Hypertension
By the end of the week, students will be able to:
Normal Blood Pressure Regulation
- Describe the relationship of cardiac output/total peripheral resistance to blood pressure.
- Explain the role of abnormal pressure natriuresis and sodium sensitivity in the development of hypertension
- Review ECV control (afferent limb of volume sensing-atrial filling, baro-receptors, and afferent renal blood flow/pressure, etc.), renal mechanisms responsible for sodium balance (neuro-humoral, tubulo-glomerular feedback, myogenic response, and nephronal sites of regulation of sodium reabsorption). [Week 2]
Systemic and Cellular Mechanisms Involved in the Pathogenesis of Hypertension
- Describe the role of Renin-Angiotensin System-dysregulation with renal blood flow, sodium balance, and experimental Goldblatt hypertension. Explain why most subjects with hypertension have no demonstrable abnormality of the Renin-Angiotensin-Aldosterone axis.
- Explain the role of increased peripheral vascular resistance in the maintenance phase of hypertension including:
a. The Endothelium: Nitric Oxide/Endothelin and other Vasoactive substances
b. Vascular Smooth Muscle: Sympathetic Nervous System, Human Ouabain-like Hormone, Intracellular Ca+2 and Membrane Transport Abnormalities (Na+: Ca+2 and Na+/H+ Exchange)
- Defend the difference between normal blood pressure regulation and hypertension
Genetics of Hypertension
- Describe familiar inheritance patterns(Polygenetic)
- Evaluate experimental models (Genetic Knock-outs and Transgenics) and clinical associations (Polymorphisms-ACE and Angiotensin Receptors) of hypertension
- Assess hypertension in the Metabolic Syndrome of Obesity and Insulin Resistance
Differentiate secondary forms of hypertension and understand mechanisms including:
- Priimary Excess Mineralocorticoids (Aldosterone)
- Primary Renal Sodium Retention-Na+ Channel (ENaC)-Liddle’s Syndrome
- Renal Vascular Hypertension
- Renal Insufficiency
- Increased Catecholamines (Endogenous and Exogenous)
Compare the mechanisms of action, clinical uses, side-effects and pharmacokinetics of the following classes of antihypertensive agents:
- Ace Inhibitors and Angiotensin Receptor Blockers
- Alpha- and Beta-Adrenergic Receptor Blockers
- Diuretics
- Ca+2 Channel Blockers
- Centrally-acting Alpha-2 Agonists
- Direct Vasodilators
Analyze the clinical evaluation of an individual with hypertension that is cost effective (history, physical examination, and laboratory/imaging studies)
Review the updated Hypertension Guidelines
Assess the natural history of untreated and treated hypertension.
Defend the role of lifestyle modifications (weight, exercise, diet, alcohol intake, and smoking) in reducing adverse outcomes in hypertension
