Term
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1 million people globally
1:3 adults in america
men> women before age 55
men more likely to suffer an MI
women are likely to suffer a stroke |
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| Arterial blood pressure (ABP) |
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Definition
| "rhythmic ejection of blood from the left ventricle into the aorta" |
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represents ventricular contraction and the ejection of blood from the left ventricle (typically 70% of the blood leaves the Lt ventricle during the first 1/3 of systole)
ideal pressure <120mmHg |
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represents relazation of the ventricle and blood flow into peripheral vessels
ideal pressure <80mmHg |
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| difference between s systole and diastolic blood pressure |
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| represents the average pressure in the arterial system during the ventricular contraction and relaxation |
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| this equals stroke volume x heart rate |
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| peripheral vascular resistance |
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| change in the radius of arterioles and the ciscosity of the blood |
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| systemic vascular resistance |
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Definition
| the force opposing the movement of blood withint he blood vessels dependent upon blood viscosity and vessel diameter |
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| vasoconstriciton, increases contractility, increased HR |
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| vasodilation, decrased contractility, decreased HR |
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| located in walls of blood vessels and heart, decrease dBP produces a decrease in stretch of baroreceptors as a result increased HR and SNS stimulation increased PVR and increased BP |
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sensitive to change in oxygen, CO2, and H+ content of blood
located in carotid bodies
communicate with CV centers in brain stem to induce vasoconstriction with ABP drops below a critical level. |
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released from pituitary glad in response to decreases in blood volume and blood pressure
has a vasoconstrictor effect |
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| Renin-angiotensin-aldosterone system (RAAS) |
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Definition
| Renin- is an enzyme that is released from the kidney when perfusino is decreased. it binds to an inactive peptide called antiotensinogen, converting it to angiotensin I, then converted to Angiotensin II by angiotensin converting enzyme (ACE) |
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| is a potent vasconstrictor and causes the release of Aldosterone from the adrenal cortex of the kidney |
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Term
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Definition
- no known cause
- chronic elevation in blood pressure that occurs without evidence of other dieases
- risk factors: family history, race, age, insulin resistenace and metabolic abnormalities, life style- high Na diet, obesity, low K
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Primary hypertension
(clinical manifiestations) |
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Definition
asymptomatic until severe and target organ disease has occurred- fatigue, dizziness, activity intolerance, palpitations, angina, dyspnea
complications- target organ diease |
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Term
| isolated systolic hypertension |
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Definition
systolic pressure is selectively elevated->140/90 mmHg
contribute to CV risk in 2 ways
elevation in SBP- cause development of left ventricular hypertrophy, increased myocardial oxygen demands and leftheart failure
disproportionate rise in pulse pressure- elevation in pulse pressure produce greater stretch of arteries causing damage to the elasticity of the vessel predisposing them. |
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- 5-10% of all cases
- many conditions cuasing secondary hypertension can be cured by surgery or medical intervention
- yonger individuals- renal artery stenosis, coaretation of the aorta
- other factors- cocaine, erythropoietin, licorice, kidney disease
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| caused by decreased renal blood flow and activation of the RAAS |
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| Disorder of adrenocorticosteroid hormones |
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Definition
| cause salt and wter retention, primary hyperaldosteronism, cushings disease |
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Definition
| tumor in adrenal medulla that secrete epinephrine and norepinephrine, causing headache, excessive sweating, palpation |
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| narrowing of the aorta that results in decrease blood flow to kidneys |
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Target organ diease of hypertension
(manifestations) |
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Definition
symptoms usually related to long term effects of hypertenion on other organ systems
heart- leftventrical hypertrophy
CAD-leads to angina or MI, heart failure
brain- stroke
kidney-nephrosclerosis, chronic kidney disease
bloodvessels-PVD
eyes- retinopathy |
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hypertension
diagnosis/treatment |
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Definition
diagnosis: repeated blood pressure measurements- 2 or more BP readings taken 2 or more visits
lab tests done to confirm organ damage and to rule out secondary hypertension
treatment: goal- bp <140/90mmHg, lifestyle modification, low Na, physical activity |
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SBP 140-159mmHg
DBP-90-99mmHg
treatment thiazide-type diuretics, may consider ACE inhibitor, ARB blocker, calcium channel blocker, or combination |
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SBP> or = 160mmHg
DBP> or = to 100mmHg
treatment- two drug combination thiazide type diuretics, may consider ACE inhibitor, ARB blocker, Calcium channel blockers |
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two actions- decreased volume of circulating blood, reduce SVR
Diuretics- promote sodium and water excretino and reduce plasma volume |
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Drug therapy
Centrally acting adrenergic inhibitors Adrenergic antagonists |
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Definition
reduces sympathetic outflow of CNS, producing vasodilation and decreasing SVR and BP
ex. clonidine, guanabenz, methyldopa |
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Drug therapy
Peripheral acting adrenergic antagonists |
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Definition
prevent peripheral release of noreponephrine, resulting in vasodilation that lowers CO and reduces SBP
ex. guanethidine |
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| Angiotensin II receptor blockers |
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Definition
prevent action of angiotensin II and produces vasodilation and increased salt and water excretion
ex. irbesartan, valsartan |
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block movement of extracellular calcium into cells, causing vasodilation and decreased HR, contractility, and SVR
ex. amlodipine, diltiazem, felodipine, nicardipine |
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