

Answer 20

1. Pituitary
2. Hypothalamus
3. Tunica Media
4. Adrenal Gland

Question 21

At what age does your risk for hypertension increase?

Answer 21

75 and older

Question 22

If you are 50 yo or less, what’s the sodium intake?

Answer 22

2300mg a day

Question 23

If you are 51 or older, what’s the sodium intake?

Answer 23

1500mg a day

Question 24

How much salt does the average american intake a day?

Answer 24

3400

Question 25

What organ secretes angiotensinogen?

Answer 25

Liver

Question 26

Where is ACE secreted from?

Answer 26

Vascular endothelial cells of lung, kidney, heart, brain and adrenal medulla

Question 27

A-II goes to the cortex of the adrenal gland to release? What does this hormone do?

Answer 27

Releases aldosterone - aldosterone goes to collecting duct to bring sodium in, which brings in water to increase BP

Question 28

A-II goes to the pituitary gland to release? What does this do?

Answer 28

Anti-diuretic hormone (ADH) - can't pee excess water out of body

Question 29

A-II goes to the hypothalamus to stimulate what?

Answer 29

stimulates thirst center - makes us thirsty to drink water

Question 30

What retinal changes are found in Grade 3 HR? What's the diastolic BP around this time?

Answer 30

CWS, Exudates, Flame Shaped Hemes > 100-115 over the last 3 mo.

Question 31

What retinal changes are found in Grade 4 HR?

Answer 31

Grade 3 + ONH swelling > 200/120+

Question 32

What are the 4 things you want to ask a grade 3 or grade 4 patient?

Answer 32

1. Heart pain 2. Blood in urine 3. Pain in arm 4. HA

Question 33

What are the grades for AS?

Answer 33

1. broadened arteriole light reflex 2. Increased broadening of arteriole 3. Copper wiring 4. silver wiring

Question 34

What are the 4 causes of malignant hypertension?

Answer 34

1. Renal Artery Stenosis 2. Pheochromocytoma 3. Coarctation 4. Blockage of carotid

Question 35

What is a pheochromocytoma?

Answer 35

Tumor of adrenal gland secreting too much epinephrine/norepinephrine

Question 36

HTN can damage what important structures in the brain?

Answer 36

internal capsule and basal ganglia

Question 37

What are the 2 types of strokes?

Answer 37

Ischemia and Hemorrhage

Question 38

What percentage of strokes are ischemic?

Answer 38

85%

Question 39

The diastolic number for malignant hypertension is what?

Answer 39

usually above 120 - 130

Question 40

What should be the blood pressure of a hypertensive patient with kidney disease?

Answer 40

125/80

Question 41

What secretes renin?

Answer 41

Kidney

Question 42

What are the complications of HTN?

Answer 42

- most common cause of premature CV disease, MI - Hemorrhagic stroke - Embolic Stroke - Renal Failure

Question 43

90-95% of ppl don't know what is causing their HTN. What type of HTN is this?

Answer 43

Primary (essential) HTN

Question 44

This is known a hyalanized, thickened and calcified arterioles

Answer 44

Arteriolosclerosis

Question 45

Where is arteriolosclerosis most severe?

Answer 45

Basal Ganglia (60%) Thalamus (10%) Pons (10%) Cerebellum (10%)

Question 46

What % of all strokes occur after the age of 65?

Answer 46

75%