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38 Cards in this Set
- Front
- Back
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What are normal BP Values?
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<120 / <80
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What are Pre-Hypertension BP Values?
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120-139 / 80-89
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What are Stage 1 Hypertension Values?
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140-159 / 90-99
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What are Stage 2 Hypertension Values?
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≥160 / ≥100
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What is the epidemiology of hypertension?
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20-25% of the population
increased incidence with age blacks > whites men > women can be moderate and stable over decades (benign) |
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What are the clinical features of benign hypertension?
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Usually asymptomatic but symptoms can include headaches, dizziness, epistaxis, flushing, sweating and blurred vision
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What are the clinical considerations of longstanding benign hypertension?
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It can lead to Left Ventricular Hypertrophy (cardiomegaly) and Proteinuria and Nephrotic Syndrome (kidney damage)
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What can Hypertensive Emergency/Crisis lead to ?
(Malignant Hypertension - Diastolic BP >120 {110-130}mmhg) |
Acute End-Organ Damage
- Stroke - Acute Myocardial Infarction - Acute Renal Failure - Retinal Hemorrhage - Eclampsia of pregnancy |
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What are the two mechanisms that can lead to Hypertension?
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- Increased vascular resistance
- Increased sodium retention |
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Essential hypertension constitutes 95% of cases. What is the cause of essential hypertension?
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No causative pathology, combo of genetic and environmental factors.
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Secondary Hypertension constitutes 5% of cases. What is the causative pathology of secondary hypertension?
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- RENAL
- ENDOCRINE - Cardiovascular - Neurologic |
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Why does increased sodium retention lead to hypertension?
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Increased sodium retention increases stroke volume.
[ BP = Cardiac Output x Vascular Resistance ] |
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Why is the kidney an important organ in hypertension?
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The kidney is central to all blood pressure control:
- Renin-Angiotensin System increases blood pressure - Nitric Oxide, Prostaglandins decrease blood pressure |
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Name the hormone secreted by the heart and its effect on blood pressure.
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- Atrial Natriuretic Peptide
- Decreases BP by promoting sodium excretion |
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Name the hormone secreted by the adrenal gland and its effect of blood pressure.
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- Aldosterone
- Increases BP by promoting sodium reabsorption |
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What is the main renal cause of secondary hypertension?
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RENAL ARTERY STENOSIS
(Also, Renal Vasculitis, Chronic Renal Disease, Renin Producing Tumor) |
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What is the pathophysiology of Goldblatt Kidney?
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Occurs in renal artery stenosis: affected kidney senses decreased blood flow and autoregulates to increase blood pressure. Unaffected kidney exposed to high blood pressure via autoregulation of affected kidney and develops nephrosclerosis
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What are the two causes of renal artery stenosis?
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- ATHEROSCLEROSIS
- Fibromuscular dysplasia |
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What is the main clinical feature of Fibromuscular Dysplasia?
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MORE COMMON IN MIDDLE AGED WOMEN
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What is the main endocrine cause of secondary hypertension?
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HYPERALDOSTERISM
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What are the two adrenal pathologies that cause hypertension?
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- Adrenal cortical hyperplasia
- Adrenal cortical adenoma |
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What is Conn Syndrome?
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Solitary Adrenal Adenoma that causes primary hyperaldosterism (secondary hypertension)
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What are cardiovascular causes of hypertension?
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-Coarctation of aorta
- Polyarteritis nodosa - Increased Vascular Volume - Increased Cardiac Output - Rigidity of aorta (mainly due to atherosclerosis) |
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What are neurologic causes of hypertension?
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- Sleep apnea
- Psychogenic - Increased intracranial pressure - Acute stress |
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What is the gross cardiac damage caused by hypertension?
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Cardiomegaly with left ventricular hypertrophy
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What are the measurements for cardiomegaly and left ventricular hypertrophy?
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Cardiomegaly:
>400g men >350g women LVH: >1.5cm thickness (concentric) |
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What are the characteristic nuclei in hypertrophic myocytes?
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Box Car Nuclei
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List 3 other diseases resulting from hypertension.
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- Aortic dissection (in conjunction with atherosclerosis)
- Myocardial infarction (increased oxygen demand of hypertrophic myocardium) - Cardiac arrhythmia (abnormal elecrical current through thickened myocardium) |
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What is arteriolosclerosis?
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Damage to arterioles from chronic exposure to elevated blood pressure
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Arteriolosclerosis can cause hyaline blood vessel damage
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Arteriolosclerosis can cause hyerplastic blood vessel damage
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What causes Nephrosclerosis?
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Chronic increased renal vascular pressure
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NEPHROSCLEROSIS: Arterioloscelrosis leads to chronic ischemia which leads to glomerular sclerosis
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Gross kidney features of benign, chronic nephrosclerosis
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Shrunken, Contracted and Granular Kidney
"GRANULAR CONTRACTED KIDNEY" |
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Gross kidney features of acute, malignant hypertension
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Pinpoint hemorrhages over granular surface.
"FLEA-BITTEN KIDNEY" |
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Histological features of acute, malignant hypertension
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Necrotizing arteriolitis
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Brain damage due to hypertension
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Stroke (hemorrhagic infarcation)
-Basal Ganglia - Thalamus - Cerebellum - Subcortical white matter |
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Brain damage due to hypertension (aneurysm)
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Ruptured Berry Aneurysm
- Circle of Willis - Anterior Communicating Artery - Posterior Communicating Artery |
