CBL: Hypertension Foundations

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Questions and Answers

Which statement accurately defines hypertension?

A temporary condition often resolved by hydration.

A condition characterized by low blood pressure.

A persistent increase in systolic or diastolic blood pressure above normal levels. (correct)

An episodic rise in blood pressure due to stress.

What is a recommended lifestyle change for patients with hypertension?

Avoiding all forms of exercise.

Adopting a high-sodium diet.

Increasing physical activity levels. (correct)

Engaging in high-intensity weight lifting exclusively.

How does Lisinopril function in the treatment of hypertension?

By enhancing sodium reabsorption in the kidneys.

By increasing blood volume and cardiac output.

By stimulating the release of adrenaline in the body.

By inhibiting the angiotensin-converting enzyme, leading to vasodilation. (correct)

Which of the following best describes shock?

An acute circulatory failure resulting in inadequate blood flow to tissues. Signup and view all the answers

What is the primary sympathetic nervous system response to hypovolemic shock?

Increased heart rate and force of contraction. Signup and view all the answers

How does Hydrochlorothiazide (HCTZ) aid in treating hypertension?

By inhibiting the reabsorption of sodium and water in the distal convoluted tubule. Signup and view all the answers

What is the primary focus of MK-01 in the context of medical education?

Core of basic sciences related to normal structure and function Signup and view all the answers

Which learning outcome is associated with understanding the pathology and pathophysiology of the body and organs in disease?

MK-05 Signup and view all the answers

In which discipline is the normal structure and function of the body primarily studied?

Embryology Signup and view all the answers

What is a significant characteristic of hypertension according to medical practice?

It is the most common cardiovascular disease worldwide. Signup and view all the answers

Which of the following is not included in the competency related to therapeutic interventions?

Diagnosis of acute illnesses Signup and view all the answers

What is the focus of MK-06 in the context of medical education?

Foundations of therapeutic intervention including treatments and prevention Signup and view all the answers

Which learning outcome relates specifically to acute care within the major organ systems?

LO-05 Signup and view all the answers

What does MK-02 emphasize regarding the body's major organ systems?

The normal structure and function of body systems Signup and view all the answers

What is the condition referred to as the "silent killer" due to its asymptomatic nature?

Primary Hypertension Signup and view all the answers

What is the common threshold for diagnosing Primary Hypertension based on systolic blood pressure?

<blockquote> 130-140 mm Hg </blockquote> Signup and view all the answers

Which of the following is NOT a common mechanism involved in the development of Primary Hypertension?

Decreased Cardiac Output Signup and view all the answers

What is the primary driver of Primary Hypertension, according to the mechanisms discussed?

Elevated systemic vascular resistance (SVR) Signup and view all the answers

Which organization stated that a blood pressure of 120-129 mmHg systolic is considered "Elevated"?

American Heart Association Signup and view all the answers

Which factor can affect both blood pressure directly and indirectly, influencing its regulation?

Sympathetic Nervous System Signup and view all the answers

What often leads to increased intra-vascular volume, thereby affecting blood pressure?

Excess salt intake Signup and view all the answers

In the context of hypertension, what is meant by 'total peripheral resistance' (TPR)?

The resistance offered by all peripheral blood vessels Signup and view all the answers

What effect does the activation of alpha1-receptors have on blood vessels?

Vasoconstriction, increasing systemic vascular resistance Signup and view all the answers

What is the primary function of Lisinopril as a medication for hypertension?

It inhibits the conversion of Angiotensin 1 to Angiotensin 2 Signup and view all the answers

Which receptor does Angiotensin 2 bind to in its role as a vasoconstrictor?

AT2 receptor Signup and view all the answers

Which of the following correctly describes Hydrochlorothiazide's mechanism of action?

It increases urine output to lower systemic volume Signup and view all the answers

What is the relationship between norepinephrine release and hypertension in certain patients?

Some patients may release excess norepinephrine, leading to hypertension Signup and view all the answers

What primary factor is targeted in clinical practice to manage hypertension?

Systemic vascular resistance and systemic volume Signup and view all the answers

What do ACE inhibitors like Lisinopril prevent in the context of hypertension?

The conversion of Angiotensin 1 to Angiotensin 2 Signup and view all the answers

What are some critical aspects of treatment to learn regarding hypertension medications?

Common side effects and contraindications Signup and view all the answers

What is a common side effect of Lisinopril due to its impact on bradykinin metabolism?

Dry cough Signup and view all the answers

What complication is most closely associated with the use of HCTZ?

Hypokalemia Signup and view all the answers

In primary hypertension, what is often the main driver of elevated blood pressure?

Increased vascular resistance Signup and view all the answers

What physiological response occurs first in the event of hypovolemic shock?

Activation of the sympathetic nervous system Signup and view all the answers

Which of the following best defines shock?

Inadequate circulation of blood to the organs Signup and view all the answers

What is the role of norepinephrine during profound hemorrhage?

Promote arteriolar constriction Signup and view all the answers

Which of the following conditions can cause hypotension?

Septic shock Signup and view all the answers

What happens to the arterial pulse in the presence of profound vasoconstriction from hypovolemic shock?

It becomes weak and barely palpable Signup and view all the answers

Study Notes

Hypertension Overview

Hypertension, known as the "silent killer," is the most prevalent cardiovascular disease worldwide and in the US medical practice.
It often remains asymptomatic, causing damage to the heart, kidneys, and brain over time.
Classified as Essential (Primary) Hypertension when blood pressure exceeds 130-140 mm Hg systolic or 80-90 mm Hg diastolic on two or more occasions without an identifiable cause.
Diagnosed levels are based on chronic exposure leading to organ damage.

Blood Pressure Definitions

Elevated blood pressure is classified as 120-129 mmHg systolic as per 2019 American Heart Association guidelines.
Blood pressure thresholds can change with age.

Mechanisms of Blood Pressure Regulation

Blood pressure (BP) is influenced by cardiac output (CO) and systemic vascular resistance (SVR), where:
- CO = Stroke Volume (SV) × Heart Rate (HR)
- BP is directly proportional to CO × SVR.
Normal heart rate in hypertension makes HR a less common treatment target; elevated SVR usually drives primary hypertension.

Causes of Hypertension

Increased SVR is the primary cause of primary hypertension.
Additional causes include an increase in intravascular volume due to excessive salt intake and renal reabsorption.
The sympathetic nervous system (SNS) impacts blood pressure; overactivity leads to elevated levels of norepinephrine, causing vasoconstriction via alpha1-receptors.

Key Vasoconstrictors

Angiotensin II is a potent vasoconstrictor that also binds to AT2 receptors, playing a critical role in hypertension.
Medications targeting the angiotensin pathway are first-line treatments for hypertension.

Hypertension Treatments

Main medications include:
- Lisinopril: An ACE inhibitor that prevents the conversion of Angiotensin I to Angiotensin II, decreasing SVR.
- Hydrochlorothiazide (HCTZ): A diuretic that increases urine output, reducing blood volume (SV).
Important side effects:
- Lisinopril may cause a dry cough due to bradykinin accumulation.
- HCTZ can lead to hypokalemia (excess potassium loss).

Shock and Its Mechanisms

Hypotension (low blood pressure) can result from shock, defined as inadequate oxygen delivery to tissues.
Focus on hypovolemic shock, caused by loss of intravascular fluid from hemorrhage or severe dehydration.
Blood pressure formula: BP = CO (HR × SV) × SVR helps in understanding shock’s management.

Physiological Responses to Blood Loss

In hypovolemic shock, the SNS is activated, causing norepinephrine release.
Norepinephrine binds to alpha1-receptors, leading to arteriolar constriction and diversion of blood to vital organs, potentially resulting in a weak pulse in emergency settings.

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Description

This quiz focuses on hypertension within the context of case-based learning in a foundational block. Presented by Dr. Zoe Cohen and Dr. William Adamas-Rappaport, it covers key concepts and clinical approaches to understanding hypertension. Prepare to engage with real-life scenarios and deepen your knowledge through this interactive session.