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14 Cards in this Set
- Front
- Back
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How does renin cause HTN? (4)
Another renal mechanism: excessive tubular reabsorption caused by excess ________ Stimulus for increased renin secretion: |
in renal artery stenosis
afferent arteriolar atherosclerosis renin secreting tumor coarc of aorta aldosterone decreased GFR |
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Ang II constricts the ________, increases H2O filtration at _______, increases Na+ and H2O reabsorption at ________.
Overall effect: ________ GFR while also _____ fluid, Na+ retention. |
constricts efferent arteriole
increases H2O filtration at glom increases Na+, H2O reabsorption at DCT, CT increases GFR, fluid, Na+ retention |
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Where does aldosterone primarily act?
Primary cause of HTN in bilat renal artery stenosis? What's more effective in reducing volume? |
DCT, CT
decreased kidney perfusion --> decreased excretion, volume overload diuretics |
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In coarc of the aorta, where is the BP less than normal due to pressure drop?
effect on kidneys? Mechanism of preeclampsia? What happens to glom membranes? |
below the coarc, due to pressure drop across constriction
increased renin secretion placental derived toxins block normal vascular fxn, decreased NO --> vasoconstriction glom membranes --> more thick, less filtration |
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Neurogenic HTN:
Acute mechanism? Chronic mechanism? Mechanism of salt-sensitive HTN? |
acute - emotion, anticipation of activity
chronic - increassed pressor region output, decreased depressor region output, vasomotor center ischemia loss of kidney's normal fxn, fxnal units from disease, aging; abnormal renin-ang reflex |
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What % of HTN is essential HTN?
normally due to what? (5 mechanisms) |
80-95%
altered receptor activity - ANP, Ang II, aldosterone, ADH altered hormone release altered tubular epithelium loss of fxnal renal tissue altered hormonal reflex increased TPR |
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How does elevated tissue flow effect HTN?
Explain myogenic vasoconstriction: |
elevated flow --> more vasoconstriction --> increased TPR, lowered CO
smooth muscle/CT atrophy --> increased wall thickness less compliance less response to stimulating hormones less cell-cell communication |
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Where do you often first notice elevated BP?
3 mechanisms of acute, malignant HTN? Systemic result of malignant HTN: ability of _________ to control perfusion is overwhelmed _______ arterial wall ______ CHP _____ damage and failure _____ edema |
retinal vascular damage, papilledema
ARF cocaine acute change of meds local mechanisms overwhelmed overstretched arterial wall increased CHP renal damage, failure cerebral edema |
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values for:
Stage 1, 2,3 HTN How many Americans have HTN? prevalence of HTN in US? prevalence in blacks? lifetime risk of HTN in non-HTN 55-65 y/o living to 80-85? |
Stage 1: 140-159/90-99
Stage 2: 160-179/100/109 Stage 3: >180/110 50 million 27.9% 33.5% 90% |
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Heart disease and stroke are the _____ and ____ killers in the US annually.
What fraction of dx'ed HTN pts are not on tx? fraction receiving tx, not well controlled? --> increasing trends in _____ and ______ |
#1, #3
1/3 1/3 increasing trends in ESRD, HF hospitalization |
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Explain each risk factor for HTN:
Age Gender Race Psychosocial, Cultural Genetics, Family hx |
Age: 3-5 mm increase with each decade of life
Gender: females more at risk Race: blacks more than whites Psychosocial, cultural: stress, cultural changes related to immigration, changes in diet Genetics: clear influence on HTN |
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Risk factors for developing HTN:
Increased _________ (3) Decreased _________ (3) Periodic screening is recommended after age ____. T/F: HTN can be dx'ed after 1 measurement. How often should you be checked if normal BP and if elevated BP? |
increased: BW, Na+, EtOH
decreased: physical activity, K+, fruits and vegetables 21 y/o F - need more than 1 normal - q 2 years elevated - q 1 year |
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BMI of ___ or greater is closely closely correlated with HTN.
Effect of excess EtOH ingestion? Dietary Na+ and K+ recommendations? Guidelines for pharmacological tx? |
BMI - >27
can cause resistance to therapy, risk factor for stroke Na+ <6 g/day, K+ >2 g/day start low, slow, work up to therapeutic levels |
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What type of drugs should you first consider?
HTN in blacks is generally _____ responsive to monotherapy with diuretics and Ca-channel blockers than to BB's, ACEI's. |
diuretic, B-blocker
more responsive to monotherapy |
