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74 Cards in this Set

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Define systolic BP
The pressure in mm Hg at the height of the pulse pressure (ventricular contraction)
Define diastolic BP
The pressure in the vascular system during the relaxation phase of cardiac contration. This pressure is maintained by the elastic recoil of the arterial walls.
Pulse pressure
the difference between the systolic and dialstolic preassure, usually around 40 mmHg
Mean arterial pressure
the average preassure in the arterial system during ventricular contraction and relaxation (90-100 mmHg). It is a good indicator of tissue perfusion
conditions that effect diastolic BP
the ability of the elastic arteries to stretch and store energy, the competency of the aortic valve. simpathetic stimulation increases diastolic BP by . periferal resistance.
neural regulation of BP
located in the reticular formation of the lower medulla and pons(autonomic nervous system)(cardiovascular center)
describe cardiovascular center regulations
parasympathetic impulsess are transmitted to the heart through the vegas nerve, and transmits sympathetic signals to the heart and blood vessels via the spinal cord and peripheral sympathetic nerves.
effects of vagal stimulation
slows the heart rate
sympathetic stimulation
increases HR and contractility (force of contraction)
what are arterial chemoreceptors
receptors that are sensitive to cahnges in O2, CO2, and H blood content. they are located in the carotid body and the aortic body and monitor blood for changes
how is the ANS of BP mediated
intrinsic circulatory reflexes,extrinsic reflexes, and chemoreceptor mediated reflexes. and are important in rapid and short term regulation of BP
sensors for extrinsic are found
outside the circulation, associated with BP responses to pain and cold.
intrinsic regulation of BP
channeled through the hypothalamus, which plays an essential role in the control of sympathetic NS response
higher center responses
are those caused by changes in mood and emotion.
baroreceptors
are pressure sensitive reseptors that are located n the walls of blood vessels and the heart. The carotid and aortic receptors are srategicly located between the heart and brain.
Hummoral mechanisms
hormone that effect BP
renin-angiotensin-aldosterone mechanism
play a entral role in BP regulation,
renin
an enzyme that is synthesuzed, stored, and released by the kidneys in respose to > in sympathetic NS activity or a < in BP ,extracellular volume, or extracellular Na concentrations
renin-angiotensin
renin enters the blood, where it is convertes an inactive plasma protein (angiotensin)to angiotensin I, this travels to the lungs where it is converted to angiotensin II. angiotensin II has a short t1/2, but renin remains in the blood for up to an hour producing angiotensin II
Angiotensin II
functions in the short and long term. it is a strong vasoconstrictor of arteriols and to a lesser extent veins.

stimulates aldosterone > Na and water retention.
vasopressin (ADH)
is released from the posterior pituitary gland in response to a < in blood volume and BP, an > in osmolality of body fluids, and other stimuli. it has a direct vasoconstriction effect on blood vessels
Long term regulation of BP
hormonal mechanisms of BP regulation is short lived and unable to maintaineffectiveness over time. Long term BP regulation is largely maintained by the kidneys and their role in regulating extracellular fluid volume.
Renal Mechanisms
many hypertensive meds produce their BP < effects by > Na and water elimination
discuss the two ways that arterial BP can be > by the kidneys
by shifting the elimination of salt and water to a higher pressure level, and by changing the extracellular fluid level at which diuresis and naturiuresis occur.
discuss kidney funtion in long term BP regulation
excess sympathetic nerve activity or the releases of vasoconstrictor substances can alter the transmission of arterial pressure to the kidneys. Changes in neural and hormonal control of kidney function can shift the diuresis-natriuresis to a higher fluid pressure level, initiating an > in arterial pressure.
BP effects of extracellular fluid
a direct effects on cardiac output, or an indirect effect, resulting from an autoregulation of blood flow and it's effects on peripheral resistance.
Bllod flow to tissue beds and its effect on BP
when the blood flow to a particular tissue is in excesse, local blood vessels constrict, and when flow is deficient, local vessels dilate.
In situations of > volume and cardiac output, increased flow causes vasoconstriction, > peripheral resistance and BP.
Circadian rhythms and BP
normal changes in BP follow a pattern. highest early in the morning and decreases gradually throughout the day. normatensive people decrease by 20% from waking to sleeping hours.
describe the Korotkoffs Sounds
Phase I - V
Phase I
marked by the first tapping sounds which gradually > in intensity
Phase II
a murmur or swishing sound is heard
Phase III
sounds are crisper and greater in intensity
Phase IV
distinct abrupt muffling or by a blowing sound
Phase V
sounds disappear
Hypertension
is propably the most common of all health problems in adults and is the leading risk factor for cardiovascular disorders.
Primary (essential) Hypertension
the chronic occurs without evidence of other disease.
Secondary hypertension
results from some other disorder, such as kidney disease.
Malignant Hypertension
is an excellerated form of hypertension
What are the values of
Normal
Prehypertensive
stage I hyper
stage II hyper
norm = systolic < 120 and diastolic <80
Prehyper =systolic 120-139 OR diastolic 80-89
stage I = systolic 140-159 OR diastolic 90-99
stage II hyper = systolic > or = 160 OR diastolic > or = 100
Name risk factors for hypertension
family history, race, age related factors,diabetes type II, obesity
What are dippers and nondippers
dippers have a normal circadian profile in which BP falls during the night, and nondippers profile is flattened
What conditions are related to nondippers
malignant hypertension, cushing syndrome, preeclampsia, orthostatic hypotension, congestive heart failure, sleep apnea
Lifestyle risk factors
high Na, excesse calorie intake, obesity, inactivity, excessive alcohol, low potassium intake, oral contraseptives
how can weight loss effect hypertension
weight reduction as little as 4.5 kg(10lb)can produce a decrease in BP in overweight people.
which is more dangerous, systolic or diastolic hypertension
historically diastolic hypertension was thought to confer a greater risk factor, however there is mounting evidence that elevated systolic BP is at least as important, if not more so
discuss the two aspects of systolic hypertension that confer increasd risk of cardiovascular disease.
the actual elevation in systolic pressure, and the disproportionate rise in pulse pressure. elevated systolic pressure favor LV hypertrophy, > myocardial O2 demands, and eventual left heart failure. elevated pulse pressure produce greater arterial stretch, causing vessel damage and possible anyerism or thrombis formation.
What are the manifestations of hypertension
essential hypertesion is typically asymptomatic. when symptoms do occur they are usually related to the long term effects on target organs.
what are the target organs
heart, brain, kidney, peripheral vascular, and retina
define nephrosclerosis
a common cause of renal insufficiency. sclerotic changes to the blood supply of the nephron inhibit the kidneys ability to consentrate urine.
How is hypertension diagnosed
the diagnosis of hypertension in a person who is not taking antihypertensive meds should be based on two or more blood pressure readings taken at two or more visits after an initial screening visit. no caffeine or smoking for at least thirty minutes bfore testing.
treatment goals
main goal in essential hypertension is to achieve and maintain BP < 140/90. with diabetes or renal disease < 130/80
treatment options
without compelling indications
lifestyle modifications. If not at goal antihypertensive meds. stage I thiazide - type diuretics maybe ACEI, ARB, BB, CCB. stage II two drug combo thiazide and ACEI, ARB, BB, CCB.
with compelling indications
other antihypertensive drugs (diuretics, ACEI, ARB, BB, CCB.
weight reduction
maintain normal body weight (BMI, 18.5-24.9)
5 - 20 mmHg/10 Kg weight loss
eating plan
consume a diet rich in fruits, vegetables, low fat. 8-14 mmHg reduction
sodium reduction
2.4g or 6g chloride. 2-8 mmHg reduction
physical activity
brisk walking at least 30 minutes a day most days. 4-9 mmHg decrease
moderate alcohol intake
no more than 2 drinks per day in men and 1 per day for women. 2-4 mmHg decrease
common causes of secondary hypertension
kidney disease (renovascular hypertension), adrenal cortical disorders, pheochromocytoma, coartation of the aorta, and sleep apnea.
renovascular hypertension
reduced renal blood flow and activation of the renin-angiotensin-aldosterone mechanism. the reduced renal flow causes the effected kidney to release excessive renin, which increases angiotensin II causing vasoconstriction
what are the two major types of renovascular disease.
atherosclerotic artery stenosis and fibromuscular dysplasia
Atherosclerotic artery stenosis
accounts for 70 - 90% of cases and is seen most often in older people, particularly those with diabetes, aortoliliac disease, coronarey artery disease,or hypertension
fibromuscular dysplasia
is more common in women and tends to occur in younger age groups, often in their third decade. genetic factors may be involved and is increased with smoking and hyperlipidemia.
Disorders of adrenocorticosteroid hormones
hyperaldosteronism and excess levels of glucocorticoid raise BP by fasilitating Na and water retention by the kidneys.Aldosterone increases Na absorption in exchange for potassium.(treat with potassium sparing diuretics)
Characteristics of malignant hypertention
sudden marked elevations in BP with diasolic values > 120mmHg complicated by evidence of acute life threatening organ disfunction. effects younger people, often blacks, women with toxemia pregnancy, and people with renal collagen disease.
Malignant hypertension problems
spasm of cerbral arteries with hypertensive encephalopathy, cerebral edema, papilladema, headache, restlessness, confusion, stupor, motor and sensory deficits, convulsions and coma.
Gestational hypertension
BP elevation, without proteinuria, that is detected for the first time during midpregnancy and returns to normal by 12 weeks postpartum
Chronic hypertension
BP > or = 140 mmHg systolic or > or = 90mmHg diastolic that is present and observable before the 20th week. Hypertension that is diagnosed for the first time during pregnancy and does not resolve after is classified as chronic.
Preeclampsia-eclampsia
pregnancy specific syndrome. BP > 140 mmHg systolic or > 90 diasolic that occurs after the first 20 weeks and is accompanied by proteinuria(0.3g protein in a 24 hr specimen)
Preeclampsia superimposed on chronic hypertension
chronic hypertension BP > or = 140 mmHg systolic or > or = 90 mmHg diastolic prior to the 20th week, with superimposed protinuria and with or without signs of the peeclampsia syndrome.
isolated systolic hypertension
most common type of hyretension in elderly, systolic BP is elevated while diastolic is normal
risks of ISH
important risk factor for cardiovascular morbitity and mortality in elderly. stroke is 2 - 3 times more common
orthostatic hypotension
or postural hypotension is an abnormal drop in BP upon standing
causes of orthostatic hypotension
reduced blood volume,drug induced hypotension, altered vascular responses associated with aging, bed rest, and ANS disfunction.