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Hypertension 1

Hypertension
pathophysiology

Question

Vignette:

A 45-year-old man presents to the emergency department with complaints of severe, sharp chest pain radiating to his back. He has a history of poorly controlled hypertension. His blood pressure is 210/120 mmHg, pulse rate is 110 bpm, and respiratory rate is 20 breaths per minute. An ECG shows no changes indicative of acute myocardial ischemia. A CT scan of the chest reveals aortic dissection. The patient is immediately started on intravenous medications to lower his blood pressure.

Which of the following substances is most likely increased in this patient's bloodstream and contributing to his vascular pathology?

Choices

A. Nitric Oxide

B. Angiotensin II

C. Prostaglandin I2

D. Thromboxane A2

E. Endothelin-1

Answer

B. Angiotensin II

Explanation

Angiotensin II is a potent vasoconstrictor and plays a key role in the pathophysiology of hypertension. It stimulates the release of aldosterone from the adrenal cortex, leading to sodium and water retention, thereby increasing blood volume and pressure. In addition, it directly constricts arterial smooth muscle, contributing to an increase in systemic vascular resistance. Chronic exposure to high levels of angiotensin II can lead to vascular remodeling, including hypertrophy and hyperplasia of the vascular smooth muscle, and increased vascular stiffness. These changes can weaken the vascular wall and make it more susceptible to damage, such as that seen in aortic dissection. Therefore, in a patient with poorly controlled hypertension, such as this one, it is likely that there are increased levels of angiotensin II in the bloodstream, contributing to the underlying vascular pathology.

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