Vascular system & hypertension (small vessels)

21 important questions on Vascular system & hypertension (small vessels)

What is the function of the large arteries, smaller arteries and arterioles?

Distribution of blood and giving resistence.

What part of the vascular system has the heighest blood volume, and why?

- The veins,
- to have a reserve in case of bleeding (so your blood pressure does not drop that much immediately)

What is remarkable about the blood pressure of a giraffe, and why is this the case?

- The giraffe has a super high systolic blood pressure (280 mmHg)
- because above the heart (also in humans) the blood pressure is lower (because of gravity), and this effect is really severe in the giraffe.
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What happens with the blood pressure in space?

There is no gravity to pull fluids down, but their are muscles to help fluids to move up, so fluids pool neear the chest and the heart.

What blood pressure values are called hypertension?

- Higher than 140 mmHg systolic, or
- higher than 90 mm Hg diastolic pressure.

For what diseases is hypertension a risk factor?

All kinds of cardiovascular diseases, including
- myocardial infarction,
- stroke.
Also
- kidney diseases,
- cognitive decline in aging.

Which organs determine blood pressure?

- Brain (via nerves),
- blood vessels (via resistance),
- kidneys (determine blood volume),
- heart.

What is meant by vascular resistance?

- The resistance that must be overcome to push blood through the circulatory system and create flow.
- R = n * L / r^4
n = blood viscosity
L = vessel length
r = vessel radius
so narrowing of vaculature is a VERY important factor for resistance: relevant for hypertensive patients

Why is resistance not dominated by the capillaries, since these have the smallest diameter?

Because of the many parallel pathways of capillaries (so together their diameter is really large.

How does hypertension relate to the dynamics of vascular diameter?

A dysbalance in vasoconstriction and -dilation.

What does hypertension cause to the blood vessels?

-Damage to endothelial cells (one of the first to 'suffer' from hypertension): the balance between constricting and dilating factors is shifted
- which results in less dilatory factors and more constricting factors.
- This causes vessels to constrict,
- which causes the resistance to become larger, and this increases the blood pressure even more (= vicious cycle)
The restriction of blood vessels instead of dilation is counter-intuitive and it also makes the situation worse.

How are these changes to endothelial function called, and what can these changes cause in the long run?

- Functional changes.
- Functional changes can cause remodeling in the long run, which means that vessel restriction is structural and more permanent.

What has been changed in remodelled vessels, and what can this cause on the longer term?

- The media is thicker (higher media/lumen (M/L) ratio),
- which is associated with higher risk on events like strokes.

What are five possible ways of treating hypertension?

- Inhibiting renin-angiotensin system (causes vasodilation)
- Calcium channel blockers (causes vasodilation)
- Diuretics (reduction in volume)
- Beta-blockers (reduce cardiac output)
- Lower salt intake (reduction in volume)

How can blood pressure be measured in rats?

  • Tail cuff method
  • Pressure transducer (by catheterization)
  • Telemetric (implanted sensor)

What has been found in the heart rate of spontaneously hypertensive rats (SHRs)

- In hypertensive rats, also the heart rate is higher,
- which causes a higher blood pressure because higher heart rate means a higher cardiac output (important factor for blood pressure)

What has been found in the pulsations of the carotid arteries?

In hypertensive rats the carotid arteries are more stiff (pulsatility is lower).

What differences have been found between hypertensive rats that get hypertensive drugs (beta-blocker, vasodilator) and other hypertensive rats?

- The contractile force of the smooth muscle cells of the hypertensive rats without drugs is lower,
- and also the relaxation of the endothelial cells is lower when stimulated (= endothelial function is lower)
- The diameter of the vessels is also lower in hypertensive rats without drugs.

As seen before, the pulsatility is reduced in hypertensive rats. What does this cause?

- The ability of the vessels to dampen the blood pressure differences from the heart has gone down,
- meaning that the smaller vessels are exposed to higher fluctuations in blood pressure.

What is the function of the glymphatic system? (Relation to hypertension ??? → not written down in powerpoint → ask other people)

A fluid-clearance pathway in the brain that is primarily active during sleep.

In conclusion, what three effects does hypertension have on blood vessels (especially in the brain)?

- Artery stiffening → increased resistance
- Endothelial dysfunction: poor blood flow regulation
- Reduced pulsatility → less dampening of the pressure fluctuations

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