Reading Assignment

Question 1

What is the clinical standard of chronic arterial hypertension?

Answer 1

Greater than or equal to 140/90 over several weeks or months

Question 2

What is hypertension a leading risk factor for?

What is hypertension a major contributor to?

Answer 2

stroke

morbidity and mortality associated with heart failure, coronary artery disease, atherosclerosis, and renal insufficiency

Question 3

What occurs if hypertension is left untreated?

Answer 3

It gets worse over time and must be treated with medication

Question 4

More attention is now being paid to reduction of high systolic or pulse pressures: why?

Answer 4

Because of the effect of these variables on myocardial afterload and oxygen demand

Question 5

Several causes of secondary hypertension are? (6)

Answer 5

Renal artery stenosis, renal parenchymal disease, primary aldosteronism, pheochromocytoma, aortic coarctation, and thyrotoxicosis

Question 6

Renal artery stenosis:

1. What occurs to the renal arteries?
2. Causes what down stream from the stenosis?
3. How does the body counteract?

Answer 6

1. atherosclerotic plaques in one or both
2. reduced arterial pressure –> reduced water and sodium excretion
3. Activation of the renin-angiotensin system and elevated plasma A II

Question 7

Renal parenchymal disease

Impairs kidney’s ability to do what?

Answer 7

To excrete sodium and water

Question 8

Primary Aldosteronism

Hypersecretion of aldosterone results in?

Answer 8

Abnormal retention of salt and water

Question 9

Pheochromocytoma

What does the tumor secrete? What is the result?

Answer 9

Epinepherine and norepinepherine result in elevated peripheral resistance

Question 10

Aortic coarctation

1. What is CO like?
2. Where is there going to be elevated arterial pressure?
3. Where is the blood pressure normal?

Answer 10

1. Normal
2. Because CO is normal, there will be increased pressure upstream from the coarctation - will read a higher BP in the brachial arteries
3. Normal after the coarctation - will read normal BP in the lower extremities

Question 11

Thyrotoxicosis

1. What is this?
2. Result?
3. ONLY form of chronic arterial hypertension caused by elevated ____ with essentially normal ____ ____.

Answer 11

1. Excessive production of thyroid hormone with resultant increase in metabolic activity of all tissues including the heart
2. Increased CO and HR
3. CO; vascular resistance

Question 12

Prehypertension range?

Answer 12

120/80-135/85

Question 13

Mild hypertension

Answer 13

130/85 - 139/89

Question 14

Stage one hypertension range?

Answer 14

140/90 - 159/99

Question 15

Stage two hypertension range?

Answer 15

160/100 - 179/109

Question 16

Stage three hypertension range?

Answer 16

180/110 - 209/119

Question 17

Stage four hypertension range?

Answer 17

GREATER than or equal to 210/120

Question 18

Stages 1-4 required pharmacological intervention. What level is considered a serious threat to the patients immediate well being?

Answer 18

Greater than or equal to 160/100 (Beginning of stage 2)

Question 19

What are some initiating factors?

Answer 19

Genetics, renal, CNS, sodium

Question 20

Salt dependent hypertension has been associated with an especially high incidence of ____.

How can this be attenuated?

Answer 20

Stroke

Increase in dietary K+ consumption

Question 21

What occurs to the baroreceptors in hypertensive individuals?

Answer 21

They are both re-set to a higher mean arterial pressure reference point AND de-sensitized to any increases in mean arterial pressure

Question 22

Normal plasma renin levels when arterial pressure goes up in normotensive individuals?

What happenes with hypertensive individuals?

Answer 22

The renin levels should reflexively decrease

Plasma renin levels are not decreased in patients so their “normal” value for plasma renin activity is actually unacceptably high and suggest there must be a defect in the regulatory mechanism involving the renin-angiotensin system

Question 23

Mean arterial pressure = ______ x _____

Answer 23

Cardiac output X vascular resistance

Question 24

What are the three ways to sustain an elevation of mean arterial pressure?

However - it has been known that ___ is normal in patients with essential hypertension (except in ____)

Answer 24

1. Increased CO
2. Increased vascular resistance
3. Increase CO and increased vascular resistance

CO; thyrotoxicosis

Question 25

Because there is normal CO (except for thyrotoxicosis) there must be an ____ \_\_\_\_ ___ \_\_\_. And thus hypertension is classified as a ____ disease.

Answer 25

Elevated peripheral vascular resistance; vascular

Question 26

Two major types of vascular change that contribute to increased resistance?

Answer 26

1. Changes in the structure of the arterial wall 2. Functional changes in the responsiveness of arteries to vasoactive agents

Question 27

What can occur to the structure of the arterial wall?

Answer 27

Thicken and thus narrow the lumens

Question 28

How do vascular walls thicken?

Answer 28

Smooth muscle hypertrophy and hyperplasia as well as increased accumulation of water and connective tissue in the arterial wall

Question 29

For the same degree of muscle shortening, an artery with a thickened wall will exhibit a greater increase in ___ as compared to a thinner walled artery.

Answer 29

resistance

Question 30

What mitogens can lead to vascular wall thickening in the absence of an elevation in arterial pressure?

Answer 30

Norepinepherine, Angiotensin II and endothelin

Question 31

Arteries from hypertensive individuals and animals exhibit excess production of ____ \_\_\_ ____ such as ____ \_\_\_\_.

Answer 31

Reactive oxygen species; superoxide anion

Question 32

ROS are _____ and \_\_\_\_\_. In addition they damage the arterial endothelium and ______ chemically quenches \_\_\_.

Answer 32

mitogenic; vasoconstrictive; superoxide; NO