Hypertension and Stroke Risk Factors Quiz

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Questions and Answers

Which of the following is considered a major modifiable risk factor for stroke?

Diabetes

Increasing age

Tobacco use

Uncontrolled primary hypertension (correct)

What is the traditional threshold blood pressure (BP) value for a diagnosis of hypertension?

150/90 mmHg

130/80 mmHg

120/80 mmHg

140/90 mmHg (correct)

According to European guidelines, what is the blood pressure (BP) threshold for a diagnosis of hypertension?

130/80 mmHg

120/80 mmHg

150/90 mmHg

140/90 mmHg (correct)

What is the relationship between blood pressure (BP), cardiac output (CO), and systemic vascular resistance (SVR)?

BP = CO SVR (B) Signup and view all the answers

What is 'pressure natriuresis'?

The increase in renal sodium excretion due to mild increases in blood pressure (C) Signup and view all the answers

What is the 'set-point BP'?

The blood pressure at which extracellular volume and pressure natriuresis are in equilibrium (C) Signup and view all the answers

Which of the following is NOT a common cause of end-stage kidney disease?

Obesity (B) Signup and view all the answers

What is the lifetime risk for developing hypertension in men and women aged 55 to 65 years?

Above 90% (C) Signup and view all the answers

What are the main factors that stimulate the release of renin?

Decreased renal afferent perfusion pressure, decreased sodium delivery to the macula densa, and activation of renal nerves via β1- adrenergic receptor stimulation (C) Signup and view all the answers

What is the function of aldosterone in hypertension?

Aldosterone increases sodium reabsorption in the distal tubule by increasing the activity of the epithelial sodium channel (ENaC). (A) Signup and view all the answers

How does angiotensin II contribute to target-organ injury in hypertension?

Angiotensin II is associated with endothelial cell dysfunction and produces extensive fibrotic and inflammatory changes, largely mediated by increased oxidative stress, resulting in renal, cardiac, and vascular injury. (C) Signup and view all the answers

How does angiotensin II influence the Renin-Angiotensin-Aldosterone System (RAAS)?

Angiotensin II increases sodium reabsorption in the proximal tubule by increasing the activity of the sodium:hydrogen exchanger (NHE3), the sodium-bicarbonate exchanger, and Na+-K+- ATPase. (C) Signup and view all the answers

Which of the following are paracrine factors involved in pressure natriuresis?

NO and ATP (A) Signup and view all the answers

How does angiotensin II type 2 receptor (AT2R) stimulation differ from angiotensin II type 1 receptor (AT1R) stimulation?

AT2R stimulation is associated with vasodilation, natriuresis, and antiproliferative effects. AT1R stimulation is associated with vasoconstriction, sodium retention, and pro-proliferative effects. (A) Signup and view all the answers

What is the primary function of renin in the RAAS?

Renin cleaves angiotensinogen to angiotensin I (B) Signup and view all the answers

What is the primary pathway through which aldosterone increases sodium reabsorption?

Aldosterone activates the mineralocorticoid receptor, leading to increased expression of the epithelial sodium channel (ENaC) (B) Signup and view all the answers

What is the primary characteristic of obesity-related hypertension?

Impaired sodium excretion and endothelial dysfunction (D) Signup and view all the answers

What is the meaning of 'hypertrophied' in the context of fat tissue in obesity?

Larger fat cells (D) Signup and view all the answers

How does impaired NO synthesis contribute to obesity-related hypertension?

Increases blood pressure by promoting vasoconstriction (A) Signup and view all the answers

What is the correlation between visceral adipocyte mass and aldosterone secretion?

Direct correlation (B) Signup and view all the answers

What is a common finding in obese individuals compared to lean individuals regarding natriuretic peptides?

Lower levels of natriuretic peptides (B) Signup and view all the answers

What is NOT a key component of the evaluation of patients with hypertension?

Evaluating the patient's favorite food choices (D) Signup and view all the answers

Which symptom is present in more than 10% of patients presenting with diastolic blood pressure (DBP) levels above 120 mm Hg?

Headaches (C) Signup and view all the answers

Why is obtaining a detailed family history important in the diagnostic approach to hypertension?

To identify genetic predispositions to hypertension (B) Signup and view all the answers

What is the primary mechanistic difference between patients with high and suppressed plasma renin activity levels in terms of hypertension?

High renin activity levels indicate vasoconstriction mediated by the RAAS as the primary cause of hypertension, while suppressed renin activity levels suggest other mechanisms. (C) Signup and view all the answers

Why are ACEIs and ARBs less effective in lowering blood pressure in older individuals compared to thiazide diuretics and CCBs?

Older individuals generally have lower renin activity levels, making RAAS blockers less effective. (C) Signup and view all the answers

What type of patients are calcium antagonists particularly well-suited for?

Patients with low renin activity levels and increased arterial dysfunction. (B) Signup and view all the answers

What is the major contributor to ankle edema in older individuals taking calcium antagonists?

Profound vasodilation with poor venous return. (A) Signup and view all the answers

What did the ACCOMPLISH trial suggest regarding the combination of CCBs and ACEIs in patients with chronic kidney disease?

The combination resulted in fewer patients requiring dialysis compared to a diuretic-ACEI combination, despite a small difference in blood pressure between the groups. (D) Signup and view all the answers

Why is nebivolol considered a more suitable beta blocker for older adults than earlier generations of beta blockers?

It has a lower risk of causing depression, sexual dysfunction, dyslipidemia, and hyperglycemia. (C) Signup and view all the answers

Based on the content, what is the recommended blood pressure target for individuals with stage 3 or higher chronic kidney disease and very high albuminuria?

Less than 140 mmHg. (A) Signup and view all the answers

What is the primary rationale for using RAAS-blocking agents in individuals with stage 3 or higher chronic kidney disease?

To slow the progression of chronic kidney disease. (D) Signup and view all the answers

In managing hypertensive emergencies involving the kidney, what is the most important predictor of the need for acute dialysis?

The level of creatinine (B) Signup and view all the answers

What drug is often preferred for hypertensive emergencies resulting from catecholamine excess states due to its lack of toxic metabolites and specific renal vasodilating effects?

Fenoldopam (D) Signup and view all the answers

Which of the following drugs is NOT contraindicated in managing hypertensive emergencies during pregnancy?

Hydralazine (B) Signup and view all the answers

Which of the following is the recommended approach for managing hypertensive urgencies?

Observation and referral for long-term hypertension management (B) Signup and view all the answers

What is the most important aspect of managing a hypertensive urgency?

Ensuring adherence to long-term hypertension therapy (C) Signup and view all the answers

Which of the following medications is commonly used to manage hypertensive emergencies involving cardiac ischemia/infarction or pulmonary edema?

Clevidipine (D) Signup and view all the answers

Which of the following statements about the management of hypertensive emergencies during pregnancy is TRUE?

Delivery of the infant is often hastened to manage hypertension (A) Signup and view all the answers

What is the primary concern when managing hypertensive emergencies involving the kidney?

Preventing further damage to the kidneys (D) Signup and view all the answers

Which of the following is a characteristic of a patient classified as a "nondipper"?

Their blood pressure decreases by less than 10% during sleep (B) Signup and view all the answers

What is the optimal blood pressure measurement interval for 24-hour ambulatory blood pressure monitoring (ABPM)?

Every 20 minutes during the day and every 30 minutes at night (A) Signup and view all the answers

Which of the following is NOT a consistently superior marker for target-organ damage compared to office blood pressure?

Blood pressure variability (C) Signup and view all the answers

What is the main advantage of using 24-hour ambulatory blood pressure monitoring (ABPM) over traditional office blood pressure measurements?

It can provide more detailed information about blood pressure fluctuations over time (B) Signup and view all the answers

Based on the provided information, which of the following conditions is most likely to be detected using 24-hour ambulatory blood pressure monitoring (ABPM)?

Masked hypertension (B) Signup and view all the answers

Which of the following is TRUE regarding the association between blood pressure variability and cardiovascular events?

Increased blood pressure variability is associated with increased event rates. (A) Signup and view all the answers

Why is it clinically relevant to assess a patient's dipping status during sleep?

To evaluate the risk of cardiovascular events and target-organ damage (A) Signup and view all the answers

Which of the following statements accurately reflects the information provided about the relationship between office blood pressure and out-of-office blood pressure in terms of cardiovascular outcomes?

Out-of-office blood pressure is consistently a more accurate predictor of outcomes than office blood pressure. (C) Signup and view all the answers

Study Notes

Systemic Hypertension: Mechanisms, Diagnosis, and Treatment

Uncontrolled primary hypertension is the most important modifiable risk factor for stroke, heart failure, end-stage kidney disease, and memory loss.
After tobacco use and diabetes, uncontrolled primary hypertension is the most important risk factor for peripheral vascular disease.
The traditional threshold blood pressure (BP) value for hypertension is 140/90 mmHg, derived from epidemiologic studies.
US guidelines define hypertension as ≥130/80 mmHg, while European guidelines define it as ≥140/90 mmHg.
Age and high sodium/low potassium diets are major risk factors for developing hypertension.
More than 125 different medications, primarily generic, are available for treating hypertension.

Pressure Natriuresis and Salt Sensitivity

Pressure natriuresis is the increase in renal sodium excretion due to mild increases in blood pressure. This generally occurs due to extracellular fluid expansion that keeps blood pressure within the normal range.
Set-point BP is the BP at which extracellular volume and pressure natriuresis are in equilibrium.
Pressure natriuresis takes hours to days and is modulated by both biophysical and humoral factors. Mechanisms include increasing blood flow through the vasa recta and stimulating paracrine factors like NO and ATP. These factors can inhibit tubular sodium reabsorption at various nephron sites.

Renin-Angiotensin-Aldosterone System (RAAS)

Renin, an enzyme produced and stored in the juxtaglomerular apparatus of the kidney, is released in response to reduced renal afferent perfusion pressure. Lower sodium delivery, nerve activity, and beta-adrenergic stimulation also trigger its release.
Renin cleaves angiotensinogen into angiotensin I, which is then converted to angiotensin II by angiotensin-converting enzyme (ACE). Angiotensin II is a potent vasoconstrictor, affecting vascular smooth muscle and causing systemic vasoconstriction.
Angiotensin II also increases sodium reabsorption in the proximal tubule and induces aldosterone release from adrenal glands, promoting sodium (and water) retention.
Angiotensin II type 1 receptor (AT1R) mediates most of the effects of angiotensin II, including vasoconstriction.
Angiotensin II type 2 receptor (AT2R) has opposite effects, resulting in vasodilation, increased sodium excretion (natriuresis), and antiproliferation.
Angiotensin (1–7) is formed by ACE2 and its actions are opposite to those of angiotensin II.

Sympathetic Nervous System

Many patients with hypertension exhibit autonomic imbalance, with increased sympathetic and decreased parasympathetic activity.
This involves elevation in plasma catecholamine levels and heightened microneurographic activity.

Other Pathophysiological Factors

Arterial stiffness is an important factor in the pathogenesis of hypertension, particularly in isolated systolic hypertension.
Natriuretic peptides (ANP, BNP, and urodilantin) have important roles in salt sensitivity, heart failure, and hypertension.
Endothelial integrity plays a crucial role in blood pressure regulation, with NO being a very important and crucial endothelial-derived vasodilator. Its interruption leads to hypertension.
The immune system's innate responses, like those mediated by macrophages, are linked to hypertension induced by angiotensin II, aldosterone, and nitric oxide (NO) antagonism.

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Description

Test your knowledge on hypertension-related concepts and risk factors for stroke with this quiz. Explore key topics such as blood pressure thresholds, the role of angiotensin II, and pressure natriuresis. Perfect for students and healthcare professionals alike.