All about

Hypertension

I. Definition
Hypertension is a systolic blood pressure
greater than 140 mmHg and a diastolic
pressure greater than 80 mmHg over a
sustain period.
CLASSIFICATION OF blood pressure for adults
aged 18 years or older is as follows:

Normal- systolic lower than 120 mmHg

- diastolic lower than 80 mmHg

Pre- Hypertension- systolic 120-139 mmHg

- diastolic 80-89 mmHg

Stage 2 – systolic equal to or more than

160mmHg
- diastolic equal to or more than
100 mmHg
Normal blood pressure wit respect to
cardiovascular risk is less than 120/80 mmHg.

Pre- hypertension emphasizes that

patients are at risk for progression to
hypertension, and that lifestyle
modifications are important as
preventive strategies.
II. Primary or Essential Hypertension
1. No known cause
2. Risk factors
- aging
- family history
- black race, with higher
prevalence in male
III. Secondary Hypertension

1. Treatment depends on the cause and

the organs involved.
2. Secondary hypertension occurs as a
result of other disorder or conditions
3. Precipitating
disorders or
conditions

a. cardiovascular

disorders

b. renal disorders
c. Endocrine system disorders

d. pregnancy
e. medications
Hypertension may be caused by one or more of
the following:
Increased sympathetic nervous system activity
related to dysfunction of the autonomic nervous
system.
Increased renal reabsorption of sodium, chloride
and water related to genetic variation in the
pathways by which the kidney handle sodium.
 Increased activity of the renin-
angiotensin- aldosterone
system, resulting in expansion of the
extracellular fluid volume and
increased systemic vascular resistance

 Decreased vasodilation of the

arterioles related to dysfunction of
the vascular endothelium

 Resistance to insulin in action, which

may be a common factor linking
hypertension, type 2 diabetes
mellitus, hypertriglyceridemia,
obesity and glucose intolerance
 V. Clinical Manifestation
May be asymptomatic
Headache
Visual disturbances
Dizziness
Chest pain
Tinnitus
Flushed face
Epistaxis
 VI. Assessment and Diagnostic
Evaluation
1. Laboratory Studies

a. CBC, count serum electrolytes, serum creatinine,

serum glucose, uric acid and urinalysis

b. Lipid profile (total cholesterol, low- density

lipoprotein, and high density lipoprotein and
triglycerides)

c. Determination of sensitive thyroid- stimulating

hormone (TSH) level excludes hypothyroidism as a
cause of hypertension
2. Imaging Studies

a. Echocardiography
b. Imaging studies for renovascular stenosis

3. Other tests
a. Electrocardiograms
b. Ambulatory blood pressure monitoring
VII. Pharmacologic Therapy
 Diuretic
 Alpha 1- adrenergic blockers
 ß- blocker
 Peripheral vasodilators
 Calcium channel blocker
 Angiotensin- converting enzyme inhibitor
 Angiotensin II receptor antagonists
 Aldosterone antagonists
 Alpha- adrenergic agonists
VIII. Nursing Interventions
1. Goals:
a. To reduce the BP
b. Prevent or lessen the extent of the organ
damage
2. Question the client regarding the signs and
symptoms indicative of hypertension
3. Obtain the BP two or more times on both
arms with the client supine and standing
4. Compare the BP with the prior
documentation.
5. Determine family history of hypertension
6. Identify current medication therapy
7. Obtain weight.
8. Evaluate dietary patterns and sodium
intake
9. Asses for visual changes or retinal
changes.
10. Asses for cardiovascular changes such as
distended neck veins, increased heart rate,
dysrhythmias
11. Evaluate chest x-ray film for heart
enlargement
12. Asses neurological system
13. Evaluate renal function
14. Evaluate results of diagnostic and laboratory
studies
IX. Client Education
 Describe the importance of
compliance with the
treatment plan

 Describe the disease

process, explaining that
symptoms usually do not
develop until organs have
suffered damage

 Initiate and assist the client

in planning a regular
exercise program, avoiding
heavy weight lifting and
isometric exercises
 Instruct the client and
family about the dietary
restrictions, which may
include sodium, fat,
calories, and cholesterol

 Instructthe client about

actions, side effects,
and scheduling of
medications
 Stress up the
importance of follow-
up care
 Encourage the client
to express feeling
about daily stress
 Limited alcohol
consumption and
avoidance of
cigarette smoking
The End

Thank
you!!!