Term
| Hypertension affects ______________ million Americans. (1/3) |
|
Definition
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Term
| What are some lifestyle modifications that can improve hypertension? |
|
Definition
1. Weight loss
2. DASH diet
3. Reduce Na+
4. Increase physical activity
5. Moderation of EtOH |
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Term
| T/F: Most hypertensive patients have the B.P. under control, < 140/90 mmHg. |
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Definition
| False; the out of 39-44% getting treated about 56% of these patients do not reach their goal. |
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Term
| What is the primary goal for the therapy of hypertension? |
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Definition
| Not only the reduction of B.P. but also a reduction in all end organ damage. |
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Term
| A 10-12 mmHg decrease in Systolic B.P. is associated with a 16% decrease in ___________ and a 38% decrease in ____________. |
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Definition
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Term
| What is the target B.P. in patients with added risk factors such as diabetes or CAD? |
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Definition
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Term
| What is considered to a be a 'pre-hypertensive' state? |
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Definition
A Systolic btwn 120-139 mmHg
or a
Diabstolic btwn 80-89 mmHg |
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Term
| T/F: Most patients with hypertension only require 1 drug. |
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Definition
| False; 64% of Americans are on 2 or more drugs to acheive the target goal B.P. |
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Term
| What is the current criteria to be consider as hypertensive? |
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Definition
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Term
| Hypertension can be classified by degree. What are they? |
|
Definition
1. Labile
2. Borderline
3. Chronic (Benign)
4. Malignant |
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Term
| Labile Hypertension is B.P. characterized by its ________________ and ___________. |
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Definition
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Term
| What is White Coat hypertension? |
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Definition
| An increase in B.P. (causal diastolic > 90mmHg) caused by the presence of medical personnel. |
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Term
| With chronic hypertension death is usually a result of ______________ complications and is considered to be the "____________". |
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Definition
Athersclerotic
Silent Killer |
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Term
| With Chronic hypertension ________________ and _______________ occurs if B.P. is left untreated. Magnitude of reduction of life expectancy increases with elevation of B.P. |
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Definition
Premature death
Disability |
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Term
| T/F: Chronic hypertension has more symptoms than malignant hypertension. |
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Definition
| False; Chronic is few to none whereas malignant has more symptoms. |
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Term
| Malignant hypertension is characterized with a __________ and ____________ increase in B.P. If not treated 80-90 % die within 1 yr. Most deaths are associated with _________________ damage. |
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Definition
Rapid
Severe
Target organ |
|
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Term
|
Definition
Swelling of the optic disc
(common in malignant hypertension patients) |
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Term
| Which systems regulate blood pressure? |
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Definition
1. Sympathetic nervous system
2. Endocrine system
3. Kidney system |
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Term
| Catecholamines, the RAAS and ADH all have effects on __________ and _______. |
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Definition
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Term
|
Definition
|
|
Term
| What is insulin-hyperinsulinemia? |
|
Definition
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Term
| What are some hypertensinogenic effects that occur with hyperinsulinemia? |
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Definition
1. Antinatriuretic = retains Na+ if insulin is high
2. Stimulates SNS
3. Increases vascular responsiveness
4. Elevated LDL and reduced HDL
5. Insulin = growth factor
6. Effect transport systems on VSM |
|
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Term
| Kinins release ___________________(NO), and PG. Both are vasodilators and have _____________ and _____________ effects. |
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Definition
EDRF (Endothelium derived relaxation factor)
Diuretic, Natriuretic |
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Term
| PG inhibit the release of _______________. |
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Definition
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Term
| EDRF, NO works by relaxing VSM via ___________. |
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Definition
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Term
|
Definition
Endothelium derived Contracting factor
|
|
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Term
| What are some characteristics of EDCF? |
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Definition
1. Potent Vasoconstrictor
2. Mitogen for VSM
3. Anti-natriuretic (retains Na+) |
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Term
| What is the major stimulus for ANH (Atrial Natriuretic Hormone)? |
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Definition
| An increase in atrial pressure (increase in volume) |
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Term
| ANH functions as a ____________ that increases Na+ and H2O _______. |
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Definition
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Term
| ANH acts as a vaso____________. |
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Definition
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|
Term
| T/F: ANH has many antihypertensive actions. |
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Definition
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Term
| How does ANH have natriuretic and diuretic effects? |
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Definition
| It dilates afferent and constricts efferent arterioles which increase the GFR. Also reduces VSM contractile effects |
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Term
| What are some antihypertensive actions that ANH does? |
|
Definition
1. Decreases Aldo and ADH
2. Increases GFR
3. Reduces VSM contractile effects
4. Decreases renin release
5. Antagonize responses to Ang II |
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Term
| ANH mechanism of action is via an increase in ____________. |
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Definition
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|
Term
| Digitalis-like-factor/ Natriuretic factor/ Quaban-like factor stimulus is an increase in __________ and inhibits _____________. |
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Definition
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|
Term
| What does Natriuresis mean? |
|
Definition
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Term
| Why do Digitalis-like-factor, Natriuretic factor and Quaban factor increase the B.P.? |
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Definition
| Because they increase the intracellular Na+ and Ca2+ while reducing the NE uptake. And now have enchanced vasoconstriction because there is more Na+ and Ca2+ in the muscles. |
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|
Term
| How does the kidneys maintain long term control on volume regulation? |
|
Definition
| Pressure Diuresis/ natriuresis |
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Term
| If left untreated, and because of high pressure you can develop __________. |
|
Definition
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|
Term
| Hypertension can be classified by type: Primary accounts for _______ of cases whereas Secondary accounts for ________. |
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Definition
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Term
| Primary hypertension is idiopathic. What are some possible etiologies of the disease? |
|
Definition
1. Genetics
2. Environment
3. Age
4. SNS
5. Glucose intolerance/insulin resistnace
6. Kidney |
|
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Term
| What is the Na+ recommendation? |
|
Definition
|
|
Term
| In the US and China we consume ___________ NaCl or (4-5 gm Na)...and we only need _________. |
|
Definition
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|
Term
| T/F: There is no cure for hypertension. |
|
Definition
| True, since most cases are idiopathic (meaning we dont know its origin) we can not cure, but only treat! |
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|
Term
| Why do you tend to see an increase in B.P. with an increase in age? |
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Definition
| Because of structural changes such as hardening of the arteries |
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Term
| Increase in Age/B.P., reduced sensitivity of ______________ which gradually resets it. |
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Definition
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|
Term
| ___________ % of essential hypertensives are also insulin resistant. |
|
Definition
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|
Term
| T/F: Secondary hypertension is hypertension resulting from an identifiable cause. |
|
Definition
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Term
| Describe the 2 kidney 1 clip model. |
|
Definition
Clip off one kidney causes a decrease in RBF to that kidney.
This stimulates renin release to release Ang II and Aldo to increase TPR and Volume. The other kideny does pressure diuresis and gets rids of the excess H2O.
It is a high resistance Hypertension. |
|
|
Term
| Describe the 1 kidney, 1 clip model. |
|
Definition
There is no normal kidney, and the one kidney is clipped.
Renin is initailly elevated but then excess volume and Na+ and pressure shuts down renin release.
It is a low renin, high volume hypertension |
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Term
| Pheochromocytoma is a tumor of the ____________ cells. |
|
Definition
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|
Term
| Pheochromocytoma is said to be a ____________ hypertension. |
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Definition
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Term
| What is the symptomatic triad (in addition to hypertension) in patients with Pheochromocytoma? |
|
Definition
1. Tachycardia
2. Headaches
3. Attacks of sweating (on face, chest, back) |
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Term
| Primary Aldosteronism is aka __________. |
|
Definition
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|
Term
| With Conns Syndrome there is an autonomous production of _________ and is the most common in secondary hypertensive patients. |
|
Definition
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Term
| Conns syndrome should be considered in patients who are spontaneously _____________ becuase it can lead to ________________. |
|
Definition
Hypokalemic (< 3mEq/L)
Nephropathy |
|
|
Term
| Patients with Conns Syndrome do not have the feedback mechanism, so renin is ________ and not stimulated by a low Na+ diet. ____________ is also not reduced by a high Na+ diet. |
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Definition
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|
Term
| In Primary Aldosteronism, both CO and TPR are ___________. Patients do not present with _____________. |
|
Definition
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|
Term
| Secondary Aldosteronism occurs with conditions that ______________________. |
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Definition
| Elevate renin and Ang II levels |
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Term
| With Cushings syndrome there is an increase in glucocorticoids. This will _______TPR. |
|
Definition
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|
Term
| What effects do glucocorticoids have that lead to the increase in TPR? |
|
Definition
1. Enhance vascular reactivity to NE
2. Inhibit catecholamine reuptake
3. Increase synthesis of Angiotensinogen and increases the # of AT1 R |
|
|
Term
| Glucocorticoids can have mineralocorticoids effects. Some of these effects are ? And what does it do to the CO? |
|
Definition
Retain Na+ and H2O to increase the volume
This will increase CO |
|
|
Term
|
Definition
De nova hypertension (>140/90 mmHg) in late pregnancy (after 20th wk- 3rd tri).
It is hypertension + proteinuria (>300mg/day) or edema |
|
|
Term
| Why is pre-eclampsia considered a multisystemic disease? |
|
Definition
Can have coagulation problems, liver abnormalities, epigastric pain, visual disturbances
(on top of the B.P., proteinuria and edema) |
|
|
Term
| In normal pregnancy what happens to volume and TPR? |
|
Definition
Volume = increases 40-60% cuz your feeding another person
TPR = decreases and vessels are hyporesponsive to Ang II |
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|
Term
| What happens with the volume, and TPR in pre-eclampsia patients? |
|
Definition
Volume = does not increase further
TPR = Increases so it is more responsive to Ang II, NE and ADH |
|
|
Term
| What are some theories for pre-eclampsia? |
|
Definition
1. Increase ET1
2. Increase AT1R #
3. Increase Insulin resistance
4. Increase Deoxycorticosterone
5. Increase Natriuretic factor
6. Decrease in EDRF
7. Decrease in Prostacyclin/Thromboxane ratio
8. Decrease in Vit E/lipid peroxides ratio |
|
|
Term
| T/F: In pre-eclampsia there is a reversal of circadian B.P. rhythm. It is higher in the morning. |
|
Definition
| False; it is higher at night! |
|
|
Term
| What are some other secondary causes for hypertension? |
|
Definition
1. Aortic coartation
2. Birth control
3. Thyrotoxicosis
4. Atherosclerosis |
|
|
Term
| What are some myocardial complications of hypertension? |
|
Definition
1. LVH (left ventricular hypertrophy)
2. CAD (coronary artery disease)
3. CHF (congestive heart failure) |
|
|
Term
| Name some Atherosclerotic complications of hypertension? |
|
Definition
1. Angina
2. Myocardial infarct (MI)
3. Peripheral vascular disease (PVD) - aneurysm |
|
|
Term
| What is the most important complication of chronic hypertension? |
|
Definition
| Athersclerotic complications |
|
|
Term
| When systolic B.P. > 250 mmHg then the risk of atherosclerosis is ___________. |
|
Definition
|
|
Term
| When systolic B.P. > 160 mmHg thent he risk of stroke increased ____________. |
|
Definition
|
|
Term
|
Definition
| An interruption of blood supply to a portion of the brain with resulting neurological deficit. |
|
|
Term
| Give examples of cerebral complications of hypertension. |
|
Definition
1.Stroke
2. Transient Ischemic Attack (TIA) |
|
|
Term
| T/F: Every 45 seconds someone suffers from a stroke. |
|
Definition
|
|
Term
| What are some causes for a stroke? |
|
Definition
1. Emboli or infarct = 10-15%
2. Atherothrombosis = 70-80%
3. Hemorrhage = 20-30% |
|
|
Term
| Which is the earliest organ affected by hypertension? |
|
Definition
The eye
(complications usually dont threaten life of patient) |
|
|
Term
| What is the Keith-Wagener Group? |
|
Definition
4 grades that describe hypertensive retinopathy
I = Vascular spasm
II = Vascular sclerosis
III = Hemorrhage "cotton wool" exudate
IV = Papilledema |
|
|
Term
| ____________% of patients discontinue antihypertensive therapy after 1 year. This shows adherence problem. |
|
Definition
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