ClinE 470 > HTN > Flashcards

HTN Flashcards

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1
Q

Define Blood pressure.

A

The pressure exerted on the arterial walls by the blood.

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2
Q

What is systolic blood pressure?

A

The pressure exerted on the arterial walls by the blood during a contraction (systole).

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3
Q

What is diastolic blood pressure

A

The pressure exerted on the arterial walls by the blood during relaxation (diastole).

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4
Q

What are the two influencing factors affecting blood pressure?

A

Blood pressure= cardiac output x total peripheral resistance.

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5
Q

What is cardiac output and what are the contributing factors to cardiac output (Q).

A

Heart rate x Stroke volume

Contributing factors = blood volume, venous return and arterial/venous compliance.

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6
Q

What factors influence total peripheral resistance?

A

The structure and the function of the blood vessels - regulated by the neuroendocrine factors secreted from the kidneys.

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7
Q

What is the baroreceptor homeostatic feedback loop?

A
  1. An increase in Blood pressure stimulates baroreceptors in the carotid sinuses and the aortic arch
  2. Increased impulses from the baroreceptors stimulates the PNS and inhibits the SNS
  3. Decrease in SNS causes a drop in HR, contractility and cardiac output
  4. Vasodilation occurs
  5. Blood pressure returns to the homeostatic range
  6. A decrease in blood pressure inhibits the baroreceptors in the carotid sinuses and the aortic arch
  7. Decreased impulses from the baroreceptors stimulates the SNS and inhibits the PNS
  8. Increase in the SNS causes HR to increase, contractility and CO to rise
  9. Vasoconstriciton occurs
  10. Blood pressure returns to the homeostatic range
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8
Q

What is the Renin Angiotensin Aldosterone (RAAS) feedback loop?

A
  1. Dehydration, Na+ deficiency or hemorrhage (for examples) cause a decrease in blood volume
  2. This causes a decrease in blood pressure
  3. The juxtaglomerular cells in the kidney are stimulated to release renin and angiotensin 1
  4. The liver is stimulated to release angiotensinogen
  5. At the lungs the angiotensin 1 gets activated (by angiotensinogen) to angiontensin 2
  6. Angiotensin 2 causes vasoconstriction and the release of aldosterone in the adrenal cortex
  7. Aldosterone stimulats Na+ and water absorption in the kidneys and increases secretion of K+ and H+ into the urine
  8. Blood volume increases and combined with the vasoconstriction blood pressure returns to normal
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9
Q

Where are the baroreceptors found?

A

In the carotid sinus and the aortic arch.

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10
Q

What does increased baroreceptor activity stimulate?

A

The PNS system activity therefore causing a drop in heart rate and a drop in blood pressure.

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11
Q

What does inhibited baroreceptor activity stimulate?

A

The SNS system (inhibiting the PNS system) causing an increase in heart rate and thus an increase in blood pressure.

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12
Q

What could cause a drop in blood volume stimulating the RAAS feedback loop?

A

Dehydration, an Na+ deficiency or a hemorrage.

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13
Q

Which cells in the kidney does increased blood pressure stimulate and what substances do they release?

A

The juxtaglomeruler cells which release renin and angiotensin 1.

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14
Q

What enzyme converts inactive angiotensin 1 to it’s active form (angiotensin 2) and where does this process occur?

A

Angiotensinogen causes the transformation - this occurs at pulmonary sites (the lungs).

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15
Q

What does the active form of angiotensin 2 stimulate?

A

It causes vasoconstriction and the release of aldosterone from the adrenal cortex.

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16
Q

What does aldosterone do?

A

It causes an increased uptake of Na+ and water into the kidneys and increases the secretion of K+ and H+ into the urine.

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17
Q

Define Hypertension.

A

The transitory or sustained elevation of arterial blood pressure likely to induce cardiovascular damage or result in other adverse health consequences.

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18
Q

Classify the normal, prehypertension, Stage 1 hypertension and stage 2 hypertension values.

A

Normal = <120 mmHg / <80 mmHg
Prehypertension = 120-139 mmHg / 81-89 mmHg
Stage 1 hypertension = 140-159 mmHg / 90-99 mmHg
Stage 2 hypertension = >160 mmHg / >100 mmHg

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19
Q

What are the social contributory/risk factors for hypertension?

A

Housing, education, income, aging, urbanization and globalization.

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20
Q

What are the behavioral contributory/risk factors for hypertension?

A

Unhealthy diet, tobacco use, physical inactivity and harmful alcohol consumption.

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21
Q

What are the metabolic contributory/risk factors for hypertension?

A

Obesity, raised blood lipid profile and diabetes.

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22
Q

What are the co-morbdities and/or consequences of hypertension?

A

CVD, heart attack, strokes, heart failure and kidney failure.

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23
Q

Why are lifestyle modifications encouraged regardless of blood pressure?

A

Blood pressure naturally increases with age and these modifications can help act as a preventative measure.

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24
Q

At what stage are drugs used to treat hypertension?

A

Drugs are likely at stage 1 hypertension - at stage 2 hypertension a combination of drugs may be needed.
Lifestyle modification is of course still needed at both these stages.

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25
What types of hypertension are there?
Primary Hypertension - this accounts for 95% of cases - it has no known universally established cause (idiopathic) - it can also be known as essential hypertension. Secondary Hypertension - This accounts for 5% of cases where there is a rectifiable, known cause.
26
What are the known causes of hypertension (Secondary hypertension)?
Renal Hypertension - due to kidney disease/failure Endocrine Hypertension - primary aldosteronism (aldosterone over production), Cushing's syndrome - high cortisol levels or even pill induced (in females).
27
What can hypertension sometimes be called?
A silent killer due to lack of any or consistant symptoms at the early stages.
28
What symptoms could one with high hypertension experience?
Headaches, dizziness, palpitations, fatigue or blurred vision.
29
When hypertensive what is the % increase risk of CVD from a 5 mmHg increase in DBP - who found this?
21% increased risk - MacMahon (1990)
30
When hypertensive what is the % increase risk of stroke from a 5 mmHg increase in DBP - who found this?
34% increased risk - MacMahon (1990)
31
When hypertensive what is the % increase risk of CVD from a 10 mmHg increase in DBP - who found this?
37% increased risk - MacMahon (1990)
32
When hypertensive what is the % increase risk of stroke from a 10 mmHg increase in DBP - who found this?
57% increased risk - MacMahon (1990)
33
What did Vasan 2001 find?
There is an increased risk of a cardiovascular event with age for those with normal or high normal blood pressure compared to those with optimal blood pressure.
34
What damage does/could hypertension cause to the cardiovascular system?
Atherosclerosis, CAD, Acute MI, Arterial aneurysm, dissection or rupture, ventricular hypertrophy, dysfunction or failure
35
What damage does/could hypertension cause to the kidneys?
Glomerular sclerosis leading to impaired function and can end up as end stage kidney disease Ischaemic kidney disease - this is especially common when renal artery stenosis is the cause of the hypertension.
36
What damage does/could hypertension cause to the nervous system?
Stroke, intercerebral and subaracnoid hemorrhage | Cerebral atrophy and dementia
37
What damage does/could hypertension cause to the eyes?
retinopathy, retinal hemorrhage, retinal detatchment impaired vision, vitreous hemorrhage Neuropathy/paralysis/dysfunction of the nerves leading to the extraoccular muscle
38
What reduction in blood pressure did Paulev et al (1984) find and at what level of exercise was this study?
Mean arterial blood pressure was reduced 10-12mmHg 4 hours after a 20 minute bout of cycling at a moderate pace.
39
Who examined exercise intensity and what did they find in relation to hypertension?
Eicher (2010) found a dose/response relationship between exercise and blood pressure - the higher the exercise intensity the greater the decrease in systolic/diastolic pressure
40
What did Ciolac et al 2009 find?
The affects of an acute bout of exercise can last up to or more than 24 hours therefore daily bouts of exercise are of great benefit when hypertensive.
41
Describe baroreflex resetting.
There is an decrease in the blood pressure set point after exercise. This means baroreceptors are triggered at a lower blood pressure.
42
What is the baroreflex set point?
The blood pressure level at which barorecetors are triggered to decrease SNS and increase PNS activity.
43
What did Paulev et al (1984) find with regards to total peripheral resistance?
There was a 25% reduction in TPR four hours after exercise compared to pre-exercise values.
44
What are the 2 mechanisms thought to be responsible for the acute drop in blood pressure post exercise.
A decreased baroreflex set point and a decreased TPR.
45
What are the chronic exercise adaptations that benefit one with hypertension?
Possible decreases in SNS activity (SNS may be higher in sedentary individuals) Improved vascular responsiveness Reduced vascular resistance due to vascular remodelling.
46
What is vascular remodelling?
An increased length, cross-sectional area and diameter of existing vasculature and angiogenesis.
47
Who found evidence of vascular remodelling occuring?
Dinenno et al 2001 foundtrained men to have a 20% greater femoral artery diameter He also found a 3 month training intervention to increase the femoral artery diameter by 9% in those who were sedentary.
48
What did Higashi et al 1999 find?
Participants had an increased responsiveness to an arterial dilator (acetylcholine infusion) after a 12 week exercise program - this provides evidence to support improved vascular responsiveness.
49
What are the recommended lifestyle changes for someone with hypertension?
Weight reduction Dietary changes - increased fruit and veg, decreased fat and sodium Physical Activity A moderation of alcohol consumption.
50
What amount of aerobic exercise is recommended for someone with hypertension?
40-70% Vo2 Max, 30-60 minutes, 3-7 days a week.
51
What amount of resistance exercise is recommended for someone with hypertension?
40-60% 1RM, 1 set of 15-30 reps, 2-3 days a week
52
What should someone with stage 2 hypertension be advised?
They should only start exercising after initiating drug therapy - only moderate endurance exercise should be done.
53
At what blood pressure should no exercise be undertaken?
200/110 mmHg
54
What blood pressure is the termination criteria during an exercise stress test?
250/115 mmHg
55
What is the side effect of some antihypertensive drugs and why is this important with regards to exercise?
Some of the medications can impair thermoregulatory ability therefore this could lead to heat intolerance when exercising.
56
What is a ball park percentage of the amount of people with hypertension in the UK and America?
Around 30%
57
At what mmHg does the relationship between BP and CVD start?
At the measurement as low as 115/70 mmHg - the risk doubles for each 20/10 mmHg increase.
58
How do systolic and diastolic blood pressure change with increasing age?
SBP continues to increase throughout adult life (due to naturally progressive arterial stiffening). DBP increases until the 6th decade of life when it plateaus and then starts to decrease.
59
What approximate amount of individuals with hypertension are on antihypertensive drugs?
Around half - with only a fraction of these having normal BP due to the insufficient implementation of contemporary guidelines.
60
What did both Maiyai et al and Manolio et al (and other studies) show to be an accurate predictor of future hypertension?
An exaggerated exercise BP response in normotensive individuals - a 2-3x increase in developing hypertension within the next 5 years after testing.
61
Why is exercise testing not widely used as a predictor of future hypertension?
There is not enough evidence to define the level of BP exaggeration and future risk. Also, there may be a number of confounding factors that need to be considered that cannot always be adequately accounted for.
62
What do studies find with regards to the relationship between PA and hypertension risk between the genders?
Many studies on the male population show a decreased risk of hypertension with increased PA. Although less studies, no significant relationship has been found between decreased hypertension risk with increased PA in women.
63
What is ambulatory blood pressure and why might this be a better measure than a one off testing?
Ambulatory blood pressure is the average blood pressure measured at regular intervals often over a 24 hour period. It is better than a one off measurement as it increases the reliability of a generalized blood pressure over time. Ambulatory blood pressure is also a better measure of post exercise blood pressure as it can help to determine how long the effects of exercise last.
64
Who does dynamic aerobic training benefit most?
BP is reduced after dynamic aerobic training in both normotensive and hypertensive individuals - however the effects are more pronounced in hypertensive subjects.
65
What level of exercise is needed for exercise induced hypotension to occur?
Exercise induced hypotension can occur at an exercise duration of just 3 minutes and at exercise intensities as low as 40% VO2 max.
66
What did Hill et al find with regards to BP after resistance exercise?
1 hour after a 11-18 minute resistance exercise session there was a statistically significant reduction in DBP however no reduction in SBP - this suggests resistance exercise may only be of benefit in eliciting chronic adaptations with no apparent acute BP drops.
67
What did the British Regional Heart Study find?
The long term risk of CVD in hypertensive men showed a J shaped curve with regards to exercise intensity - moderately active men have a reduced risk, however vigorously active men may have an increased risk.
68
What did Hagberg et al find with regards to exercise intensity and hypertension?
A greater reduction of BP occurs at exercise less tha 70% VO2 max - higher intensities may create damage when exercising due to further BP increases.
69
At what level on the RPE should one with hypertension work at?
Level 12-13.
70
What is Poiseuille's Law?
TPR is directly proportional to blood viscosity and length of the blood vessel but inversely proportional to the fourth power of the radius.
71
What happens to norepinephrine after exercise?
Brown et al reported decreased NE release which means less NE at the synapse and decreased HR. (However this is speculative).
72
What happens to angiotensin 2 and renin after exercise?
There are reports of reduced renin and angiotensin 2 with training however this has not been consistently found in hypertensive subjects.
73
What percentage of SBP drop after exercise is considered to be genetic?
Rice et al suggested genetic factors accounted for approximately 17% of the reduction in SBP after exercise training.
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