Hypertension is defined as systolic or diastolic blood pressure greater than _______
140/90
Hypertension by known causes such as NSAIDS, caffeine, ephedrine, etc is known as _______ hypertension.
Secondary
T or F? 90-95% of hypertensive patients has primary (essential) hypertension.
True
What are some possible mechanistic contributors to essential hypertension?
Neuronal Mechanism
Peripheral Autoregulatory Mechanisms
Humoral Factors
Vascular Endothelial Mechanisms
What are the neuronal mechanisms associated with hypertension?
Overstimulation of the SNS
Disturbance in the baroreceptor reflex
What are the peripheral autoregulation mechanisms associated with hypertension?
Kidneys reset equilibrium point for appropriate blood volume to a higher level which leads to increased blood volume.
What are the humoral factors associated with hypertension?
- Increased activation of renin-angiotensin-aldosterone system
- Insulin resistance and hyperinsulinemia
What can insulin resistance and hyperinsulinemia do to cause hypertension?
- Can lead to activation of SNS
- Can stimulate hypertrophy of vascular smooth muscle which reduces the internal diameter of arterioles and results in an increase in TPR
- Can change sodium and calcium transport across cell membranes of vascular smooth muscle, thereby sensitizing arterioles to vasopressor stimuli
What are the vascular endothelial mechanisms associated with hypertension?
- Deficiency in local vasodilator substances (bradykinin, nitric oxide, etc)
- Increased production or release of vasoconstriction substances (endothelin, etc)
What are the risk factors of hypertension?
- Aging
- Excessive salt intake
- Race
- BMI > 30 (i.e obesity)
- Genetic Susceptibility
- Insulin resistance and compensatory hyperinsulinemia
- Cigarette Smoking
- Excessive alcohol
- Use of oral contraceptives
- Low dietary potassium
Obesity is associated with what factors?
- Insulin resistance and hyperinsulinemia
- Increased fluid volume
- Increased stimulation of SNS
- Increased stimulation of RAAS
- Inflammation
How can cigarette smoking cause hypertension?
Nicotine causes discharge of catecholamines.
How can excessive alcohol use cause hypertension?
May involve increased plasma catecholamines
How can the use of oral contraceptives cause hypertension?
It can stimulate RAAS.
How can a low potassium diet cause hypertension?
Potassium consumption increases excretion of sodium, so low potassium consumption will cause more sodium to stay in the body.
What is the natural course of systemic hypertension?
- Hypertension accelerates atherosclerosis
2. Hypertension causes LEFT ventricular hypertrophy and dysfunction
What are the main cause of death in a hypertensive patient?
Stroke Cardiovascular accidents (Atherosclerosis with resulting myocardial infarction and heart failure) Renal failure (due to arteriosclerosis in renal arteries)
How does ACE-Inhibitors affect MAP?
Decrease Ang II production, decreasing TPR and decrease blood volume and CO.
How does Angiotensin-II receptor blockers (ARBs) affect MAP?
Blocking Ang II receptor decreases TPR and decreases blood volume and CO.
How does renin Inhibitors affect MAP?
Ang II will decrease therefore decrease TPR and decrease blood volume and CO
How does aldosterone antagonists affect MAP?
Will decrease retention of water and salt, therefore decrease blood volume and CO.
How does beta blocker affect MAP?
Blocks norepi from binding to beta receptors, therefore decrease HR and contractility and decrease CO.
How does calcium channel blockers affect MAP?
Blocks L-type Calcium channels decrease contractility, therefore decrease CO
How does diuretics affect MAP?
Blocks reabsorption of sodium and water, therefore decreasing blood volume and CO.
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EXAM 3 QUESTIONS19
