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Definition. Classification. Diagnosis. Major Risk Factors. complicatio
ns of hypertension. hypertensive emergency. Treatment of hypertension. Tip
s for hypertension.
Chronic and sustained elevation of systolic blood pressure, diastolic or both in
the arteries above normal.
MAN AGE 16 -18 19 -24 25 -29 30 -39 40 -49 50 -59 60 ...
NORMAL SYSTOLIC 105-135 105-140 108-140 110-145 110-155 115-165 115-170 HIGH 145
150 150 160 170 175 190
NORMAL DIASTOLIC 60 -86 62 -88 65 -90 68 -92 70 -96 70 98 70 -100 WOMEN AGE 16 -
18 19 -24 25 -29 30 -39 40 -49 50 -59 60 90 95 ... HIGH 96,100,104 NORMAL SYSTOL
IC 106 110 105-135 105-140 108-140 110-145 110-155 115-165 115-170 HIGH 145 150
150 160 170 175 190
Normale s High s values of blood pressure.
NORMAL DIASTOLIC 60 -86 62 -88 65 -90 68 -92 70 -96 70 98 70 -100 90 95 96 ALTA
100 104 106 110
Hypertension can be classified in three ways:
A) For the reading level of the PA. B) Because of the importance of organ damage
. C) On the etiology. D) for their stability over time (stable, labile)
Classification of hypertension by the level of blood pressure reading.
<85 85-89
PA PA high normal normal slight hypertension (stage I) moderate hypertension (st
age II) severe hypertension (stage III)
P r e s i o n a r t e r i a l
90-99 100-109 ³ 110
<130 130-139
PA PA high normal normal slight hypertension (stage I) moderate hypertension (st
age II) severe hypertension (stage III)
160-179 140-159 ³ 180
Classification of hypertension by the importance of organ damage
Phase I. There are signs of organic disorder objectives.
• Left ventricular hypertrophy (LVH) • Focal and generalized narrowing of retina
l arteries. • Proteinuria and slight increase in creatinine concentration in pla
sma or one of them.
Phase II. Appear at least one of
the following signs of organic disease
Stage III. Symptoms and signs of
injury of some organs due to hypertension
• Heart: left ventricular failure (LVF). • Brain: cerebral hemorrhage, cerebella
r or brain stem: hypertensive encephalopathy. • Fundus: retineanos hemorrhage an
d exudates with or without papillary edema.
Classification According to Etiology
It is said that approximately 90 to 95% of all people with hypertension have pri
mary hypertension. This term simply means that no clear organic cause is unknown
. The pathogenesis is still unknown but several studies indicate that genetic an
d environmental factors play an important role in the development of primary HT.
The primary hypertension, idiopathic or essential
s hypertension of known cause, is approximately between 5 and 10%. It is importa
nt to diagnose because some asos can be cured with surgery or specific medical t
reatment. ou can be by: - For cargo volume with increase in extracellular fluid
ECF. - For vasoconstriction is an increase in TPR. - For combination of volume o
verload and vasoconstriction. Ausàs: renal, endocrine, neurological, pregnancy,
drug. Hypertension in primary care is the most common cause of drug intake SECON
DARY, especially hormonal contraceptives.
Set whether or not sustained hypertension over time. To establish whether the pa
tient will benefit from treatment. To detect the coexistence of other diseases.
To identify the presence or absence of organic disease. To detect the coexistenc
e of other vascular risk factors. Rule out any treatable causes of hypertension.
personal and family history of cardiovascular disease Lifestyle: snuff, alco
hol, diet, physical activity, occupation, drug interference
2. Physical examination
Weight and height correct T.A. Determination heart rate and Fundus Examination o
f neck pulse, heart murmurs, thyroid ...
A) Unmodified
B) Change
A) Unmodified FACTORS
People over 65 have increased risk of systolic hypertension. The age of risk is
reduced when two or more associated risk factors.
Men are more prone to cancer than women until they reach the age of menopause,€f
rom which the frequency in both sexes are equal. This is because nature has give
n to women while you are of childbearing age with a protective hormones are estr
ogens and thus has less risk of cardiovascular disease. However, in younger wome
n there is a particular risk when taking birth control pills.
Hypertension occurs more frequently and aggressively in blacks.
The presence of cardiovascular disease in a family to 2nd degree of consanguinit
y before the sixth decade of life, definitely influence the presence of cardiova
scular disease
B) modifiable factors
• SMOKING Other • ALCOHOL • sedentary • NUTRITION
• Obesity • Dyslipidemia • DIABETES MELLITUS
BEHAVIOURAL modifiable factors
The snuff is responsible for the annual death of about 3,000,000 people in the w
orld. The snuff is responsible for 25% of chronic disease. Smokers are twice as
likely to develop hypertension.
Drinking a glass of alcohol increases by 1 mmHg systolic and 0.5 mmHg diastolic.
It has been shown that daily alcohol consumption in level of 6.6 mmHg SBP and D
BP of 4.7 mmHg higher than those who do it once a week, regardless of the total
weekly consumption.
A sedentary lifestyle increases in muscle mass (overweight), increased cholester
ol. Sedentary A sedentary person has a higher risk (20-50%) of developing hypert
ension, high consumption of sodium in salt and low potassium intake are associat
ed with hypertension. The consumption of fats, especially saturated animal is a
risk factor for hypercholesterolemia because of the power increases atherogenic
LDL cholesterol levels.
ENVIRONMENTAL NOISE. STRESS. ALTITUDE. Geographical location. The hardness of dr
inking water. ETC.
• complications
Arteriosclerosis: in
response to rising TA blood vessels thicken and lose flexibility, the latter bei
ng more vulnerable to the setting of excess fats that circulate in the blood.
Coronary intensive care:
HBP because the heart is forced to work more effectively to maintain blood flow
in tissues, which result in heart failure intensive.
Renal disease: a rise
above normal levels of TA leads to worse performance in I kidneys, to the point
where it can lead to kidney failure.
Stroke: When
atherosclerosis affects blood vessels of the brain stroke are due to a ruptured
vessel (hemorrhagic stroke) or a blockage of blood or a clot (cerebral thrombosi
• Emergency
We have to differentiate the following terms: urgent, accepting arbitrary figure
s DBP> 120 mm Hg.
a hypertensive crisis is any rise in tension leading to an acute medical consu
ltation HYPERTENSIVE EMERGENCY situation in which the blood pressure elevation
is accompanied
a concomitant condition of target organs and requires immediate treatment to avo
id the possibility of death or irreversible consequences. In this situation, the
application of appropriate behavior patterns immediately can mean the salvation
of the individual or prevent irreversible injury that may result.
hypertensive emergency: situation in which the blood pressure elevation is acc
ompanied by NO
of disorders that involve a commitment to immediate and vital, therefore, can be
corrected in 24-48 hours with an oral agent.
HYPERTENSIVE EMERGENCY FALSE: are elevations tension that do not damage the
target organs and are reactive to situations of anxiety, pain syndromes or proce
sses of any other nature. Elevated blood pressure is corrected to stop the trigg
ering stimulus and requires no antihypertensive therapy specific.
Hypertensive emergency
• Hypertensive crisis idiopathic. • Hypertensive crisis by renal or renovascular
disease. • Hypertensive crisis secondary to endocrine pathology. • Hypertensive
crisis linked to drugs. • Hypertensive crisis secondary to toxic substances: co
caine, amphetamines, angel dust. • Hypertensive crisis during pregnancy. • Hyper
tensive crisis in special situations. - Refractory hypertension. - Surgery. - Ne
urological pathology. - Severe burns.
Pheochromocytoma. Catecholamine-producing tumor, typically, is a cause of hypert
ension. pressure values> 250/140. The symptoms (headache, heat intolerance, trem
or, paleness, weakness, fatigue, nausea,€chest or abdominal pain and weight loss
) appear as paroxysmal, and in the intervals between attacks patients are normot
ensive and asymptomatic, or even hypotensive. The diagnosis established from the
history, physical examination and determination of catecholamines and metabolit
es in plasma and urine. While the treatment is surgical and has curative intent,
some care is necessary before and after surgery. Thus, medical treatment is per
formed with Phentolamine (alpha-blocker)
Among these Syndromes hyperadrenergic different situations include: - SD. Alcoho
l withdrawal. - Overdose of amphetamines. - Abuse of diet pills. - SD. Tyramine
and MAOIs. - Effect of clonidine withdrawal rebound. - Intake of cocaine or synt
hetic drugs. - Crisis of panic. In general, hypertension accompanying these synd
romes is of short duration, reaching a peak very quickly, then returned to norma
l. The drugs of choice in these situations are the alpha-blockers and beta-block
Hypertensive emergency
• Confirm that this is a true hypertensive crisis. • Discriminate properly betwe
en urgency and hypertensive emergency.
• Initiate the study of its etiology.
To do all this we will build on:
• Anamnesis: known in the hypertensive patient is important to specify the origi
n of hypertension, duration and impact on target organ, presence of concomitant
diseases and previous treatment characteristics. If the patient is not known hyp
ertensive will have more relevance the clinical characteristics and evolution of
the crisis. • Physical examination: First, keep the patient at rest in a quiet
place without noise for at least 30 minutes, then a new measurement of the PA, b
ecause sometimes, to discriminate between urgency and emergency. There shall be
full general examination aimed at assessing the potential impact of target organ
s (SN, circulatory system, retinal vessels). BE SURE TO REVIEW THE PRACTICE fund
us figures for patients with PAD> 120 mmHg, as funduscopic abnormalities may imp
ose specific therapeutic approaches. • TESTING: In principle it would be necessa
ry to do anything. However, according to the suspected etiology, pathology or co
ndition accompanying target organ may be necessary to practice: blood count, cre
atinine and serum electrolytes, urine analysis, ECG and chest X-ray ..
Every patient with a hypertensive emergency may be treated in outpatient half. S
ent to hospital only those cases that do not respond to treatment or requiring a
ny additional test that can not be done outside the hospital. The decrease of bl
ood pressure should be obtained gradually, between 12-48 hours, as a sudden decr
ease or obtaining very low levels of PA could lead to decreases in cerebral or c
oronary flow, thereby affecting disease in these territories . On 1 goal should
be to reduce 20-25% of initial value of the PA, not descending to SBP <160 mmHg
or DBP <100 mm Hg. The subsequent decline is slow and monitored to prevent ische
mic events in target organs. Most hypertensive emergencies are handled with a si
ngle drug
No drug:
- Weight reduction - reducing the consumption of alcohol, reducing salt intake,
physical exercise (before recommending it to an EKG).
- Diuretic + b-adrenergic blocker - K-sparing diuretics + ACE - ACE + channel bl
ockers, Ca - adrenergic blocker + Ca channels - Diuretic + a-1-adrenergic - rece
ptor antagonist of angiotensin II + diuretic
1.Consejos for
Community Nursing. Masson The médico.net Enferurg.com Monografias.com