HSC 4555 Lecture Notes - Lecture 16: Hypertensive Emergency, Brainstem, Ace Inhibitor

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30 Apr 2016
Copstead-Kirkhorn: Pathophysiology, 4th Edition
Chapter 16: Alterations in Blood Pressure
Key Questions
1. How do changes in cardiac output and systemic vascular resistance affect blood
The formula for blood pressure is: BP = cardiac output (CO) x systemic vascular resistance
(SVR). Therefore, a change in either CO or SVR will result in a direct change in blood pressure
(increase in CO or SVR causes an increase in BP; decrease in CO or SVR causes a decrease in
BP) (pgs. 375-379).
2. How is blood pressure regulated on a short- and long-term basis?
Blood pressure is regulated on a short-term basis through the interaction of the carotid and aortic
baroreceptors, the vasomotor center in the brainstem, and the activations of the sympathetic
nervous system and inhibition of the parasympathetic nervous system influences on the heart and
smooth muscle in the arterioles. Short-term regulation primarily involves heart rate and SVR.
Regulation of blood pressure on a long-term basis is complex, involving the nervous system,
release of hormones, and responses of the kidneys to pressure changes (pgs. 378-381).
3. What are the risk factors for the development of primary hypertension?
Risk factors for the development of primary hypertension include non-modifiable risk factors, such
as increasing age and family history, and modifiable risk factors, such as obesity, sedentary
lifestyle, metabolic syndrome, dietary factors, and tobacco use (pgs. 382-383).
4. How is secondary hypertension defined, and what are the common etiologies?
Secondary hypertension is due to a specific identifiable cause. The common etiologies of secondary
hypertension include renal disease or disorders, coarctation of the aorta, tumors, and endocrine
disorders, and may also be associated with pregnancy, or obstructive sleep apnea (pgs. 387-389).
5. How is hypertension detected, classified, and managed?
Hypertension is detected by routine screening in most cases as it is typically asymptomatic until it
causes symptoms of end-organ damage. It is classified as prehypertension (systolic BP 121-139
mm Hg or diastolic BP 81-89 mm Hg); Stage I hypertension (systolic BP 140-159 or diastolic BP
90-99 mm Hg), Stage 2 hypertension (systolic BP >160 or diastolic BP >100 mm Hg). It is
managed with lifestyle modifications and medications including diuretics, beta-blockers, ACE
inhibitors, angiotensin receptor blockers, calcium channel blockers, and aldosterone antagonists
(pgs. 385-386).
6. What are the end-organ consequences of inadequately controlled hypertension?
End-organ consequences of inadequately controlled hypertension include renal failure,
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