BIO 326 Assignment 10.1: Disorders of Blood Pressure Regulation Case Study

BIO 326 Assignment 10.1: Disorders of Blood Pressure Regulation Case Study

BIO 326 Assignment 10.1: Disorders of Blood Pressure Regulation Case Study

BIO 326 Assignment 10.1: Disorders of Blood Pressure Regulation Case Study

1. Speculate how Leon’s ethnicity contributes to his hypertension. What other determinants of health contribute to the prevalence of hypertensive disease in this population?

Leon is an African American, which is a documented risk factor for hypertension. High blood pressure is more prevalent in African Americans compared to any other racial/ethnic group in the US. Besides, African Americans have the highest prevalence of hypertension-related cardiovascular disease (CVD) and end-stage renal disease (ESRD) in the US. The lifestyle and environmental exposures among African Americans contribute to the increased risk for hypertension (Muntner et al., 2018). For instance, African Americans engage in minimal physical activity compared to non-Hispanic whites, increasing hypertension risk.

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Furthermore, African Americans are disproportionately exposed to chronic stressors that increase the risk for HTN, like discrimination, low socioeconomic status, and relationship stress contributing to health disparities (Muntner et al., 2018). The low socioeconomic status limits many African Americans from accessing high-quality fresh food. This leads to high consumption of high-fat and high-sodium food that promotes obesity and elevated blood pressure.

2. What is the significance of an elevated systolic pressure, even in the absence of diastolic hypertension?

Isolated systolic hypertension (ISH) is a systolic BP (SBP) at or greater than 140 with a diastolic BP (DBP) below 90. It is a major health threat, particularly for older adults. ISH is attributed to the stiffening of the large artery due to structural changes within the vasculature (Koracevic et al., 2020). ISH is significant because it is linked to increased cardiovascular risk and peripheral vascular disease. In addition, a sustained elevated SBP is linked with an increased risk of heart disease, stroke, acute coronary events, and chronic kidney disease.

What is the mechanism of action of the two classes of drugs Leon was prescribed for the management of his hypertension?

Leon was prescribed a diuretic and ACE inhibitor to manage hypertension. There are three types of diuretics, namely Thiazide diuretics, Loop diuretics, and Potassium-sparing diuretics. Thiazide diuretics inhibit the reabsorption of water, sodium, and chloride in the distal tubules while allowing the excretion of potassium, magnesium, and bicarbonate (Wright et al., 2018). Loop diuretics inhibit the reabsorption of water, sodium, and chloride in the ascending loop of Henle and allow potassium excretion. Potassium-sparing diuretics inhibit the reabsorption of sodium ions, act on the distal renal tubule, and promote potassium absorption, thus retaining potassium in the body (Wright et al., 2018). ACE inhibitors act by blocking angiotensin-converting enzyme (ACE) activity. ACE converts angiotensin I to angiotensin II, a potent vasoconstrictor (Aronow, 2018). This reduces the retention of sodium and water and decreases peripheral vascular resistance, which contributes to a reduced blood pressure.

References

Aronow, W. S. (2018). Antihypertensive drug therapy. Annals of translational medicine, 6(7), 123. https://doi.org/10.21037/atm.2018.01.26

Koracevic, G., Stojanovic, M., Kostic, T., Lovic, D., Tomasevic, M., & Jankovic-Tomasevic, R. (2020). Unsolved Problem: (Isolated) Systolic Hypertension with Diastolic Blood Pressure below the Safety Margin. Medical principles and practice : international journal of the Kuwait University, Health Science Centre, 29(4), 301–309. https://doi.org/10.1159/000508462

Muntner, P., Abdalla, M., Correa, A., Griswold, M., Hall, J. E., Jones, D. W., … & Appel, L. J. (2018). Hypertension in blacks: unanswered questions and future directions for the JHS (Jackson Heart Study). Hypertension, 69(5), 761-769. https://doi.org/10.1161/HYPERTENSIONAHA.117.09061

Wright, J. M., Musini, V. M., & Gill, R. (2018). First-line drugs for hypertension. The Cochrane database of systematic reviews, 4(4), CD001841. https://doi.org/10.1002/14651858.CD001841.pub3

Value: 20 points

Introduction

Complete the Leon Case Study

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Week 10: Cardiovascular DysfunctionWelcome to Week 10.

This week’s material covers cardiovascular disorders. The material in Chapters 26 and 28 cover disorders of blood flow in the systemic circulation and disorders of cardiac conduction and rhythm, respectively. Chapter 27 covers two additional sets of material on disorders of disorders of cardiac function, and heart failure and circulatory shock. You should pay attention to the development of specific cardiac dysfunction in each set of material, as well as the resultant effects on the body of such disorders. Hypertension, coronary artery disease, MI, cardiomyopathies, arrhythmias, and the effects of valvular dysfunction on cardiac function are covered in detail.

Lesson 1: Disorders of Blood Pressure Regulation

Lesson 1: Disorders of Blood Pressure Regulation

The material in the Disorders of Blood Pressure Regulation presentation is primarily about hypertension, in light of the cardiovascular consequences of this disease (although additional content is presented).

Learning Outcomes

At the end of this lesson, you will be able to:

Hypertension

Define hypertension and relate it to normal physiology
Delineate the four stages of hypertension development by describing the systolic and diastolic pressures in each stage

Define the term “volume-loading hypertension” that is caused by renal impairment

Describe how primary aldosteronism can also lead to a volume loading hypertension

Understand how secondary hypertension is caused by a number of pathophysiological conditions. Understand in each case how the condition results in volume-loading hypertension and vasoconstriction

Describe the primary causative factors for primary hypertension and how lifestyle affects the development of hypertension

Hypotension
Describe the causative factors that lead to blood pressure decreases in orthostatic hypotension

Before attempting to complete your learning activities for this week, review the following learning materials:

Learning Materials

Read the following in your Porth’s Pathophysiology: Concepts of Altered Health States textbook:

Chapter 26, “Disorders of Blood Flow and Blood Pressure Regulation”

Leon Case Study

Leon is an African American 55-year-old male. He is a non-smoker, is a nondrinker, and has a healthy weight for his height. On weekends, he coaches a youth baseball team in his community and loves to eat hot dogs and nachos with the children after they play. Leon attends a community health clinic to have a routine urinalysis and blood pressure monitoring. At his last visit, his blood pressure was 168/92 mm Hg. Although Leon was pleased that the lower number had dropped from 96 to 92, his physician was still concerned. He warned Leon about the dietary choices he was making and reminded him to limit his salt intake. He also renewed Leon’s prescription for diuretics and added an ACE inhibitor to Leon’s treatment regime.

Student Name:
Speculate how Leon’s ethnicity contributes to his hypertension. What other determinants of health contribute to the prevalence of hypertensive disease in this population?
What is the significance of an elevated systolic pressure, even in the absence of diastolic hypertension?What is the mechanism of action of the two classes of drugs Leon was prescribed for the management of his hypertension?