[3Y2T2S] [CPR] [2.1.1] Systemic Arterial Hypertension

Encompasses all organs of the body supplied by blood

Cardiovascular disease

Cardiovascular disease is a major risk factor for?

Atherosclerotic cardiovascular disease (ASCVD)

This remains a major contributor of CAFD, CHF, CVD, and ESRD.

High BP

This accelerates atherogenesis and increases risk of cardiovascular events

High BP

Levels of SBP & DBP are associated with cardiovascular events in a _____

Continuously graded & apparently independent fashion

True or False: SBP and DBP are considered equally important and independent predictors of cardiovascular events.

TRUE

Which specific type of uncontrolled blood pressure elevation makes a patient more prone to heart failure?

Systolic Blood Pressure (SBP) elevation

Which specific type of uncontrolled blood pressure elevation makes a patient more prone to coronary artery disease / acute coronary syndromes / acute MI / heart attack?

Diastolic Blood Pressure (DBP) elevation

Hypertension is associated with which group of atherogenic factors? A. Diabetes, Heart disease, Obesity, Gout B. Dyslipidemia, Hyperinsulinemia, Obesity, Glucose intolerance C. Dyslipidemia, Hypertension, Obesity, Glaucoma D. Diabetes, Hyperinsulinemia, Overweight, Glucose

B. Dyslipidemia, Hyperinsulinemia, Obesity, and Glucose intolerance

What is a central concept in the development of different diseases like HTN, dyslipidemia, and diabetes?

Obesity

True or False: The association of hypertension with other risk factors is multiplicative rather than additive.

TRUE

True or False: Most patients with high blood pressure exhibit noticeable symptoms attributable to the elevation.

FALSE

Coronary Artery Disease (CAD) is approximately how many times as prevalent in hypertensives compared to normotensive persons of the same age? A. Thrice B. Four times C. Twice D. Five times

C. Twice

What are the factors that contribute to the increased risk of CHD associated with high BP?

Coronary arteriolar hypertrophy, Accelerated narrowing of epicardial arteries, Reduced myocardial vascularity, Perivascular fibrosis

What is the pressure measured in the brachial artery during the ventricular emptying and contraction period?

Systolic Blood Pressure (SBP)

What is the pressure measured in the brachial artery during the ventricular filling and relaxation period?

Diastolic Blood Pressure (DBP)

What is the pressure measured by the first loudest audible sound?

Systolic Blood Pressure (SBP)

What is the pressure measured by the level where you no longer hear the sound?

Diastolic Blood Pressure (DBP)

True or False: Diastolic Blood Pressure is defined as the last audible sound heard during measurement.

FALSE

“Average” pressure throughout the cardiac cycle against the walls of the proximal systemic arteries (aorta)

Mean Arterial Pressure (MAP)

Which of the following is the correct formula to estimate Mean Arterial Pressure (MAP)?
A) (SBP + DBP) / 2
B) 1/3 (SBP - DBP) + DBP
C) SBP - DBP
D) 1/3 (DBP - SBP) + SBP

B) 1/3 (SBP - DBP) + DBP

What clinical strategy involves not lowering blood pressure immediately in stroke patients to maintain blood flow to viable tissue?

Permissive Hypertension (HTN)

True or False: A blood pressure reading of 220/120 mmHg is associated with the risk of rupture.

TRUE

What term refers to the sum of all forces that oppose blood flow?

Total Peripheral Resistance (TPR)

True or False: Blood pressure in the peripheral system originates from the central aortic blood pressure.

TRUE

What is the peak pressure required to "defeat" or overcome the blood pressure in the aorta?

140 mmHg

Arterial pressure is the mathematical product of which two main components?

Cardiac Output (CO) and Peripheral Resistance

This refers to the amount of blood pumped by the heart per minute

Cardiac Output

Cardiac output is based on?

Stroke volume and heart rate

This refers to the amount of blood ejected by heart per contraction

Stroke volume

True or False: If the heart becomes weak, such as in heart failure, the Stroke Volume (SV) will typically increase.

FALSE

When Stroke Volume (SV) decreases, how does a healthy body typically compensate to maintain homeostasis?
A) Decreasing peripheral resistance
B) Increasing Heart Rate (HR)
C) Decreasing Heart Rate (HR)
D) Increasing vascular compliance

B) Increasing Heart Rate (HR)

What are the two primary factors that determine Peripheral Resistance?

Vascular structure and Vascular function

True or False: Vasoconstriction can be triggered by a cold environment, nicotine, or caffeine.

TRUE

Which of the following is a potential consequence of uncontrolled vasoconstriction?
A) Hypotension
B) Hypertension and Stroke
C) Improved vascular compliance
D) Increased stroke volume

B) Hypertension and Stroke

Vasodilation (dilation of the blood vessels) can be caused by which of the following?
A) Nicotine
B) Cold environment
C) Warmth or hydrotherapy
D) Caffeine

C) Warmth or hydrotherapy

What is the office BP values of non-elevated BP?

SBP < 120 mmHg and DBP < 70 mmHg

What is the home BP monitoring values (HBPM) of non-elevated BP?

SBP < 120 mmHg and DBP < 70 mmHg

What is the amb BP monitoring - daytime values (ABPM) of non-elevated BP?

SBP < 120 mmHg and DBP < 70 mmHg

According to the blood pressure classification, this classification has insufficient evidence confirming the efficacy and safety of BP pharmacological treatment

Non-elevated BP

What is the office BP values of elevated BP?

SBP 120-139 mmHg or DBP 70-89 mmHg

What is the home BP monitoring - values (HBPM) of elevated BP?

SBP 120-134 mmHg or DBP 70-84 mmHg

What is the amb BP monitoring - daytime values (ABPM) of elevated BP?

SBP 120-134 mmHg or DBP 70-84 mmHg

According to the blood pressure classification, this classification has a risk stratify to identify individuals with high cardiovascular risk for BP pharmacological treatment

Elevated BP

What is the office BP values of hypertension?

SBP ≥ 140 mmHg or DBP ≥ 90 mmHg

What is the home BP monitoring values (HBPM) of hypertension?

SBP ≥ 135 mmHg or DBP ≥ 85 mmHg

What is the amb BP monitoring - daytime values (ABPM) of hypertension?

SBP ≥ 135 mmHg or DBP ≥ 85 mmHg

According to the blood pressure classification, this classification has cardiovascular risk that is sufficiently high to merit BP pharmacological treatment initiation

Hypertension

According to the blood pressure category (AHA 2025), what is the systolic and diastolic values of normal BP? (SBP, condition, DBP)

Less than 120 and less than 80

According to the blood pressure category (AHA 2025), what is the systolic and diastolic values of elevated BP? (SBP, condition, DBP)

120-129 and less than 80

According to the blood pressure category (AHA 2025), what is the systolic and diastolic values of stage 1 high BP? (SBP, condition, DBP)

130-139 or 80-89

According to the blood pressure category (AHA 2025), what is the systolic and diastolic values of stage 2 high BP? (SBP, condition, DBP)

140 or higher or 90 or higher

According to the blood pressure category (AHA 2025), what is the systolic and diastolic values of hypertensive crisis? (SBP, condition, DBP)

Higher than 180 and/or higher than 120

According to the blood pressure category (PSH-PSA 2020), what is the systolic and diastolic values of normal BP?

According to the blood pressure category (PSH-PSA 2020), what is the systolic and diastolic values of borderline BP?

120-139/80-89 mmHg

According to the blood pressure category (PSH-PSA 2020), what is the systolic and diastolic values of hypertension BP?

or equal to 140/90 mmHg

What are the four principal mechanisms that regulate arterial pressure?

Intravascular volume, Autonomic Nervous System (ANS), Renin-Angiotensin-Aldosterone (RAA) System, and Vascular Mechanisms

True or False: During exercise, there is an increase in parasympathetic stimulation and a decrease in sympathetic stimulation.

FALSE

Which of the following increases during exercise to ensure the heart pumps faster?
A) Stroke Volume (SV)
B) Heart Rate (HR)
C) Cardiac Output (CO)
D) All of the above

D) All of the above

What two factors contribute to increased venous return during exercise?

Sympathetic stimulation and muscle pumping

True or False: In the periphery, Cardiac Output (CO) is redistributed to favor non-working areas during exercise.

FALSE

Which local metabolite is specifically mentioned as a cause for the dilation of blood vessels during exercise?

Lactic acid

What occurs in non-working areas of the body during exercise to help redistribute blood flow?
A) Local vasodilation
B) Sympathetic vasoconstriction
C) Parasympathetic activation
D) Increased regional blood flow

B) Sympathetic vasoconstriction

True or False: During normal exercise, there is a significant increase in Diastolic Blood Pressure (DBP).

FALSE

True or False: The mean BP is constant or slightly elevated during exercise.

TRUE

True or False: Systemic vascular resistance significantly decreases during exercise.

TRUE

What is the definition of a "hypertensive response to exercise" regarding blood pressure changes?

If SBP increases more than 20 mmHg or DBP increases more than 10 mmHg

By how much does oxygen consumption increase during exercise? A) x2 B) x5 C) x10 D) x20

D) x20

What is the primary determinant of arterial pressure over the long term?

Intravascular volume

True or False: Alterations in total extracellular fluid volume are associated with proportional changes in blood volume.

TRUE

Which substance is the primary determinant of extracellular fluid volume?

Sodium

Under intravascular volume, what is the most modifiable risk factor for hypertension? A) Age B) Sodium intake C) Genetic predisposition D) Baroreceptor sensitivity

B) Sodium intake

When NaCl intake exceeds the kidney's capacity to excrete it, what two things initially increase?

Vascular volume and cardiac output

The Autonomic Nervous System maintains cardiovascular homeostasis via which types of signals? A) Pressure B) Volume C) Chemoreceptor signals D) All of the above

D. All of the above

Name the three endogenous catecholamines that play important roles in cardiovascular regulation.

Norepinephrine, Epinephrine, and Dopamine

The three endogenous catecholamines play important roles in ____

Tonic and phasic cardiovascular regulation

True or False: Adrenergic reflexes modulate blood pressure over the long term

FALSE

Which of the following controls the minute-to-minute and second-to-second variations of blood pressure? A. Sodium levels B. Adrenergic reflexes C. Renal parenchyma D. Cardiac hypertrophy

B. Adrenergic reflexes

Adrenergic function contributes to long-term regulation of arterial pressure when working in concert with two other factors, which are?

Hormonal and volume-related factors

True or False: Norepinephrine and Dopamine are released directly into the circulation upon adrenal stimulation.

FALSE

Which of the three endogenous catecholamines is synthesized specifically in the adrenal medulla?

Epinephrine

What is the specific term for the nerves that supply the blood vessels?

Nervi vasorum

Where are Norepinephrine and Dopamine stored within the neuron before release?
A) Synaptic cleft
B) Vesicles
C) Adrenal medulla
D) Carotid sinus

B) Vesicles

Which catecholamine acts as a precursor to Norepinephrine?

Dopamine

By what process is Norepinephrine typically removed from the synaptic cleft back into the neuron?

Active reuptake process

True or False: The rate of firing of baroreceptors decreases as arterial pressure increases.

FALSE

Baroreceptors are stretch-sensitive sensory nerve endings located in which two primary anatomical sites?

The carotid sinuses and the aortic arch

What is the net effect of baroreceptor activation in response to high blood pressure?
A) Increased sympathetic outflow
B) Increased Heart Rate
C) Decreased sympathetic outflow resulting in decreased BP and HR
D) Increased peripheral resistance

C) Decreased sympathetic outflow resulting in decreased BP and HR

True or False: Baroreceptors are the primary mechanism for rapid buffering of acute BP fluctuations during postural changes, behavioral or psychologic stress, and changes in blood volume.

TRUE

What happens to baroreceptors during sustained increases in arterial pressure?

They decline, adapt, or "reset" to higher pressures

Which condition is associated with extremely labile blood pressures and difficult-to-control episodic BP spikes? A) Essential Hypertension B) Autonomic neuropathy and impaired baroreceptor reflex C) Hyperthyroidism D) Renal artery stenosis

B) Autonomic neuropathy and impaired baroreceptor reflex

True or False: Adrenergic reflexes are responsible for the long-term, month-to-month regulation of blood pressure.

FALSE

Baroreceptor reflexes modulate blood pressure on what time basis?
A) Daily
B) Hourly
C) Minute-to-minute
D) Year-to-year

C) Minute-to-minute

Which of the following is NOT an acute fluctuation that baroreceptors help buffer? A) Postural changes B) Behavioral or psychologic stress C) Changes in blood volume D) Chronic renal failure

D) Chronic renal failure

In which specific kidney cells is Renin synthesized?

Juxtaglomerular (JG) cells (located in the renal afferent arteriole)

True or False: Renin secretion is stimulated when there is an increase in NaCl transport in the thick ascending limb of the loop of Henle.

FALSE

Which of the following is NOT one of the three primary stimuli for renin secretion? A) Macula densa mechanism B) Baroreceptor mechanism C) Parasympathetic nervous system stimulation D) Sympathetic nervous system stimulation

C) Parasympathetic nervous system stimulation

What are the sensory cells located at the distal end of the loop of Henle that monitor sodium levels?

Macula densa

True or False: The afferent arteriole carries blood into the kidney from the systemic circulation.

TRUE

Sympathetic stimulation of renin-secreting cells occurs specifically through which type of receptors?

Beta-adrenoreceptors