WELCOME

Athira Abraham
2 nd Year MSc Nursing
Manguluru
Blood pressure is the force of blood
pushing against the walls of arteries.
 DEFINITION

Hypertension is defined as a systolic blood

pressure greater than 140 mm Hg and a diastolic pressure
greater than 90 mmHg, based on two or more
measurements. Blood pressure can be classified as
follows:
Normal: systolic less than 120 mm Hg; diastolic less
than 80 mm Hg

 Pre hypertension: SBP: 120-139 mmHg

DBP: 80-89 mmHg

 Hypertension stage I: SBP: 140-159 mmHg

DBP: 90-99 mmHg

 Hypertension stage II: SBP: More or equal to

160 mmHg
DBP: More or equal to 100 mmHg
 Incidence in India
• 25% of urban population and 10 % of
rural population suffer from
hypertension.

• 70% of all hypertensive patients are

stage I hypertension.

• 12% of all hypertensive suffer from

isolated systolic hypertension
 RISK FACTORS

05/26/2024 7
 RISK FACTORS

MODIFIABLE RISK FACTORS

 Alcohol consumption
 smoking
 Tobacco use
 Excessive dietary intake of sodium
 Obesity , Atherosclerosis
 Sedentary life style
 stress
NON MODIFIABLE RISK FACTORS

 Age: chance of CAD after 50 yrs

 Gender - men and postmenopausal
women
 Family history
 Race or ethnicity – High in Ameri-
can as in white.
 ETIOLOGY
 Primary /Idiopathic HTN: It is the elevation in
BP without an identified cause.
 Secondary HTN: it is the elevation in BP with an
exact cause. This type accounts for 5-10% of total
cases.
 The causes of Secondary HTN include
⚫ Congenital narrowing of the aorta
⚫ Renal disease
⚫ Endocrine disorders like cushing’s syndrome
⚫ Neurological disorders like brain tumors and
head injury
⚫ Sleep apnea
⚫ Medications like oral contraceptive pills,
NSAID, and coccaine
⚫ Cirrhosis of liver
 TYPES OF HYPERTENSION
1. Primary (essential) hypertension: most common.
95% of all cases. combination of genetic and
environmental factors such as a sedentary lifestyle,
obesity, stress, smoking, and a diet high in salt and
saturated fats leads to hypertension.

2. Secondary hypertension: It is caused by an underlying

medical condition or medication.
kidney disease, adrenal gland tumors, thyroid problems,
sleep apnea, and certain medications such as birth control
pills, decongestants, and steroids.
3. Isolated systolic hypertension (ISH): High blood
pressure readings, where only the systolic pressure is
elevated (systolic blood pressure of 140 mmHg or higher
and a diastolic blood pressure of less than 90 mmHg).

4. Malignant hypertension is defined as a systolic blood

pressure of 180 mmHg or higher and/or a diastolic blood
pressure of 120 mmHg or higher, along with evidence of
acute organ damage.

5. Resistant hypertension: High blood pressure that

remains elevated despite the use of three or more different
types of blood pressure medications.
6. Pseudo hypertension: The blood pressure
readings appear to be higher than they actually
are due to the calcification and hardening of the
arteries.

7. White coat hypertension: (white coat

syndrome), a person's blood pressure readings
are higher when measured in a medical setting,
such as a doctor's office or clinic, compared to
when measured at home or in other settings.
 PATHOPHYSIOLOGY

The normal blood pressure is maintained

by four mechanisms

⚫Activities of Sympathetic nervous system

⚫Activities of vascular endothelium

⚫Activities of renal system

⚫Activities of endocrine system

 SYMPATHETIC NERVOUS SYSTEM ACTIVITIES

 Release of neurotransmitter activation of SNS

increases the heart rate and cardiac contraction.

 vasoconstriction in the peripheral arterioles and promote the

release of renin from the kidney.
 The net effect of SNS activation is to increase arterial blood
pressure by increasing cardiac output and systemic vascular
resistance. BP=CO X SVR
CO = HR X SV
 ACTIVITIES OF VASCULAR ENDOTHELIUM

 The vascular endothelium is a single cell layer

that lines the blood vessel.
 Atherosclerosis

 It will produce vasoactive substances and

growth factors like nitric acid, endothelin, etc..
 These substances are potent vasoconstrictors
and causes increased blood pressure level.
 Activities of renal system
Due to etiological factors

Decreased blood flow to renal arteries

Release of renin by juxtaglomerular

Renin enters the bloodstream

Conversion of angiotensinogen ( liver) to angiotensin I

 Angiotensin I passes through the lung capillaries

ACE
converts angiotensin I angiotensin II

Angiotensin II is Stimulates adrenal gland and

(Vasoconstritor) release of aldosterone in

the adrenal gland

vascular resistance Sodium retention

HYPERTENSION
In short…………….

RAAS (RENIN ANGIOTENSIN –ALDOSTERON SYSTEM)

1.RELESE OF RENIN BY NEPHRON

2. IT ACT ON ANGIOTENSINOGEN(LIVER) AND

CONVERT ANGIOTENSINOGEN TO ANGIOTENSIN 1.

ACE (LUNGS)
3. ANGIOTENSIN 1 ANGIOTENSIN 2

(Vasoconstrictor, production of aldosterone, vasopressin…)

 ACTIVITIES OF ENDOCRINE SYSTEM

 When the angiotensin-II is stimulated in the

adrenal cortex, it will secrete aldosterone.

 The aldosterone will stimulate the kidneys to

retain sodium and water. Thus the BP and

cardiac output will get increased.

 CLINICAL FEATURES

 Some times the high blood pressure

does not causes any symptoms, so
that it is known as a silent killer
disease.

 Insome patients the symptoms

will develop like,

 Severe head ache

 Blurred vision
 Nausea

 Vomiting

 Fatigue

 Dizziness

 Confusion

 epistaxis
 Chest pain
 Shortness of breath
 Irregular heart beat
 papilledema
 DIAGNOSTIC EVALUATIONS

 History collection and physical examination

 Family history of DM and HTN
 Ambulatory Monitoring
 Chest x-ray – Size of the heart.
 ECG – Evidence of previous heart attack,
enlargement, CAD
 Echo
–Detect cardiac morphologic and
hemodynamic Monitoring
 Laboratory Tests
 Routine Tests

• Urinalysis
• Blood glucose,
• Serum potassium, creatinine, or the corresponding
estimated GFR, and calcium.
• Lipid profile, after 9- to 12-hour fast, that includes high-
density and low-density lipoprotein cholesterol, and
triglycerides.
 Optional tests
 Measurement of urinary albumin excretion or
albumin/creatinine ratio.
 More extensive testing for identifiable causes is not generally
indicated unless BP control is not achieved.
MANAGEMENT
 Mainly the management of
hypertension is possible by
two ways, which include
⚫ Life style modification
⚫ Pharmacological therapy
Non pharmacological
Treatment

DASH
diet

Regular exercise

Loose weight , if obese

Reduce salt and high fat diets

Avoid harmful habits ,smoking ,alcohal

• DASH Diet - It is a flexible eating plan
that can help lower blood pressure. The
diet is rich in fruits, vegetables, whole
grains, low-fat dairy product, and lean
protein. It also limits foods that are high
in salt, added sugar, and saturated fat.
• Nutrients include minerals like potassium,
calcium, magnesium, protein, and
fiber. The diet also limits processed and
cured meats, which have been shown to
cause hypertension.
•7-8 servings of grains
per day
•4-5 servings of
vegetables and fruits
per day
•2-3 servings of low-fat
or fat-free dairy
products .
•2 or less servings of
meat, poultry, and fish
per day
•4-5 servings of nuts,
seeds, and dry beans
per week
 PHARMACOLOGICAL THERAPY

Various groups of drugs are used for the

treatment of hypertension, collectively these drugs are

called as anti-hypertensive drugs.

Mnemonic
 ACE Inhibitors: This group of medication will

reduce the conversion of A-I to A-II and

prevents vasoconstriction.
Eg: Captopril, Ramipril
 Alpha blockers: These medications causes the peripheral

vasodilation of blood vessals.

Eg: Prazosin

 Beta blockers: These medications reduces the workload

of the

heart and blood vessel and causing the heart to beat slowly

and with less force.

Eg: Atenolol, propanolol

 Calcium channel blockers: These medicines
will block the movement of extracellular
calcium to intra cells and causing vasodilation
and decreased heart rate.
Eg: Amlodipine, Verapamil
Vasodilators: These medications act
directly on the muscles in the wall of
arteries and prevent the muscles from
tightening and arteries from narrowing.
1. Nitroprusside:- 0.25-10 µg/kg/min as IV
infusion
2. Nitro-glycerine:- 5-10 µg/min as IV
infusion
3. Nicardipine:- 5-10 mg/hr IV
 Diuretics: it helps the kidneys to inhibit the

sodium reabsorption in the distal convoluted

tubules, ascending limb and loop of henle. Eg:

chlorothiazide, furosemide
 Alternativetherapies which are helpful to
regulate blood pressure includes
acupuncture, relaxation techniques
and diversional therapies.
 Algorithm for
Treatment of Hypertension

Lifestyle Modifications

Not at Goal Blood Pressure (<140/90 mmHg)

(<130/80 mmHg for those with diabetes or chronic kidney disease)

Initial Drug Choices

Without Compelling With Compelling

Indications Indications

Stage 1 Hypertension Stage 2 Hypertension Drug(s) for the compelling

(SBP 140–159 or DBP 90–99 mmHg) (SBP >160 or DBP >100 mmHg) indications
Thiazide-type diuretics for most. 2-drug combination for most (usually Other antihypertensive drugs (diuretics,
May consider ACEI, ARB, BB, CCB, thiazide-type diuretic and ACEI, ARB, BB, CCB)
or combination. ACEI, or ARB, or BB, or 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.
Combination therapy

To treat hypertension (high blood

pressure) when a single medication is
not effective in controlling blood
pressure.
Eg: ACE Inhibitors and Diuretics
STEP UP MEDICATION STEP DOWN
THERAPY MEDICATION THERAPY
Start with low dose of Start with combination
a single
antihypertensive of antihypertensive
medication and medications at higher
gradually increasing
dose and then gradually
dose.
reducing the number of
medication until reach
the target level.
 NURSING DIAGNOSIS
• Ineffective cerebral tissue perfusion related to
complications of hypertension (cerebra edema
secondary to hypertensive crisis, IC bleed.

•Ineffective therapeutic regimen management

related to lack of knowledge, high-cost drugs, side
effects of drugs etc.

• •Anxiety related to the complexity of the

management regimen, possible complications

• Disturbed body image related to diagnosis of

hypertension
 NURSING MANAGEMENT

 Proper history collection should be done which

includes family history also.
 Dietary habits should be assessed
 Identify the medical history such as diabetes, CAD,
renal disease etc…
 Instruct the patient to avoid smoking and alcoholism
 Auscultate heart rate and palpate peripheral pulses.
Identifythe use of medications such as
contraceptives, steroids, NSAID etc…
Monitor vital signs frequently
Provide diet which is low in sodium
and rich with fruits and vegetables.
Monitor the blood cholesterol level
frequently
 Complications
•Heart attack or stroke
•Aneurysm
•Heart failure , Kidney problems
•Eye problems
•Metabolic syndrome – Group of conditions that
increses the risk of heart diseases, stroke and diabetic.

•Changes with memory or understanding

•Dementia.
CONCLSION

An estimated 1.28 billion adults aged 30–79

years worldwide have hypertension, most (two-
thirds) living in low- and middle-income
countries. Hypertension is a silent killer. So
early identification and prevention is very
important.
NEWS PAPER ARTICLE
Garlic as a natural agent for the treatment of
hypertension.
Objective : To re-evaluate the effects of garlic on blood
pressure with respect to its ability to provoke a decrease in
blood pressure and to determine the length of time that
this decrease would require.
Spontaneously hypertensive were given
garlic orally. The blood pressures were measured
immediately before the extract was given, and then
0.5,2,4,6, and 24 h after the extract was given.
A blood pressure measurement was also taken at
48 hr. after.
There was a marked decrease in the systolic
blood pressure of all after three doses and the
decrease occurred within 30 min in each case.
The results indicate that garlic is an effective
natural agent for the treatment of hypertension.
RESEARCH ARTICLE
Topic : prevalence of hypertension and associated factors
among the residents of Nigeria on 2018.
Methods: A descriptive cross-sectional design was used. The
study involved 806 respondents aged from 18-90 years from 171
households, selected by cluster sampling technique. It was a
house-to-house survey. Behavioural risk factors were measured
using World Health Organisation (WHO) STEP wise approach to
chronic disease risk factor surveillance (STEPS 1 & 2).
Results: The overall prevalence of hypertension was
33.1% (male 36.8% and female 31.1%). The proportion
of self reported hypertension was 11.1%, while 5.1%
were currently on anti-hypertensive medication.
Conclusion: This study revealed a high prevalence of
hypertension. These data underscores the need for
urgent steps to create awareness and implement
interventions for prevention and early detection .
 REFERENCES
1. Joice and Black, Jane Hokanson Hawks, A text book
of medical Surgical Nursing , Volume I, 7th edition, A
division of reed Elsevir India Private limited
Publications.

2. Javid Ansari, Davinder Kaul, A textbook medical

Surgical Nsg II, Volume I, 2015 edition, Vikas company
medical publishers.

3. Lewis Dirvsen, heit Kemper, Bucher, A text book of

medical surgical Nursing, volume II, Second South Asia
Edition, Elsevier India Private limited publications.
4.Brunner & Suddarth's, Text book of medical.
Surgical Nursing, Volume I, 10th edition, Lippincot
Raven Publishers.

Research Article –
Ikeoluwapo 0, md. Ibukun o Sowemimo, 17
Eagle's Heart Foundation, Ibada ogostate,
Nigeria, September 20, 2018.

web references - https:// higj cardiologdo.com