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19 Cards in this Set
- Front
- Back
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1. How does renin cause HTN? (4)
2. Another renal mechanism: excessive tubular reabsorption caused by excess ________ 3. Stimulus for increased renin secretion: |
1. a. in renal artery stenosis
b. afferent arteriolar atherosclerosis c. renin secreting tumor d. coarc of aorta 2. aldosterone 3. 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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1. Where does aldosterone primarily act?
2. Primary cause of HTN in bilat renal artery stenosis? 3. What's more effective in reducing volume? |
1. DCT, CT
2. decreased kidney perfusion --> decreased excretion, volume overload 3. diuretics |
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1. In coarc of the aorta, where is the BP less than normal due to pressure drop?
2. effect on kidneys? 3. Mechanism of preeclampsia? 4. What happens to glom membranes? |
1. below the coarc, due to pressure drop across constriction
2. increased renin secretion 3. placental derived toxins block normal endothelial vascular fxn, decreased NO --> vasoconstriction (afferent arteriole and systemic) 4. glom membranes --> more thick, less filtration |
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Neurogenic HTN:
1. Acute mechanism? 2. Chronic mechanism? 3. Mechanism of salt-sensitive HTN? |
1. acute - emotion, anticipation of activity (increased output of pressor region
of vasomotor center and decreased output of depressor region) 2. chronic - increassed pressor region output, decreased depressor region output, vasomotor center ischemia (increased output of vasomotor center may reset level at which BP is controlled) 3. loss of kidney's normal fxn, fxnal units from disease, aging; abnormal renin-ang reflex |
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Describe what is increased output of vasomotor center may reset level at which BP is controlledpredominantly secretion is usually norepinephrine
What does this stiumulate? |
pheochromocytoma- Simulates sympathetic stimulation of
CV system – TPR, HR, Contractility etc. |
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Elevated pituitary secretion of ACTH marked by Elevated cortisol production by adrenal cortex also has Cortisol mimics effect of mineralocorticoids (aldosterone)
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Cushings syndrome
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1. What % of HTN is essential HTN?
2. normally due to what? () |
1. 80-95%
2. a. Unkown |
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1. Define Metabolic syndrome...
2. why is it important |
1. Central obesity plus 2 of the following:
a. TG>150 b. reduced HDL <40 c. hypertension syst:>130, diastolic >85 d. fasting glucose> 5.6 mmol/L 2. predicts 2 to 3 fold increase in Cardio probls |
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1. How does elevated tissue flow effect HTN?
2. Explain myogenic vasoconstriction: |
1. elevated flow --> more vasoconstriction --> increased TPR, lowered CO
2. smooth muscle/CT atrophy --> increased wall thickness less compliance--> less response to stimulating hormones less cell-cell communication |
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1. 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 |
1. 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 |
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pt: recent strep infection, ha, blurred vision, chest pain, pulmonary edema, stopped BP meds,
PE- BP 220/166 Explain each sign... |
1. chestpain- heart working too hard
2. pulm edema- Left side working too hard. |
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Explain generally Leptin and role adipose tissue hormones in HTN and how it relates to fatties
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In general increase Sympathetic outflow, which increases vascular smooth muscle tone
- natriuretic effect not prevalent with obesity Overall adipose tissue hormones elevate AngII, aldosterone, induce production of oxidative inflammatory agents, and insulin sensitivity |
