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29 Cards in this Set
- Front
- Back
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What is the major mediator of the SNS?
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NE
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True/False: SNS activation tends to decrease with age and weight
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FALSE--it tends to increase
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What are the three effects of the renal efferent nerves?
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Increase BP through 1. stimulating renin release 2. causing an increased sodium retention by restricting renal blood flow and 3. increasing sodium recovery in the tubules
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What stimuli are responsible for renin synthesis and release by the kidneys?
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Stimulated by an increase in SNS activity through B1 receptors in the kidney, decreased renal perfusion pressure, and reduced Na+ or increased K+ excretion
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What are the many effects of angiotensin II?
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Stimulates aldosterone release, causes vasoconstriction, stimulates Na+/water retention, stimulates remodeling of cardiac muscle, causes release of ADH, and causes free radical generation
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What is the root cause of Atherosclerosis?
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Angiotensin II stimulating free radical formation
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What leads to ATERIOSCLEROSIS?
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Elevated BP over time causes vessels to become thicker because VSM cells proliferate and this increases systemic vascular resistance
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What are the effects of aldosterone? What can block its activity?
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Elevates BP through Na+ retention and K+ excretion and also through increased SNS activation--block with spironolactone
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What happens to the two numbers of BP as you age?
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Diastolic goes up until middle age and then goes down and Systolic goes up--systolic is the better predictor of vascular events
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Which is more dangerous--a high Systolic and Low Diastolic or a High Systolic and a High Diastolic?
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High Systolic/Low Diastolic because it correlates with stiff vessels and atherosclerosis that occurs with age due to elastin being replaced by collagen so that the heart pumps against a stiff vessel and this WIDENS THE PULSE PRESSURE(wave summation in systole)
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HTN means ?
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Elevated blood pressure
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True/False: You can die from hypertension
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False--you die from the complications of hypertension
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A 20mmHg increase in systolic pressure does what? What does an increase in diastolic pressure do?
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Doubles cardiovascular risks--diastolic increase of 10mmHg doubles cardiovascular risks
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True/False: Cardiovascular risk doesn't begin until 140/90
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FALSE--it starts well within normal range
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Who has the highest CV risk?
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Low diastolic and High systolic
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Widening pulse pressure is a marker of what?
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Stiff blood vessels
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What are the prevalences of HTN?
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Higher in men until menopause and then prevalence in women increases--Black more than white--obese more than thin
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Should you treat prehypertension?
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No--just lifestyle changes
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What BP is the best predictor for CV risk?
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Nighttime BP
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What lab values should be evaluated when treating HTN?
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Electrolytes like Na, K, and creatine; Protein excretion and GFR to check kidney function
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True/False: The cause of Primary HTN is well known, whereas the source of Secondary HTN is unclear
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FALSE--primary HTN is multi-factorial and unknown; Secondary HTN causes include aldosteronism and pheochromocytoma as well as other problems
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What are some causes of secondary HTN?
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Primary aldosteronism, pheochromocytoma, renal artery stenosis, Cushing's syndrome, obstructive sleep apnea, etc..
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What occurs in renal artery stenosis? Treatment?
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Reduces renal perfusion which stimulates JG complex to release renin--angioplasty and stenting
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What occurs in pheochromocytoma and how is it diagnosed?
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Adrenal tumor releasing high levels of catecholamines at varying intervals--severe high systolic BP
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What are the JNC treatment guidelines based on BP?
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treat at 140/90 except if patient has diabetes, chronic kidney disease, or coronary heart disease
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What is the most effective lifestyle modification that can be made?
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Weight reduction--also dietary sodium intake, moderation of alcohol consumption, and physical activity
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What is the most important treatment for HTN?
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LOWERING BP
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True/False: HTN can be treated with one drug, usually ACEi.
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FALSE--requires multiple drugs
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What is ACCOMPLISH?
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Avoiding Cardiovascular Events through COMBination Therapy in Patients LIving with Systolic Hypertension
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