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22 Cards in this Set
- Front
- Back
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what are some causes of secondary hypertension?
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1. chronic renal disease
2. renovascular disease 3. primary hyperaldosteronism 4. Cushing's disease 5. pheochromocytoma 6. coarctation of the aorta 7. oral contraceptive-induced |
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what are the two most serious non-cardiovascular complications of chronic high blood pressure?
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1. diabetes
2. renal disease |
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hypertension causes end organ damage - what organs are most affected?
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1. heart
2. brain 3. arteries 4. kidneys |
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HTN increases the clinical risk for which heart-associated diseases?
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1. CAD
2. left ventricular hypertrophy 3. heart failure 4. sudden death from arrhythmias |
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what is the pathophysiology of ventricular arrhythmias caused by HTN?
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HTN causes left ventricular hypertrophy --> longer APs --> longer QT intervals ~ arrhythmias
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what are three manifestations of cellular remodeling due to HTN?
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1. downregulation of K channel mRNA to cause ventricular arrhythmias
2. downregulation of Ca channel and pump mRNA to cause systolic dysfunction 3. upregulation of collagen mRNA to cause diastolic dysfunction |
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what is the major risk factor for CVAs? what else is it a risk factor for?
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hypertension is the major risk factor for strokes
it is also a risk factor for coronary artery disease and highly associated with congestive heart failure and renal disease |
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what are some other risk factors that increase risk of serious complications of high blood pressure?
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1. smoking
2. high LDL 3. obesity 4. physical inactivity 5. diabetes |
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when do we treat hypertension?
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for otherwise healthy people: several readings greater than 140/90
for diabetes and patients with renal disease: 130/80 |
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what are some non-pharmacological interventions that we use to lower BP?
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1. weight loss
2. physical activity 3. low salt, high potassium diet |
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is systolic BP more important than diastolic BP?
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for the majority of patients, systolic BP is more important than diastolic BP except in patients younger than 50
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in treating other cardiovascular risk factors in a patient with HTN, when should low-dose aspirin therapy be considered?
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low-dose aspirin therapy should be considered only when the BP is well controlled because the risk of hemorrhagic stroke is increased in patients with uncontrolled HTN
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what are the four major classes of antihypertensives?
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1. thiazide diuretics
2. sympatholytics - beta blockers 3. vasodilators - calcium channel blockers 4. AngII antagonists - ACE-I's & ARBs |
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how effective are antihypertensive drugs? why?
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effective in 40% of patients
major reason for ineffectiveness is non-compliance |
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what is the hemodynamic hallmark of essential hypertension?
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chronic elevation of peripheral vascular resistance
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what are two major causes for increased peripheral resistance?
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1. functional vasoconstriction
2. structural vasohypertrophy |
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why is structural vasohypertrophy so bad?
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structural vasohypertrophy is responsible for LONG TERM hypertension - the changes can become irreversible, leading to ischemia in impt organs (heart, brain)
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describe the role of renin/AngII in hypertension
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excess renin/AngII causes
1. functional vasoconstriction (increased PR) 2. structural vasohypertrophy (increased PR) 3. increased adrenergic tone (increased PR and increased CO) |
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what are the hemodynamic mechanisms by which AngII causes vascular hypertrophy?
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increased wall tension
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what are the non-hemodynamic mechanisms by which AngII causes vascular hypertrophy?
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1. increased expression of proto-oncogenes
2. increased production of growth factors 3. increased synthesis of extracellular matrix proteins |
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how is the pressure-natriuresis relationship altered in hypertensives?
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the curve is shifted to the right in hypertensives = a higher pressure is needed to excrete the same amount of sodium
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why is the pressure-natriuresis curve altered in hypertensives? how does this change cause chronic elevation of BP?
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high adrenergic tone + high angiotensin II act on the kidneys to increase renal Na reabsorption (therefore decreased natriuresis)
increased Na reabsorption increases the fluid volume and the preload |
