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36 Cards in this Set
- Front
- Back
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BP reflects...
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rhythmic ejection of blood into aorta
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CO =
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SV * HR
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BP =
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CO * PVR
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Systolic BP =
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SV > PVR
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Diastolic BP =
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PVR > SV
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Pulse pressure =
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SBP - DBP
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MAP =
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-Good indicator of tissue perfusion
-MAP = (2/3 x DBP) + (1/3 x SBP) -Normal ~ 90-100 mmHg |
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Dicrotic notch
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arteries coming back to normal
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Starting at 115/75 CV risk _____ with an increase of _____ in SBP and ______ in DBP
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-doubles
-20 -10 |
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HTN treatment goals
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-<140/90 for most
-<130/80 for DM, CKD -<120/80 for left ventricular dysfunction -Achieve SBP goal especially in persons >=50 years of age |
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Mechanisms of BP regulation
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-Neural
-Humoral -Extracellular fluid volume -Tissue auto-regulation |
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ANS
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-Sympathetic
Increases heart rate, contractility, PVR -Parasympathetic Decreases heart rate -ANS is control mediated via intrinsic and extrinsic reflexes |
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Pre-synaptic
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-Stimulation of a2 receptors
Inhibits norepinephrine release Positive feedback mechanism -Stimulation of B receptors Causes norepinephrine release |
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Post-synaptic
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-Stimulation of B1 receptors increases heart rate
-Stimulation of B2 receptors causes arterioles & venules vasodilation -Stimulation of a1 receptors causes arterioles & venules vasoconstriction |
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Intrinsic control of ANS
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-Bareoreceptors
-Chemoreceptors |
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Extrinsic control of ANS
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-Found outside circulation
-Very diffuse -Responses are inconsistent -Associated with factors like pain, cold, and emotion |
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Which mechanism is most influential in the control of homeostatic BP?
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Humoral
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Juxtoglomerular cells
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sense decreased renal artery pressure and kidney blood flow --> release renin
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Macula densa and/or juxtoglomerular cells
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sense a decrease in sodium and chloride --> release renin
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Extracellular Fluid Volume
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-Direct = higher volumes directly increase CO
-Indirect = higher blood flow to organs causes vasoconstriction and stimulate a tissue-regulation response |
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Tissue auto-regulation
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-Purpose is to maintain adequate tissue perfusion and oxygenation
-Kidney's = volume-pressure balance/adaptation -Tissues have auto-regulatory mechanisms Normal Low-normal metabolism --> vasoconstriction High metabolism --> vasodilation -Defects in renal --> Increased volume & blood flow to tissues --> vasoconstriction --> PVR |
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Primary vs. Secondary HTN
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-Primary
90% of all cases chronic elevations in BP No evidence of otherdisease -Secondary Minority of cases HTN that results from another disorder |
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Primary Hypertension mechanism
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-Increased CO
-Increased PVR |
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Circadian Rhythm
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-BP is highest in the early morning
-Lowers throughout the day |
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Risk Factors
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-Smoking
-Obesity -Physical inactivity -Dyslipidemia -DM -Microalbuminuria or a GFR < 60 ml/min -Age (>55 for men, >65 for women) -Family history of premature CVD (men < 55, women <65)) -Race -Insulin resistance -Diet (ETOH and sodium intake) |
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Non-Modifiable Risk Factors
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-Family history
-Age -Race -Insulin resistance |
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Modifiable Risk Factors
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-Insulin resistance & metabolic abnormalities
-Sodium intake -Obesity -Excessive alcohol consumption -Stress |
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HTN related TOD
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1. Brain (stroke, transient ischemic attack, dementia)
2. Eyes (retinopathy) 3. Heart (LVH, agina or MI, priorcoronary revascularization, HF) 4. Kidney (CKD) 5. Peripheral vasculature (peripheral arterial disease) |
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Which lifestyle modifcations can help you the most?
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-Weight reduction
-Adopt DASH eating plan -Dietary sodium reduction -Physical activity -Moderating ETOH consumption |
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Secondary causes of HTN
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-Medications, medications, medications
-Renal disease -Endocrine -Sleep apnea -ETOH abuse -Sodium intake |
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Medications
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-Illicit substances
-ADD meds -Decongestants -Appetite suppressants -MAOI's, TCA's, bupropion, venlafaxine -Herbals -NSAIDS -Birth control/estrogens -Corticosteroids -Cyclosporine -Triptan's |
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Renal disease
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-Renovascular disease
Atherosclerotic disease of renal blood vessels --> Reduced renal blood flower -->RAAS activation -Renal parenchymal disease |
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Endocrine
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-Hyperthyroidism
-Primary hyperparathyroidism -Pheochromocytoma -Hyperaldosterism -Cushing's disease |
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Other Secondary causes
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-Sleep apnea
-Sodium intake -ETOH |
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White Coat HTN
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Increased BP due to seeing a healthcare professional
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Hypertensive crisis
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-BP > 180/120
urgency: no TOD emergency: with TOD |
