32 Hypertension
- pressure changes throughout day
- drink alcohol: resistant htn
- HTN screening important because association with number of diseases
Complications
- rupture of atherosclerosis leads to MI
- glassy appearing
- leakage of protein materials out of arterial wall
- much less common
- malignant: BP rises rapidly and a lot in short amt of time
- bp so high, basement membrane replicating
- symptoms can occur (usually asymptomatic)
- lower density of arterioles
- increased afterload, increased work of heart
- left: nl voltage. Right: higher
- diastolic HF, S4
- LV concentric hypertrophy:
- lumen same size, wall much thicker
- systolic/diastolic rises
- pulse pressure also rises
- when C compliance falls, delta P, change in pressure goes up
- left: compliant vessel, blood flow in and stretch vessel, pressure does not increase that much
- right: vessel can't stretch, pressure increase much higher
Urgency
- confusion
- afterload so high, no blood to heart
- microangiopathic hemolytic anemia
- rapidly progressive and fatal in 1-2 years
- now definition: severe HTN difficult to control
Secondary HTN
- secondary HTN either raise CO or raise TPR
- cannot excrete Na normally
- sympathetic ramped up from repeated episodes of apnea
- diltiazem drug of choice to treat HTN caused by these 2 drugs
- no sign of volume overload
- low plasma renin, high aldosterone. Important
- catecholamines released in episodes
- normal kidney compensates for volume retention
- pressure natriuresis: autoregulation. One kidney releasing more renin/Na causing the other to release less
- increased RAAS/BP: normal kidney can't compensate
- in setting of renal artery stenosis, pts depend on Ang II's efferent vasoconstriction to maintain GFR
- association and can develop renal artery stenosis
- healthy women in 40s develop HTN resistant to therapy and has bruit over renal artery
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