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What is the driving force for blood in the circulatory system?
Arterial BP
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What is the most controlled variable in the circulatory system?
Arterial Blood Pressure
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What is the force exerted against wall during contraction?
Systolic BP
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What is the force exerted against wall during relaxation?
Diastolic BP
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What is the difference between the systolic and diastolic pressure?
- Pulse Pressure
- Normal: 30-40mmHg
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What is the determinate of oxygen or tissue perfusion?
Mean Arterial Pressure: Average bp in systemic circulation
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How do you determine the mean arterial pressure?
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What is the determinate of blood pressure?
Cardiac output x Peripheral Vascular Resistance
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What is cardiac output?
HR x SV
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What is PVR?
Reflects tone of resistance vessels and the viscosity of blood.
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What are the short-term reugulators of blood pressure?
- 1. Neural Mechanisms
- a. Intrinsic - for rapid and short-term reg
- b. Extrinsic - repsonse to pain, cold
- c. Higher neural centers- response due to mood
2. Hormonal Mechanisms - Many
**The barorecptro reflex**
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Epinephrine and Norepinephrine cause...
vasoconstriction
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Renin-Angiotension-Aldosterone cause....
- Vasoconstriction
- Increase Blood Volume
- Reabsorbs Na and water in kidneys
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Vasopressin (ADH) causes...
- reabsorption of Na and water by the kidneys
- (not excreted through urine)
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Natriuretic peptides regulate....
- Na excretion
- Diuresis (increased uo)
- Vasodilation (decreased bp)
- and antagonism of the R-A-A system (so it vasodilates & decreases blood volume)
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Adrenomedullin
- peptide
- -vasodilates
- -fluid and electrolyte balance
- - cardiorenal regulation
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What is the long-term regulation of blood pressure and how does it work?
- Renal-Body fluid system (Renin-angiotensin-aldosterone)
- - kidneys response to changes in arterial pressure
- - Increases salt and water excretion
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Hypertension
intermittent or sustained elevation of systolic &/OR diastolic BP
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How do you determine someone has hypertension?
140/90 on three seperate occasions.
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What type of HTN has an unknown cause?
Essential or primary
90% of cases
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What type of HTN has a known cause?
Secondary HTN
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What are some risk factors for developing HTN?
- Family Hx
- Age
- Gender: men<55, women > 75
- Black
- DM
- Smoking
- Obesity
- Alcoholic
- Stress
- Diet: high-Na, sat fat; Low-K, Ca, Mg
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What are the clinical manifestations of HTN?
- Usually asymptomatic.
- High: HR, BP, Bounding pulses
- Abnormal heart sounds
- Retinal changes in eye
- Nocturia
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What are some complications of HTN?
CAD, HF, angina, MI, CVD, PVD, Renal failure, retinopathy, left ventricular hypertrophy
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How do you treat primary HTN?
- Step 1: Implement lifestyle changes (non-pharm)
- Step 2: Start Antihypertensive medications
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How do you treat secondary HTN?
Treat the cause
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What are compelling indicators of HTN?
- Heart failure
- Post MI
- High CVD risk
- Diabetes
- CKD
- Recurrent stroke prevention
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What are some non-pharmacological methods of controlling HTN?
- Weight
- Diet- restrict Na & fats
- Exercise
- Quit Smoking
- Limit ETOH
- Reduce stress
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What is Malignant HTN and what can it lead to?
rapidly progressing diastolic (>140)
can lead to encephalopathy, organ dysfunction.
Considered an EMERGENCY - need IV agents
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