HYPERTENSION

1. CONSISTENT ELEVATION
– consistent elevation of the systolic BP above 140 mmH8, a diastolic.
– BP above 90 mmHg, or report of taking antihypertensive medication
2. MODIFIABLE RISK FACTOR
– for cerebrovascular, cardiac, vascular, and renal diseases.
3. ASYMPTOMATIC
– “Silent killer”
– Slowly die due to symptoms of hypertension
– No symptoms initially
– Simple symptoms would already indicate great effects on the damage of other organs
4. CHRONICALLY HIGH BP
– has shearing effect (ginagasgas) on the intima of blood vessels that leads to atherosclerosis
5. ATHEROSCLEROSIS
– affecting vital organs: brain, heart and kidheys.
– Atheroma formation (hypertension is a risk effect)

TYPES OF HYPERTENSION

1. Primary HPN (Essential)

– accounts for more than 90 od all cases
– Has no known cause. It is theorized that the cause may be
Genetic factors
- kidney disorders
Hormonal changes
- due to pills

Alteration in sympathetic tone ( increased SNS Activity)

Risk Factors
– similar with CAD clients
– Socioeconomic status would lead to chronic consumption of unhealthy food
– Stress will stimulate the sympathetic NS that results to vasoconstriction
– Arteriosclerosis is associated with old age due to hardening of wall and lesser elasticity
– Cigarettes smoking has vasoconstriction

Risk factors
● Age (= 55 for men; > Gs for women)
 ● Alcohol
● Cigarette smoking
● Diabetes melitus
● Elevated serum lipids
● Excess dietary sodium
● Gender

2. Secondary HPN
- Develops as a consequence of an underlying disease or condition

Renal causes

Adrenal
- aldosterone
endocrine
- antidiuretic hormone
Oral contraceptives
- secondary hypertension
some drugs like cocaine, excessive alcohol intake, head trauma, pregnancy among of others
Causes of hypertension
– Pregnancy (increased vascular retention)
– Cushing syndrome (uncontrollable release of aldosterone) - chronic water and sodium
retention
– Pheochromocytoma ( condition where there is excess secretion of adrenaline)
– Coarctation of the aorta (narrowing of the lumen of aorta)

BP CLASSIFICATION

BP Classification SBP mmHg DBP mmHg

Normal >120 <80
Pre-hypertension 120-139 80-89
Stage 1 Hypertension 140-159 90-99
Stage 2 Hypertension >=160 >=100
 Smaller the size the higher the vascular resistance

Bp and cardiac output are directly related

Bp is a product of cardiac output

PATHOPHYSIOLOGY
NA and 02 balance control the BP

Other illnesses happen to maintain equilibrium

– hyperbolemia

. Sympathetic NS
- primary hypertension ate more active than normal
BARORECEPTORS
2. RAAS
water and salt retention

increase heart rate

COMPLICATION
– same with risk factors of CAD
– primary related to atherosclerosis
– Vasoconstriction increase peripheral artery resistance. Obstruction or narrowing of lumen
increases peripheral resistance.
Increase of peripheral resistance

Vascular resistance is decreased lumen or arteries and atheroma

High BP would mean increase of after load (mahihirapan ang heart mag pump due to vaso
ems)

Atherosclerosis (hardening and thickening of arteries) happen due to the shearing effect of
hypertension (ginagasgas ng hypertension ang walls )

ORGANS INVOLVED
● Cardiac system: congestive heart failure due to the overworking of the heart muscle which
makes it become enlarged)
Increase after load, the heart overcomes more (increased muscle contractions that
 Increase after load, the heart overcomes more (increased muscle contractions that
enlargement of the myocardium)

● brAin: stroke (increase pressure weakens blood vessels which can cause a clot to form or for
them to rupture)
Clot would then become ischemia part of the brain of blood vessels limits or removes the
function of that part of the brain

Total obstruction of blood supply due to bleeding (no supply anymore)

- specific parts of the brain affects specific functions of the body

● Kidneys: renal failure (weakens and narrows the arteries to the kidneys and the kidneys don't
receive proper perfusion) nephropathy hehe
Glumerulus are small arteries (micro arteries) very sensitive to decreased perfusion that
would kill them (necrosis) that would lead to renal failure

Chronically high BP leads to

● Eyes: visual changes (damages blood vessels to the retina.blurred vision.can't focus images)
Retina are small arteries similar to glumerulus

SIGNS AND SYMPTOMS

Signs and symptoms of organs that are already affected
● Headache
● Blurry vision
● Chest Pain
● Nose bleeds
● Ringing in the ears
● Dizzy (affected na ang brain)

COMPLICATIONS
Hypertensive Heart Disease
● Coronary artery disease

● Left ventricular hypertrophy

Too much force to pump ;chronic
● Heart failure
*how does hypertension lead to heart failure
*how does hypertension lead to heart failure
● Cerebrovascular Disease

Stroke
● Peripheral Vascular Disease
Vasoconstriction (decreased perfusion to distal organs) that causes necrosis

Diabetic patients are amputated due to decreased perfusion in the area (risk factor for
atherosclerosis)

Hypertension is always associated with increased or decreased peripheral resistance that is

always associated with decreased perfusion
● Nephrosclerosts = hypertensive nephropatty
● Retinal Damage

DIAGNOSTIC TEST
● Taking blood pressure is already a diagnosis
● Diagnosis requires several elevated readings over several weeks (unless 2
180/110)
Let patient rest for a while then test again after. If nothing changed after succeeding
readings, client is hypertensive
● BP measurement in both arms
– Use arm with higher reading tor measurements subsequent
– Use the same BP app
– Ask patient to rest first

OTHER DIAGNOSTIC TEST

Treat underlying cause first at the same time hypertension

To rule out an underlying cause ( if there is no underlying cause it could be primary

hypertension)

Evaluate the presence and extent of organ damage and cardiovascular disease

Identify risk factors or disorders that will affect the patient's treatment
- given statins to lower the cholesterol level to check if there is an effect to patient
– Routine diagnostic test to assess secondary causes
● CBC
● BMP
Renal function test, kidney, electrolytes
● ECG
Cardiac problems
 Cardiac problems

TREATMENT GOALS
Maintain BP normal to patient

ALGORITHM FOR TREATMENT

. Change lifestyle modifications (140/90 in borderline)
– Dietary changes (DASH)
DASH DIET
● The DASH, stands for Dietary Approaches to Stop
Hypertension.
● The DASH diet is rich in fruits, vegetables, whole grains, and low-fat dairy foods; includes
meat, fish, poultry, nuts and beans; and is limited in sugar-sweetened foods and beverages,
red meat, and added fats.
" It is a dietary pattern promoted by the US-based National Heart, Lag, and Blood Institute to
prevent and
control hypertension.
Nutritional Therapy: DASH Diet = Dietary Approaches to Stop HIN
– Sodium restriction
– Rich in vegetables, trutt, and nonfat dairy products
– Calorie restriction it overweight
limit 20000 cal. day or less

Weight reduction

Limitation of alcohol intake (2 for men

1/day for women)

Regular physialastvity = Avoidance or tobacco use

Stress management

Change diet (low fat and Na)

Increase activity

Limitation alcohol & smoking

Lose weight for obese

. Initial drug choices
A. Without
Stage 1: Give one diuretic plus ACE, ARB, BB, CCB or combination

Stage 2: Give one diuretic plus ACE, ARB, BB, CCB or combination
 Stage 2: Give one diuretic plus ACE, ARB, BB, CCB or combination
B. With
Drug for the compelling indications: Other antihypertensive drugs (diuretics, ACEl, ARB, BB,
CCB) as needed.
. Not at Goal Blood Pressure
Optimize dosages or add additional drugs until goal blood pressure is achieved.

Consider consultation with hypertension specialist.

DRUG THERAPY
Promote vasodilation

Give diuretic to decrease volume of circulating blood

Thiazide-type Diuretics
– Inhibit NaCI reabsorption
– Side effects.
● Electrolyte imbalances: | Na, 1 CL, V K* (advise K rich foods)
● Fluid volume depletion (monitor for orthostatie hypotension)
● Impotence, decreased. libido
Check bo before giving diuretic

Client may experience impotent

Adrenergic Inhibitors
Inhibits alpha receptors
– Reduce sympathetic effects that cause HIN by.
● Reducing sympathetie ouflos
● Blocking effects of sympathetic act vity on vessels
– Side effects
● Hypotension
● Varied, depending on specific drug
Alpha receptors for vasoconstriction

Vasoconstriction pressure is increased

Vasodilator pressure is increased which is why bo must be check because of the possibility or
orthostatic hypotension (nausea)
B - adrenergic blockers (suffix "olol')
Inhibits beta receptors
– (metoprolol, propranolol)
– Block B- adrenergie receptors
● decrease HR, decreased inotropy (Decreased contractility), reduces sympathetic
vasoconstriction)
– Side effects
● Bradycardia
● hypotension
● beat failure
● impotence
● Heart Failure - due to decreased contractility of the heart there is exacerbate of heart failure

ACE Inhibitors (suffix "pril)

– Enalapril, captopril
– Prevents conversion of angiotensin I to angiotensin I thereby preventing the vasoconstriction
associate with
AIL,
– Side effects
Hypotension, cough
Decreases blood volume (no more secretion of aldosterone by the adrenal gland that causes
salt and water retention)

Calcium Channel Blockers

– Nifedipine, diliazem, amlodipine, felodipine, Verapamil
– Block movement of calcium into cells, causing vasodilation
– Side effects
● Bradycardia, heart block
Calcium has a role in contraction and conduction of the electric aspects of the heart

Drug Therapy and Patient Teaching

– Identity, report, and minimize sue streets
● Orthostate hypotension - patient must sit first and sit there for a while then dangle feet until
dizziness is gone
● Sexual dysfunction - education to relive anxiety
● Dry mouth
● Frequent urinate
 – due to diuretic drugs (aside from salt and sodium, chloride and potassium is also excreted
hence advice client to eat potassium rich foods such as camote and banana)
– monitor input and output
– check blood pressure
– Offer bed urinal and diaper

Nursing Interventions for Hypertension

● Assess: measure blood pressure (obtain in both arms. make sure patient has been in a resting
position for 5 minutes, no smoking. causes vasoconstriction), ask. about family history, and if
they have any sensory changes
● Evaluate:
blood pressure reading

dietary intake

body mass index (overweight)

● Educate:
limiting sodium

alcohol and caffeine in diet

quit smoking (cigarette smoke causes vasoconstriction)

● start an exercise program (cardio vascular) for weight loss
● Importance of medication compliance (they will be at risk for developing hypertension crisis
when self medication)
NURSING MANAGEMENT
– Ineffective health maintenance
– Anxiety
– Sexual dystunction
– Ineffective therapeutic regimen management

NURSING IMPLEMENTATION
Health Promotion
● Individual patient evaluation
● Screening programs
● Cardio vascular risk factor modification

Hypertensive Crisis
High risk of damage of involved organs that could lead to stroke and heart attack

The rate of increase is the concern (The rate of increase in BP more important than the
 The rate of increase is the concern (The rate of increase in BP more important than the
absolute value)

Severe, abrupt elevation in BP

Most common in parents with a history of hypertension who have failed to comply with
medications or who have been under-medicated (do not go for check ups to update the
appropriate dose of medication)
MANIFESTATIONS
– Hypertensive encephalopathy ( H/A, seizures, confusion, coma)
– Renal insufficiency
– Heart failure
– Pulmonary edema (caused by aggregated heart failure)
Hospitalization
– IV drug therapy
– Monitor cardiac (creatinine) and renal function
– Neurologie checks (check for Level of Consciousness)
– Determine cause
– Education to avoid future crises (remind medication regimen)