HYPERTENSION a condition in which there is a sustained elevation of the arterial blood pressure the level at which the normal

al blood pressure becomes abnormally high is not firmly established borderline hypertension is termed used for those readings consistently between 140/90 and 160/95 initial elevated readings should be confirmed on at least two subsequent occasions, with average levels of diastolic pressure of 90mmHg or systolic pressure of 140 mmHg for diagnosis Classification of Blood Pressure for Adults (age 18 and older) BP Systolic Diastolic Classification* BP BP (mmHg) (mmHg) Normal <120 and <80 Prehypertensi 120-139 or 80-89 on Stage 1 HPN 140-159 or 90-99 Stage 2 HPN 160 or 100 Classification of hypertension 1. Essential/Idiopathic/ Primary HPN accounts for 90-95% of all cases of HPN cause is unknown 2. Secondary HPN due to unknown causes ex. renal failure, hyperthyroidism, pheochromocytoma, cushings disease 3. Malignant HPN severe, rapidly progressive elevation in BP that causes rapid onset of end target organ complications 4. Labile HPN Intermittently elevated BP 5. Resistant HPN HPN that does not respond to usual treatment 6. White coat HPN Elevation of BP only during clinic visits 7. Hypertensive crisis situation that requires immediate blood pressure lowering (within 1 hour, systolic pressure above 240 mmHg; diastolic pressure above 120 mmHg) Predisposing Factor: 1. Family History 2. Age: 60 years old and above 3. High salt intake 4. Obesity 5. Excess alcohol consumption 6. Smoking

7. Stress Manifestations: 1. Headache most characteristic manifestation 2. Epistaxis 3. Dizziness 4. Tinnitus 5. Visual changes blurred vision, retinopathy, papilledema 6. Chest pain Complications: The excessive pressure on the artery walls caused by high blood pressure can damage the blood vessels, as well as organs in the body. The higher the blood pressure and the longer it goes uncontrolled, the greater the damage. Uncontrolled high blood pressure can lead to: 1. Heart attack or stroke. High blood pressure can cause hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications. 2. Aneurysm. Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening. 3. Heart failure. To pump blood against the higher pressure in the vessels, the heart muscle thickens. Eventually, the thickened muscle may have a hard time pumping enough blood to meet the body's needs, which can lead to heart failure. 4. Weakened and narrowed blood vessels in your kidneys. This can prevent these organs from functioning normally. 5. Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss. 6. Metabolic syndrome. This syndrome is a cluster of disorders of the body's metabolism including increased waist circumference, high triglycerides, low high-density lipoprotein (HDL), or "good," cholesterol, high blood pressure, and high insulin levels. If you have high blood pressure, you're more likely to have other components of metabolic syndrome. The more components you have, the greater your risk of developing diabetes, heart disease or stroke. 7. Trouble with memory or understanding. Uncontrolled high blood pressure may also affect the persons ability to think, remember and learn. Trouble with memory or understanding concepts is more common in people who have high blood pressure. Diagnostic procedures: Tests may be done to look for: Urine tests to check for kidney or liver disease. Blood tests to check levels of potassium, sodium, and cholesterol. A blood glucose test to check for diabetes. Tests to measure kidney function.

 An electrocardiogram (EKG, ECG) to find out whether there is any damage to the heart. Collaborative Management of Hypertension 1. Prevention Primary Prevention aimed at reducing risk factors associated with HPN Moderate sodium intake Decrease saturate fats in the diet Maintenance of IBW Maintenance of regular pattern of exercise Cessation of cigarette smoking Moderation in consumption of alcohol Stress reduction through effective coping strategies Secondary Prevention focused on identification and control of HPN in high risk groups 2. Pharmacologic control of HPN a. Diuretics first line of drugs for treating mild hypertension promote Na and H2O excretion which decreases extracellular fluid volume thus in turn lowers BP Hydrodiuril (hydrochlorothiazide) most frequently prescribed diuretic to control mild hypertension b. Sympatholytics 1. Beta-adrenergic blockers (beta blockers) reduce CO by diminishing SNS response; lower BP by diminishing vascular resistance reduce HR, contractility and renin release ex. Inderal (propranolol), Lopressor (Metoprolol), Tenormin (Atenolol) 2. Centrally-acting sympatholytics (Adrenergic blockers) Decrease SNS response from the brainstem to the peripheral vessels Stimulate alpha-2 receptors; increase vagus activity and decrease serum epinephrine, norepinephrine and renin release ex. Aldomet (Metyldopa), Catapress (Clonidine HCl) 3. Alpha-adrenergic blockers Block alpha-adrenergic receptors resulting in vasodilatation and decreased blood pressure ex. Regitine (Phentolamine), Minipress (Prazosin HCl) 4. Adrenergic neuron blockers (peripherally acting sympatholytics) Block norepinephrine release from the SNS, that results in lowering of BP; there is decrease both in CO and peripheral vascular resistyance ex. Hylorel (Guanadrel Sulfate), Ismelin (Guanethidine Monosulfate) 5. Alpha-1 and beta-1 adrenergic blockers

c.

d.

e.

f.

By blocking the alpha-1 receptor, dilatation of the arterioles and veins occurs, therefore blood pressure is lowered By blocking the cardiac beta-1 receptor, the HR and atrioventricular conbtractility are decreased Ex. Cartrol, Ocupress (Carteolol HCl), Trandate, Normodyne (Labetalol HCl) Direct-acting Arteriolar Vasodilators Relax smooth muscles of the blood vessels, mainbly the arteries, causing vasodilation Ex. Loniten, Rogaine (MInoxidil) Angiotensin-Converting Enzyme Inhibitor Inhibit ACE which in turn inhibits the formation of angiotensin II and blocks the release of aldosterone Ex. Capoten (Captopril), Vasotec (Enalapril Maleate) Angiotensin II Receptor Antagonists/Blockers (ARBs) Block angiotensin II absorption by the receptors found in many tissues Prevents the release of aldosterone; cause vasodilation and decrease peripheral resistance Ex. Cozaar (Losartan) Calcium Channel Blockers Increases muscle contractility, peripheral resistance and blood pressure Decrease calcium levels and promote vasodilation Ex. Procardia (Nifedipine), Norvasc (Amlodipine)

3. Nursing Responsibilities Nursing problem: o Risk for decreased cardiac output related to increased afterload, vasoconstriction, myocardial ischemia, ventricular hypertrophy. o Acute pain related to increased cerebral vascular pressure o Ineffective Tissue Perfusion: cerebral, renal, cardiac related to impaired circulation. o Fatigue related to effects of hypertension and stresses of daily life o Imbalanced nutrition: More than body requirements related to excessive food intake o Ineffective health maintenance related to inability to modify lifestyle o Deficient knowledge related to effects of prescribed treatment a. Patient teaching/counseling Reduction of weight Reduction of sodium intake Excess sodium expands aggravates HPN.

intravascular

volume

and

 aim for less than 1,500 mg per day

Reduction of alcohol intake Alcohol increases the risk of obesity and may cause a rise in blood pressure. o Recommended intake is less than 60 ml spirit, 240 ml wine, or 720 ml beer per day. Eat a heart-healthy diet, including potassium and fiber, and drink plenty of water Discuss with the patient a plan of regular exercise Regular physical activity is a beneficial strategy to achieve and maintain a satisfactory weight. at least 30 minutes of aerobic exercise a day Exercise such as weight lifting is contraindicated to people with HPN because of the tremendous rise of blood pressure during activity. Teach the patient relaxation techniques which can be used to reduce stress. b. Teaching about medication most common side effects of diuretics: potassium depletion and orthostatic hypotension most common side effects of the different antihypertensive drugs: orthostatic hypotension take anti-hypertensive drugs at regular basis assume sitting or lying position for few minutes change position gradually avoid very warm bath avoid prolonged sitting or standing avoid tyramine-rich foods (CHON) as follows: aged cheese liver beer wine chocolate yoghurt herring pickle sausage soy sauce *these foods may cause hypertensive crisis c. Preventing non-compliance Inform the client that absence of symptoms does not indicate control of BP Advise the client against abrupt withdrawal of medication; reound hypertension may occur Device ways to facilitate remembering of taking medications ex. labeled containers Prepared by:

Dharline Abbygale Agullana Rodalie Bonoan BSN IV-B

Pathophysiology of Hypertension
systemic vascular afterload blood flow to the renal hyponatremia juxtaglomerular cells renin angiotensinog Angiotensinconverting enzyme (ACE) Angiotensi Angiotensin II hypovolemia

arteriolar peripheral blood

adrenal cortex aldosterone Na reabsorption H2O plasma volume (ECF)