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Cardio SDL 2
Pathophysiology of Hypertension
36
Pharmacology
Graduate
01/22/2013

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Term
Define hypertension
Definition
Persistently elevated arterial blood pressure
Term
What are the two broad categories of HTN?
Definition
Primary (idiopathic or essential)
and Secondary
Term
Define primary HTN
Definition
Cause is unknown; occurs in over 95% of patients with hypertension
Term
Define secondary HTN
Definition
Cause is attributed to a specific disease or drug therapy; occurs in less than 5% of patients with hypertension
Term
What are the two numbers in a blood pressure measurement?
Definition
Systolic pressure- cardiac contraction
Diastolic pressure- phase after contraction
Term
During a day, when are the highest BP average values?
Definition
Mid-morning
Term
Give the equation to define blood pressure
Definition
BP=COxTPR
Term
What happens when central α2-adrenergic receptors are stimulated?
Definition
Lowers blood pressure by inhibiting the vasomotor center (e.g., clonidine and methyldopa).
Term
What happens when post-synaptic α1-receptors on arterioles and venules are stimulated?
Definition
Vasoconstriction
Term
What happens when post-synaptic beta2-receptors on arterioles and venules are stimulated?
Definition
Vasodilation
Term
What happens when pre-synaptic α2-receptors are stimulated?
Definition
Norepinephrine is released from the nerve terminus
Term
What happens when pre-synaptic beta-receptors are stimulated?
Definition
Norepinephrine is released from the nerve terminus
Term
Define baroreceptors
Definition
Nerve endings within the walls of large arteries such as the carotid arteries and the aortic arch.
Term
How do local tissues autoregulate blood flow to maintain adequate oxygenation for metabolic processes?
Definition
When oxygen demand is high, local arteriolar beds vasodilate to increase blood flow and thus oxygen supply. When oxygen demand is low, local arteriolar beds remain relatively vasoconstricted.
Term
What would happen if there was a defect in the renal autoregulatory system that causes increased fluid volume and thus increased blood flow and oxygen delivery to local tissues?
Definition
Local tissue autoregulatory mechanism of vasoconstriction.

Sustained vasoconstriction in arteriolar beds would lead to sustained increases in total peripheral resistance.
Term
Define RASS
Definition
renin-angiotensin-aldosterone system

an important role in regulating sodium, potassium, fluid balance, sympathetic nervous system activity, and vascular tone.
Term
Define renin

Where is it stored?
Definition
Renin catalyzes the conversion of angiotensinogen to angiotensin

Renin is synthesized and stored in the juxtaglomerular cells located in the media of the renal afferent arterioles
Term
Define juxtaglomerular apparatus
Definition
The juxtaglomerular cells and specialized distal tubule cells
Term
What stimulates renin release?
Definition
a. decreased renal perfusion pressure
b. decrease in the amount of sodium and chloride delivered to the distal tubule of the nephron (detected by the macula densa)
c. direct stimulation of the juxtaglomerular apparatus by catecholamines
d. decreased circulating levels of angiotensin II
Term
Define ACE
Definition
angiotensin converting enzyme, converts angiotensin I to angiotensin II
Term
What is the effect of angiotensin II
Definition
Angiotensin II stimulates angiotensin II-type 1 receptors (AT1) (there may be other angiotensin II receptors with different functions) located in the brain, kidney, heart, vasculature, and adrenal tissue

This leads to vasoconstriction, catecholamine release, sympathetic activity, and aldosterone release
Term
Define aldosterone
Definition
An adrenal hormone that causes sodium and water retention in the distal tubule of the nephron in the kidney ultimately resulting in increased blood pressure
Term
What is the effect of natriuretic hormone?
Definition
Nuretic hormone is believed to block active transport of sodium out of arteriolar smooth muscle cells leading ultimately to increased vascular tone and thus elevated blood pressure.
Term
What is the effect of insulin on blood pressure?
Definition
a. increase sodium and water retention in the kidney
b. lead to enhanced sympathetic nervous system activity
c. cause hypertrophy of arteriolar smooth muscle
d. increase intracellular calcium concentrations in the smooth muscle cells of the vasculature leading to increased TPR
Term
List 3 vascular vasodilating substances
Definition
prostacyclin and bradykinin, nitric oxide
Term
List two vascular vasoconstricting substances
Definition
angiotensin II and endothelin I
Term
How does dietary sodium affect BP?
Definition
a. Dietary sodium intake is linked to hypertension.
b. The exact mechanism of this effect is not known but excessive sodium intake may be linked to an increase in circulating natriuretic hormone.
c. Reduced sodium intake lowers blood pressure in many patients.
Term
How does dietary calcium affect BP?
Definition
a. Dietary deficiencies of calcium may lead to altered calcium homeostasis with a resulting relative increase intracellularly.
b. Increased intracellular calcium in small muscle cells in arteriolar walls leads to relative vasoconstriction and thus increased peripheral vascular resistance.
c. Dietary calcium supplementation reduces blood pressure slightly in some patients.
Term
How does dietary potassium affect BP?
Definition
Poor dietary intake is associated with increased peripheral vascular resistance.
Term
List 7 diseases that can cause hypertension
Definition
1. Renovascular disease
2. Pheochromocytoma (adrenal tumors)
3. Primary aldosteronism
4. Cushing's disease
5. Coarctation of aorta
6. Sleep apnea
7. Head injury/brain tumors
Term
List 11 drugs that can cause hypertension
Definition
1. estrogens
2. corticosteroids
3. NSAIDs
4. Cyclosporine
5. Decongesants, anorexiants
6. Thyroid hormone in excess
7. Ethanol
8. Ephedra
9. Venlafaxine
10. Erythropoietin
11. MAOIs
Term
Describe cerebrovascular problems that can result from long-term hypertension
Definition
a. Strokes are one of the most common causes of death in hypertensive patients.

b. Transient ischemic attacks result from atherosclerotic disease in the carotid arteries.
Term
Describe cardiac problems that can result from long-term hypertension
Definition
a. Left ventricular hypertrophy
b. Heart failure
c. Coronary heart disease
Term
Describe renal problems that can result from long-term hypertension
Definition
a. Nephrosclerosis, secondary to accelerated arteriosclerosis, is the primary renal complication in hypertensive patients.
b. Hypertension is one of the leading causes of end-stage renal disease especially in African-American, Hispanic, and Native American patients
Term
Describe eye problems that can result from long-term hypertension
Definition
a. Retinopathy is due to accelerated arteriosclerosis in retinal arteries in hypertensive patients.
b. Manifestations include focal arteriolar narrowing, retinal infarcts, and flame-shaped hemorrhages.
c. Papilledema - a swelling of the optic disk that indicates severe hypertension and the need for emergency treatment of blood pressure.
Term
Describe peripheral vascular problems that can result from long-term hypertension
Definition
a. Peripheral vascular disease results from accelerated atherosclerosis.
b. Atherogenesis is accelerated in hypertensive patients and results in proliferation of smooth muscle cells, lipid infiltration in the vascular endothelium, and accumulation of calcium in the vasculature.
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