ANE 606 Hypertension Exam 2025

What is the formula to calculate blood pressure (BP)? - Correct Ans-BP = CO X SVR *NOTE that this would give you the MAP If you are given a CO of 4 and an SVR of 20 (Woods units), what is the approximate MAP? - Correct Ans-BP (MAP) = CO x SVR, so 4 x 20 = 80 What is the formula to calculate CO? - Correct Ans-CO= HR x SV (stroke volume) Where in the body does CO and SVR regulation occur? - Correct Ans-Arterioles, venules (capacitance vessels), heart, and kidneys A patient is seen in the clinic. In reviewing his last three BPs from his last three visits, you note that his systolic BP is at 121, 128, and 123, but his diastolic is always less than 80 mmHg. According to latest guidelines, what "BP Category" would you place him in? - Correct Ans-Elevated. SBP 120-129, but DBP always 80. To be classified as having Stage I HTN according to latest guidelines, what criteria must be met? - Correct Ans-SBP 130-139 mmHg AND DBP 80-89 mmHg What is the leading risk factor for death and disability? - Correct Ans-Systemic HTN. 50% die from IHD or CHF and 33% from stroke A patient is seen for her annual physical. Her BP last year was WNL (118/72), but this year it is mildly elevatd at 124/78. She admits she does get nervous at the doctor. What category would you place her in for HTN? - Correct Ans-Likely "White Coat Syndrome". Would still consider this "normal" despite the recommendations. When providing anesthesia to a patient with untreated HTN, what are you likely to see and how is it best treated? - Correct Ans-These patients often have very labile BP. Factors that affect vasomotor tone or preload result in greatly exaggerated effects in these patients. Treat with a bolus of IVF and reassess. The cause of most HTN (95%) is what? - Correct Ans-Unknown and referred to as "essential" HTN. How prevalent is secondary HTN? - Correct Ans-5% of cases What are some causes of secondary HTN and which is most common? - Correct Ans-Renal artery stenosis is the most common cause. Other causes include primary aldosteronism, pheochromocytoma, and other endocrine disorders. Which of the following may occur concomitantly with systemic HTN (Select all that apply): A) insulin resistance B) dyslipidemia C) GERD D) Sleep Disorders - Correct Ans-A, B, and D What are the hallmark signs of poorly controlled HTN? - Correct Ans-Bradycardia and hypovolemia. What are the three general (suspected) causes of primary HTN? - Correct Ans-Dysfunction of the ANS, RAAS, and/or endogenous vasodilator/constrictor balances. What dysfunctions within the ANS may cause primary HTN? - Correct Ans-Dysregulation of baroflex and chemoflex pathways. Baroreceptors SHOULD respond and reduce SNS activity, but if they are damaged, HTN could result. How do oxidative stress and inflammation lead to primary HTN? - Correct Ans-These can lead to stimulation of SNS output and vasopressin release all leading to vasoconstriction. They also cause endothelial dysfunction leading to changes in vasomotor tone regulation, vascular reactivity, coagulation, and fibrinolation pathways. How could a dysfunction in the renin-concerned portion of the RAAS cause primary HTN? - Correct Ans-If there is a dysfunction in the regulation of renin release, excess could be released leading to increased release of angiotensin II and aldosterone. Further, a genetic component may possibly be indicated in the decreased breakdwon of aldosterone. In addition to excessive renin release, what other dysfunctions of the RAAS could cause primary HTN? - Correct Ans-If a non-ACE enzyme cleaves AI to AII, then ACE inhbitors are rendered useless. Also, certain protein defects could inhibit the breakdown of ENaCs. These are channels through which Na+ and H2O are reabsorbed, so if there are now more of them, more Na+ and H20 will be reabsorbed. When assessing for risk factors that may predispose a patient to HTN, what are you looking for? - Correct Ans-BP levels, Hypercholesterolemia, DM, Tobacco use, stress, obesity, sedentary lifestyle, family history, age 60, and gender (varies with age) Given all other factors being equal, who is at more risk for developing HTN before the age of 45: males or females? - Correct Ans-HTN is more prevalent amongst males when age is 45. Before the age of 40, _____ are more of a risk for HTN, but between 40 and 64 what happens to this disparity? - Correct Ans-Before the age of 40, males are more likely to have HTN, but between 40 and 64, there is no gender disparity. After the age of 64, who is more likely to experience HTN: males or females? - Correct Ans-Women after the age of 64. Regardless of causation, chronic HTN will lead to what detrimental changes in the body? - Correct Ans-Remodeling of small and large arteries, endothelial dysfunction, and possibly permanent end-organ damage. What is the underlying event that causes most vascular disorders including stroke, MIs retinopathy, etc...? What can cause this event? - Correct Ans-Arterial damage (injury to vessel walls). Can be caused by things such as physical trauma (HTN), infection, inflammation, immune injury, or exposure to oxidized liquids or cigarette smoke. Intima thickening can occur as a result of arterial damage. What is this called and why is it bad? - Correct Ans-This is called arteriosclerosis. It occurs as the vascular smooth muscle (VSMC) moves from the media layer to the intima. The problem is that when it makes this move, its contractile properties no longer work, so it leads to a narrowing and stiffening of the vessel. What are some non-modifiable (constituitive) risk factors for atherosclerosis? - Correct Ans-Genetics, family hx, increaseing age, and gender (male) What are some modifiable risk factors for atherosclerosis? - Correct Ans-Smoking, obesity, diabetes, HTN hyperlipidemia, inflammation What does it mean that if HTN is