what does systolic pressure show with hypertension?
-Systolic pressure more important than diastolic pressure
-In fact, elevated systolic blood pressure has consistently
been shown to be a better predictor of cardiovascular
events, including stroke and myocardial infarction
what is hypertension associated with?
- IHD
- Heart failure
- Stroke
what does hypertension do to CO ?
increases it
what does hypertension do to SVR?
increases it
factors for CO
- Blood volume
- Renal function
- Sodium
- Mineralocorticoids
- Atriopeptin - Cardiac Factors
- Heart rate
- Contractility
- Ventricular end diastolic volume
factors in peripheral resistance
- Humoral factors
-Constrictors – angiotensin II, catecholamines,
thromboxane, endothelin, leukotrienes
-Dilators – prostaglandins, kinins, nitric oxide - Neural factors
alpha-adrenergic – constrictors
beta-adrenergic – dilators
what are some treatable causes of hypertension
- Thyroid disease
- Renal stenosis
- Valvular disease
- Anxiety disorder
- Pheochromocytoma
what causes the decreases arterial compliance in isolated systolic HTN
-Atherosclerosis
-Gradual loss of aortic distensibility
-Systolic pressure increase (140); diastolic pressure decreases (90)
-thickening of the aorta and media due to the
accumulation of collagenous fibers, as well as calcium
deposition
-Related to increased pulse pressures
in isolated systolic HTN: elderly patients tend to have
-relatively low plasma volume and relatively low levels of renin and aldosterone
in isolated systolic HTN: why is there salt sensitivity?
-Renal excretion of salt tends to be decreased in these patients, and this probably accounts for their relatively greater salt sensitivity compared with their younger counterparts
in isolated systolic HTN: what else accounts for increase in PVR?
-Decreased calcium levels resulting from increased calciuria and poor dietary intake may also increase peripheral resistance, leading to hypertension
what risk factors are ISH associated with?
-increased end-stage renal disease, cardiac disease, and stroke
-pulse pressures (SBP - DBP) are believed to have more
influence than does diastolic blood pressure on the
progression of CV disease
-associated with two to three times the risk of
cardiovascular events or mortality across ages and
genders
-ISH may also independently increase risk for
dementia
therapy for ISH
- long-acting calcium channel blockers
2.thiazide diuretics - OR beta blockers in combination with thiazide
diuretics.
-long-acting dihydropyridine calcium channel
blockers are safe to use in the elderly
pathology of HTN
-Left ventricular hypertrophy
-HTN augments atherogenesis of small vessels
-Longstanding hypertension is associated with
changes in the renal arterioles
*chronic benign HTN – hyaline arteriolosclerosis
*malignant HTN – onionskinning; hyperplastic
arteriolosclerosis
what are some of the renal affects of HTN
- Hyaline arteriolosclerosis
2. Hyperplastic arteriolosclerosis
Hyaline arteriolosclerosis
-elderly patients, diabetes
-leakage of plasma components, increased
extracellular matrix in smooth muscle layers
-homogeneous, pink, hyaline thickening of walls
of arterioles with narrowing of lumen
-seen in the kidney as benign nephrosclerosis
Hyperplastic arteriolosclerosis
-more acute or severe elevations of blood pressure
-characteristic of malignant hypertension with diastolic
pressures > 110
-onionskin lesions, concentric laminated thickening of the
walls of the arterioles
-narrowing of lumen; thickened basement membrane
-may be associated with fibrinoid and acute necrosis -
necrotizing arteriolitis
