Hypertension

By:

Jay Aries T. Gianan

EMT-B, RM, RN, LPT, MAN
Objectives:
1. What is hypertension (HTN)?
2. What are the causes of HTN?
3. What are the signs and
symptoms of HTN?
4. What are the complications of
HTN?
5. How to diagnose HTN?
6. How to manage HTN?
What is Hypertension?
Hypertension
• HYPERtension = HIGH BP
• HIGH tension on the heart and
blood vessels

• 120 - systolic
80 - diastolic
• Stage 1 hypertension is defined
as persistent blood pressure
levels in which the systolic
pressure is ____ and the
diastolic is ____.
A. 120/80 mm Hg.
B. 130/80 mm Hg.
C. 140/90 mm Hg.
D. 150/90 mm Hg
E. 180/120 mm Hg
Causes (SODA)

• S – Stress, Smoking, Sedentary

lifestyle, Stimulants
• O – Obesity, Oral contraceptives
• D – Diet (↑ sodium, ↑ cholesterol),
Diseases = DR. HH
• DM, Renal disease, HF,
Hyperlipidemia,
• A – African American, Age
Signs and Symptoms (ABC)
• Usually “asymptomatic”
• Silent killer
• A – Achy head (headache)
• B – Blurred vision (retinopathy)
• C – C hest pain (angina)

• Hypertensive crisis
• Over 180/120
Complications (AABC)
• A – Atherosclerosis,
• A – Aneurysms
• B – Broken organs
• Broken Kidneys (Renal failure)
• Broken Eyes (Retinopathy)
• Broken Heart (Heart Failure)
• Broken Nerves (Neuropathy)
• C – Clots
• Lung - PE (Pulmonary emboli)
• Brain - CVA (Stroke)
• Heart - MI (Heart attack)
How hypertension is managed?
Treatment (ABCDD-AC)
• Goal! – Calm the heart, ↓BP, ↓
HR
• A – ACE inhibitors
• A – ARBs
• B – Beta Blockers
• C – Calcium Channel Blockers
• D – Diuretics
• D – Dilators

• A – Anti Platelet
• C – Cholesterol Lowering
Angiotensin-converting enzyme (ACE) inhibitors
“-pril”
• Affects the RAAS (water regulation)
• Lisinopril, Captropril
• Chill heart
• ↓BP, rested & relax heart
• Side Effects (ACE)
• A – Avoid for pregnant
• A – Angioedema
• Swollen red tongue
• C – Cough
• E – Electrolyte imbalance
• ↓Na+, ↑K+
 Angiotensin receptor blockers (ARBs)
“-sartan”
• Affects the RAAS (water regulation)
• Losartan
• Relax man
• ↓BP d/t less workload to the heart
• Side Effects
• L – Low BP (↓BP)
• O – Other fatigue
• S – Swelling
• A – Allergic Reaction
• R – Raised K+
• T – Teratogenic
• A – Acute Kidney Injury
• N – Nasal congestion
Beta Blockers “-lol”
• Brakes on the heart (slows the heart
rate)
• Block beats
• Atenolol, Propanolol
• Lol = low HR
• Side Effects (4Bs) – Hold the medication
• B – Bradycardia (↓HR, ↓60)
• B – Bottomed out BP(↓BP, ↓80/60)
• B – Breathing Problems
(COPD,Asthma)
• B – Blood sugar masking (DM)
• Always monitor the blood glucose
of the DM pt.
Calcium Channel Blockers “-pine”
• Calms the heart rate (↓BP, ↓HR)
• (Dihydropyridine) - Amlodipine, Nifedipine
• Calms the heart, Controls BP
• Break time
• (Non-Dihydropyridine) - Diltiazem,
Verapamil
• Side Effects
• C – Cerebral vasodpasm & CHF
• H – Hypertension
• A – Angina
• S – Supraventricular tachyarrhythmia
• M – Migraines
• A – Atrial flutter & Atrial Fibrillation
 Decrease BP
Diuretics Drain fluid (urinate) – “diuresis”
Dehydrate (dried body)
• K+ wasting
• K+ Sparring
• Furosemide, hydrochlorothiazide
• Spironolactone
• Dried
• Spares the potassium
• l/t ↓ K+: Eat fruits & green leafy
vegetables • Blocks aldosterone to release Na+
• Caution: Given if K+ is normal (3.5- & H2O
5.0) • Avoid salt substitutes
• Withhold if K+ is below 3.5 • Avoid K+ rich foods
• Green leafy vegetables
• Banana, orange, avocado
Dilators (Vasodilators)
• Relieves pressure
• D – Decrease BP
• D – Dilates vessels
• D – Decrease vascular resistance
• Nitroglycerine
• Pillow (rested & relax heart)
• NO erectile drugs “-afil”
• Sildenafil(Viagra)
• Dropping BP so low l/t death
• 3H is normal: headache, hypotension
& hot flushing
AC – Anti Clogging of Arteries
• A – Anti platelet
• Anti clumping
• Aspirin (ASA - acetylsalicylic acid)
• Clopidogrel (Plavix)
• Bleeding
• C – Cholesterol lowering drug “-statin”
• Lovastatin – “stay clean”
• Liver toxic
• Cirrhosis, Liver failure pt.
• No grapefruit
 Nursing Management (DRESS)
• D – Diet
• ↓ SCC (sodium, calories, cholesterol)
• R - Reduce
• Alcohol, caffeine
• E – Exercise
• Walking (30 mins/day)
• S – Stop
• Smoking and alcohol
• S – Stress
• reduction
How hypertension is Diagnosed?
Diagnostic Exams (Labs & Imaging) - CEE
• CXR
• Measure the size of the heart
• Echocardiography
• Measure the size of the heart
• Measure the amount of blood
being pump out of the L ventricle
• Ejection fraction
• Normal - 55-70%
• Bad - 40% or less
• ECG/EKG
• Assess for tall R peaks
 Diagnostic Exams (Labs & Imaging) - BCC
•B •C •C

• B-Type natriuretic • C-Reactive Protein • C- Cholesterol Panel

Peptides (BNP)
• Bulging Ventricles • C-Chronic Inflammation • C-Clogged Arteries
• 100 or less – normal • 40 or more – HDL
• 300+ - mild • ↓200 – Total Cholesterol
• 600+ - moderate • ↓150 – Triglycerides
• 900+ - severe • ↓100 - LDL
 Question:
Diagnostic Exams 1. What is the most accurate test to
diagnose hypertension??

TEST TIPS!!

Gold Standard of HTN Diagnosis!

3 BPs
(1 week apart)
What if pharmacological treatment fail?
Surgical Management
• Goal: Give O2 to heart muscle
• A – Angioplasty
• Balloon or stent placement
• B – Bypass
• (Coronary Artery Bypass Graft)
“Cabbage”
• C – Cut out the fatty blockage
• Endarterectomy
A characteristic symptom of
damage to the vital organs as a
result of hypertension is:
A. Angina.
B. Dyspnea.
C. Epistaxis.
D. All of the above.
Pharmacologic therapy for
patients with uncomplicated
hypertension would include the
administration of:
A. Angiotensin-converting enzyme
inhibitor.
B. Alpha blockers.
C. Beta-blockers.
D. Calcium antagonists.
An expected nursing diagnosis for
a patient with hypertension is:
A. Heart failure.
B. Knowledge deficit.
C. Myocardial infarction.
D. Renal insufficiency.
• Red, a 55 y/o truck driver who arrived at
ER complaining of worsening H/A w/ a
scale of 8/10, intermittent episodes of
blurred vision that seems to be getting
worse for nearly a week now.
Assessment reveals he smoke 1
pack/day, BMI 30 frequently eat fast
foods on his daily routes. Hx includes
DM type 2 dx 20 years ago, HTN stage 2,
hyperlipidemia and recent dx of COPD.
a. As an ER nurse, what’s the main priority
right now?
b. What will you prioritize as a nurse in his
plan of care?
 Activities
You are a nursing student assigned to a
hypertension clinic. One of the patients is a
58-year-old telemarketer. During the
physical assessment, the patient, who is 5
feet 6 inches tall and weighs 180 lb, asks
you what he can do to reduce his blood
pressure.
• How would you answer this patient’s
question?
• Identify what additional data you need to
consider before you answer the patient’s
question.
• How would your assessment and plan
change if the patient also had degenerative
arthritis of his knees?