HYPERTENSION

RAJESWARI R
TUTOR
 DEFINITION
• High blood pressure, is generally defined as a
persistent elevation of systolic blood
pressure above 140 mm of Hg and diastolic
pressure above 90 mm Hg
CLASSIFICATION OF BLOOD
PRESSURE
ETIOLOGY
Primary hypertension has no single or specific cause but
it is multifactorial. It develops in response to increased
cardiac output or to a rise in peripheral resistance. 
Factors that affect these two forces include:- 
Genetic propensity to a hightened neurologic response
to stress or for a defect in renal excretion or cellular
transport of sodium
Obesity associated with high levels of insulin
(hyperinsulinemia) that lead to raised blood pressure 
Environmental stress 
Loss of elastic tissue and arteriosclerosis of aorta and
other large arteries
STRESS
 SECONDARY HYPERTENSION
Endocrine
Renal parenchymal disease -Acromegaly
-Acute glomerulonephritis - Hypothyroidism
- Hyperthyroidism
-Chronic nephritis - Hypercalcemia 
-Polycystic disease Adrenal -Cortical:- -Cushing’s syndrome -Primary
 Connective tissue disease aldosteronism -Congenital adrenal hyperplasia -Medullary:
pheochromocytoma -Extra-adrenal chromaffin tumors
-Diabetic nephropathy Exogenous hormones
-Hydronephrosis -Estrogen 
-Glucocorticoids 
Renovascular -Rennin- -Mineralocorticoids 
producing tumors -Sympathomimetics 
-Tyramine-containing foods and monoamine oxidase
inhibitor
• Coarctation of the aorta 
• Pregnancy-induced hypertension
• Neurologic disorders
Increased intracranial pressure 
Brain tumor 
Encephalitis 
• Respiratory acidosis 
• Sleep apnea 
• Quadriplegia 
• Lead poisoning 
• Guillain-Barre syndrom
• Acute stress, including surgery
• Psychogenic hyperventilation 
• Hypoglycemia 
• Burns 
• Pancreatitis 
• Alcohol withdrawal 
• Postresuscitation 
• Postoperative 
• Increased intravascular volume
• Alcohol and drugs
RISK FACTORS
Nonmodifiable Risk Factors
Family History
Age-The incidence of hypertension increases with age; 50-60 per cent
of clients over 50 years of age have a blood pressure over 140/90 mm
Hg. However, epidemiologic studies have shown a poorer prognosis in
clients whose hypertension began at a young age.
• Gender- Men experience hypertension at higher rates and at an earlier age than

do women until after age 60 years. Men also have greater risk of cardiovascular

morbidity and mortality. After age 50, hypertension is more prevalent in women.

The reasons are not clear

• Ethnic Group- Hypertension is the most serious health problem for blacks in the

United States. Hypertension is more prevalent in blacks, and at any given blood

pressure, with whites. The reason has been attributed to heredity, greater salt

intake, and greater environmental stress

MODIFIABLE RISK FACTORS
• Stress-Stress has been shown to cause increased peripheral vascular
resistance and cardiac output and to stimulate sympathetic
nervous system activity. 
• Stress may be associated with occupational factors, socioeconomic
levels, and personality characteristics
• Obesity-Obesity, in particular that located in the upper body with
increased amounts of intra-abdominal fat, is an important cause of
hypertension; the combination may be related to hyperinsulinemia
secondary to insulin resistance
Nutrients
• Sodium is an important etiologic factor in essential hypertension.
• A high salt diet may induce excessive release of natriuretic hormone,
which may indirectly increase blood pressure 
• Sodium loading has also been shown experimentally to stimulate
vasopressor mechanisms within the central nervous system
• Also Calcium intake may be lower among hypertensive than among
normotensive clients. 
• The impact of caffeine is controversial. It raises blood pressure acutely
but does not have sustained effects.
BLOOD PRESSURE OF DIFFERENT AGE
GROUPS
PATHOPHYSIOLOGY
 CLINICAL MANIFESTATIONS
• The early stages of hypertension have no clinical
manifestations, other than elevations in blood
pressure. 
• This unfortunate fact means that there are no signs
or symptoms to lead a person to seek health care.

• As hypertension advances, without treatment clients
may report morning occipital headache, fatigue,
dizziness, palpitations, flushing, blurred vision,
and epistaxis
DIAGNOSTIC ASSESSMENT
• History collection
• Physical Examination
• Blood pressure measurement
ANEROID SPHYGOMANOMETER SPHYGOMANOMETER
MANAGEMENT
MEDICAL MANAGEMENT
DRUG MECHANISM EXAMPLES

Diuretics 1. Loop diruetics Act on loop of, Henle to minimize frusemide (Laxis),
sodium and water reabsorption] Bumetadine
(bumex)

2. Potassium-Sparing [Block action of aldosterone in distal Aldactone),

Diuretics loop, promoting excretion of sodium and Triamterene
water and retention of potassium. ] (Dyrenium)]

Vasodilators direct action on smooth muscle walls of Hydralazine(apres

arterioles causing arteriolar vasodilation. oline)

Alpha adrenergic inhibitors - vasodilation occurs with a decrease in prazosin

peripheral vascular resistence hydrochloride
Beta blockers block beta receptors in the heart and propranolol, metoprolol, nadolol,
peripheral vessels to reduce peripheral atenolol
vascular resistence

Calcium channel blocking block entry of calcium in to smooth muscle nifedipine, verapamil
agents cells and may interfere with the hydrochloride, Diltiazem,
intracellular release of Ca cause arteriolar nicardipine.
vasodilation and decrease Peripheral
Vascular Resistance .
Angiotensin converting inhibits conversion of angio I to II. captopril, enalapril, lisinopril.
enzyme inhibitors:-  - Reduce Peripheral Vascular Resistance
without changing cardiac output
NON-PHARMACOLOGICAL
MANAGEMENT
• Modification of Dietary Fat- Modification of dietary intake of fat by
decreasing the fraction of saturated fat and increasing that of
polyunsaturated fat may decrease blood pressure and will decrease
the cholesterol level, which is an important risk factor for coronary
artery disease
• The use of fish oil supplements to lower cardiovascular risk has been
shown to lower blood pressure in preliminary studies, but fish oil
supplementation may cause deficient blood clotting and excessive
bleeding in some clients.
• Exercise-A regular program of aerobic (isotonic)

exercise facilitates cardiovascular conditioning, can aid

the obese hypertensive client in weight reduction, and

may provide some benefit in reducing blood pressure. 

• Heavy isometric exercises such as weightlifting may be

harmful; blood pressure often rises to very high levels

because of vasovagal reflexes that occur during an

isometric contraction
• Restriction of Alcohol-The consumption of more than 1 to 2
ounces of alcohol per day is associated with a higher prevalence
of hypertension, poor adherence to the antihypertensive therapy,
and occasionally, refractory hypertension. 
• Alcohol intake needs to be advised to do so in moderation (i.e., less
than 1 to 2 ounces of ethanol per day).
• Caffeine Restriction- Although acute ingestion of caffeine may
raise blood pressure, chronic moderate caffeine ingestion
appears to have no significant effects on blood pressure.
• Instruct clients to limit caffeine to 250 mg (the amount in two to
three cups of brewed coffee) because it probably raises blood
pressure by activating the sympathetic nervous system. This
sympathetic response particularly affects those not used to drinking
coffee
• Relaxation Techniques- A variety of relaxation therapies, including
transcendental meditation, yoga, biofeedback, and psychotherapy, have
been shown to reduce blood pressure in hypertensive clients at least
transiently. 
• Smoking Cessation-Nicotine definitely increases heart rate and produces
peripheral vasoconstriction, which does raise arterial blood pressure for a
short time. 
• Smoking cessation is strongly recommended, however, to reduce the client’s
risk for cancer, pulmonary disease, and cardiovascular disease.
• Smokers appear to have a higher frequency of malignant hypertension and
subarachnoid hemorrhage
DASH
(Dietary Approaches to stop Hypertension)
• Potassium Supplements-The high ratio of sodium to potassium in the
modern diet has been held responsible for the development of
hypertension.
• Potassium supplements may lower blood pressure
• A reduction of high sodium, low potassium processed foods with an
increase of low sodium, high potassium natural foods may be all that is
needed to achieve the potential benefits
• Calcium
Supplements-Clients
should ensure a
reasonable dietary
calcium in take rather
than using potassium
for preventing or
treating hypertension

• Magnesium
Supplements
PREVENTION
 MALIGNANT HYPERTENSION
• Malignant (accelerated) hypertension is
an emergency characterized by
diastolic pressures above 120 mm Hg,
retinal hemorrhage and exudates with
papilledema, acute renal failure, and
rapid vascular deterioration.

• peak incidence at age 40-50 years; 

• Without treatment, malignant

Papilledema results from obstruction of
hypertension results in a 90 per cent venous outflow from the optic discs

mortality rate within 1 year because of intracranial hemorrhage

• The presenting manifestations of malignant hypertension
include hypertensive retinopathy. The retinopathy is
characterized by arteriolar constriction, flame-shaped
hemorrhages resulting from damaged capillary
endothelium, and soft exudates. 

• Additional clinical manifestations include hypertensive

encephalopathy manifested by restlessness, changes in
level of consciousness (confusion, somnolence, lethargy,
memory defects, coma, seizures), blurred vision,
dizziness, headache, nausea, and vomiting. 

• Assessment may also reveal renal insufficiency,

COMPLICATIONS