Hypertension:

- Amount of resistance of blood pumping through the body/arteries

- Narrowing of arteries causes high BP

Ranges for BP:

Normal: <120/80
Prehypertension: 120-139/80-89
Stage 1: 140-159/90-99
Stage 2: >160/>100

- Hypertension is known as the “silent killer”- there is an increase in blood flow and
resistance on arteries effect major organ systems.
- “ Can’t eat your CAKE and have it too”

1. Cardio: cause CHF (overworking heart muscle = enlarged)

2. Brain: stroke (weakens and narrows vessels causing rupture or clot)
3. Kidneys: renal failure (weakens arteries to kidneys, causing decreased perfusion
4. Eyes: visual changes (damages blood vessels to retina, blurred vision, cant focus on
objects)

Causes of Hypertension:
Primary/ Essential Hypertension:
- Unknown cause
- “RISK FACTORS”
R- Race: black males
I – increased: intake of Na+ and alcohol
S- smoking and stress
K- Low K+- balance Na+ in the body and vitamin D affecting kidneys
F- Family history
A-Advanced age
C- cholesterol increased- less than 200
T- Too much caffeine
O- Obese (BMI)
R- Restricting activity
S- sleep apnea

Secondary Hypertension:
Pre-existing issues:
- Pregnancy
- Cushing syndrome
- CRF: chronic renal failure
- Diabetes
- Hypo/hyperthyroidism
Nursing management:
- Patient is asymptomatic.
- Blurred vision, headaches, chest pain- nose bleeds/dizzy, ringing in ears
- Assess, educate, evaluate
- Measure BP (both arms, 5 min in between, family history, sensory changes, BMI, report
increased BP to MD, medication compliance)
- Educate: limiting Na+, Alcohol and caffeine intake, smoking cessation, exercising cardio,
how to measure BP and keep record

Pharmacology Management:
Typically non-pharm methods used for 1-3 months while monitoring before meds, start slow
then add on
1. Thiazide diuretics: HCTZ, chlorothiazide, “iazide”, removes water and sodium via kidneys
so not for patients with renal issues, watch for patient on lithium because it may cause
lithium toxicity, educate: make sure patient is taking enough potassium because they will
be wasting potassium so take supplements, can cause photosensivity
2. ACE inhibitor: end in “pril” eg: Lisinopril which prevents vasoconstriction blocking
angiotensin 1 and 2, educate: dry cough, avoid potassium substitutes (retaining k+),
compliance (rebound hypertension), take 1 hour before meals
3. ARBS: end in “sartan”, block aldosterone and angiotensin receptor, has same effects as
ACE just doesn’t give dry cough
4. CCBs (calcium channel blockers): end in “dipine”, lowers heart rate and workload on the
heart which causes vasodilation and helps lower BP, watch for bradycardia especially
those with congestive heart failure and AV blocks
5. Beta blockers: end in “olol”, it blocks epinephrine which blocks the sympathetic nervous
system (Fight or flight) of heart, this will decreases heart rate causing vasodilation,
SHOULD NOT BE GIVEN TO PATIENTS WITH asthama, copd because it blocks the
receptors in lungs causing bronchoconstriction instead of bronchodilation which can
lead to asthma attack, also not for patients with diabetes because it masks hypoglycemic
signs (tachycardia) because this medication won’t let their heart rate increase, also
watch patients with low HR and patients with orthostatic hypotension