HYPERTENSION

INTRODUCTION

Hypertension, or high blood pressure (BP), is an important medical and public health problem.
There is a direct relationship between hypertension and cardiovascular disease (CVD).As BP
increases, so does the risk of myocardial infarction (MI), heart failure, stroke, and renal disease

DEFINITION

Hypertension is defined as a persistent systolic BP (SBP) of 140 mm Hg or more, diastolic BP

(DBP) of 90 mm Hg or more, or current use of antihypertensive medication .
-Lewis

Hypertension is a systolic blood pressure greater than 140 mmHg and a diastolic pressure
greater than 90 mm Hg, based on the average of two or more blood pressure measurements
taken in two or more contacts with the healthcare provider after an initial screening.
-Brunner

CLASSIFICATION OF BLOOD PRESSURE FOR ADULTS

Classification of Blood
Pressure SBP mmHg DBP mmHg
Normal <120 and <80

Prehypertension 120–139 or 80–89

Stage 1 140–159 or 90–99

Hypertension

Stage 2 ≥160 or ≥100

Hypertension

TYPES OF HYPERTENSION

Two types of hypertension exist:

 Primary (essential or idiopathic )
 Secondary
 Primary :elevated blood pressure of unknown cause
 Secondary: elevated blood pressure of known cause, such as renovascular disease,
pregnancy and coarctation of the aorta.
RISK FACTORS OF HYPERTENSION
Age
• SBP rises progressively with increasing age.
• After age 50, SBP >140 mm Hg is a more important cardiovascular risk factor than DBP.
Alcohol
• Excessive alcohol intake is strongly associated with hypertension.
Tobacco use
• Smoking tobacco greatly ↑ risk of cardiovascular disease.
• People with hypertension who smoke tobacco are at even greater risk for cardiovascular
disease.
Diabetes mellitus
• Hypertension is more common in patients with diabetes.
• When hypertension and diabetes coexist, complications (e.g., target organ disease) are more
severe.
Elevated serum lipids
• ↑ Levels of cholesterol and triglycerides are primary risk factors in atherosclerosis.
• Hyperlipidemia is more common in people with hypertension.
Excess dietary sodium
• High sodium intake can
• Contribute to hypertension in some patients
• Decrease the effectiveness of certain antihypertensive medications
Gender
• Hypertension is more prevalent in men in young adulthood and early middle age (<55 yr of
age).
• After age 64, hypertension is more prevalent in women.
Family history
• History of a close blood relative (e.g., parents, sibling) with hypertension is associated with
an↑ risk for developing hypertension.
Obesity
• Weight gain is associated with increased
CAUSES
 Cirrhosis
 Coarctation or congenital narrowing of the aorta
 Drug-related: estrogen replacement therapy, oral contraceptives, corticosteroids,
nonsteroidal antiinflammatory drugs (e.g.,
 cyclooxygenase-2 inhibitors), sympathetic stimulants (e.g., cocaine, monoamine
oxidase)
 Endocrine disorders (e.g., pheochromocytoma, Cushing syndrome, thyroid disease)
 Neurologic disorders (e.g., brain tumors, quadriplegia, traumatic brain injury)
 Pregnancy-induced hypertension
 Renal disease (e.g., renal artery stenosis, glomerulonephritis)
 Sleep apnea
FACTORS INFLUENCING BLOOD PRESSURE (BP)

CLINICAL MANIFESTATIONS
Hypertension is often called the “silent killer” because it is frequently asymptomatic until it
becomes severe and target organ disease occurs.
A patient with severe hypertension may experience a variety of symptoms secondary to the
effects on blood vessels in the various organs and tissues or to the increased workload of the
heart.
These secondary symptoms include
 fatigue,
 dizziness,
 palpitations,
 angina and
 dyspnea.
Patients with hypertensive crisis may experience severe headaches, dyspnea, anxiety, and
nosebleeds.
DIAGNOSTIC STUDIES
 History and physical examination, including an ophthalmic examination
 Routine urinalysis
 Basic metabolic panel (serum glucose, sodium, potassium, chloride, carbon dioxide,
BUN, and creatinine)
 Complete blood count
 Serum lipid profile (total lipids, triglycerides, HDL and LDL cholesterol, total-to-HDL
cholesterol ratio)
 Serum uric acid
 12-lead electrocardiogram (ECG)
 Optional:
• 24-hr urinary creatinine clearance
• Echocardiography
• Liver function studies
• Serum thyroid-stimulating hormone (TSH)
COMPLICATIONS
 The most common complications of hypertension are target organ diseases occurring in
the heart, brain, peripheral vessels, kidneys and eyes.
 hypertensive heart disease Left ventricular hypertrophy, Myocardial infarction, Heart failure
 brain (cerebrovascular disease),
 peripheral vessels (peripheral vascular disease),
 kidneys (nephrosclerosis), and
 eyes (retinal damage)

MANAGEMENT
Non-pharmacologic interventions are tried first, then medications are prescribed.
There is a four-step treatment plan:
Step 1:
• Lifestyle changes
• Reduce caloric intake and exercise to reduce weight
• Low-sodium diet
• No smoking
• Reduce alcohol intake
• Reduce caffeine intake
Step 2: Begin medication
• Administer diuretics to reduce circulating blood volume
furosemide, spironolactone, hydrochlorothazide, bumetanide
• Beta-adrenergic blockers to lower heart rate and cardiac output
propranolol, metroprolol, atenolol
• Calcium channel blockers to cause peripheral vasodilation, less tachycardia
verapamil, diltiazem, nicardipine
• Administer ACE to inhibit the rennin angiotensin aldosterone system.
In diabetes, ACE inhibitors also delay the progression of renal disease.
enalapril, lisinopril, benazepril, captopril, fosinopril, quinapril, perindopril
Step 3:
• Increase dosages of currently administered medication
Step 4:
• Combination of agents in above classes
• Multiple drugs may be needed to control blood pressure

NURSING INTERVENTION
 Monitor blood pressure with multiple readings—lying, sitting, and standing, bilateral
both arms.
 Provide a calm, quiet environment
 Record fluid intake and output.
 Reduce stress by providing a quiet environment.
 Assess for other signs and symptoms of hypertension, such as headache and retinal
hemorrhages
  Administer antihypertensive medications as prescribed; teach the patient to take
medications at the same time every day
 Advise the patient to stand up slowly when on antihypertensive therapy because
antihypertensive
 medications can cause dizziness
 Emphasize the importance of adhering to the medication regimen
 Advise the patient to avoid alcohol during antihypertensive therapy

PATIENT HEALTH TEACHING

Teach the patient and family about weight control, stress reduction, and smoking cessation
• No smoking—smoking contributes to cardiovascular disease, raising blood pressure.
• Change to a low-sodium and low-cholesterol diet—salt adds to elevated blood pressure in
some patients by contributing to fluid retention; lower cholesterol intake lowers risk for
associated hyperlipidemia.
• Reduce alcohol intake—reduces risk for end organ damage from alcohol intake.
• Reduce weight—decreased risk for obesity, better BP control with better weight control.
• Exercise.
• Call physician when BP is elevated.
• Side effects of medications.

CONCLUSION
Hypertension is often called the “silent killer” because it is frequently asymptomatic until it
becomes severe and target organ disease occurs.