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Hypertension Refers to a State Where a Person’s Blood Pressure

Hypertension Refers to a State Where a Person’s Blood Pressure

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Published by: anne009 on Dec 07, 2009
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05/11/2014

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Hypertension refers to a state where a person’s blood pressure remains at an elevated level at alltimes. This condition is formally known as arterial hypertension and is popularly called high bloodpressure.Two types of hypertension:Primary Hypertension – when a patient’s chronically elevated blood pressure does not have aspecific medical cause that can be identifiedSecondary Hypertension – When high blood pressure is caused by other health conditions liketumors of the adrenal gland, kidney disease of other problems.Hypertension is a dangerous condition because it can lead to serious complications. Chronicallyelevated blood pressure increases the risk of developing heart failure, heart attacks, arterialaneurysm and strokes. Many cases of chronic renal failure have been linked to high bloodpressure.Signs and Symptoms:Undiagnosed high blood pressure can lead to many physical problems including damage to major organs over a period of time. The symptoms of hypertension, if ignored, can lead to deteriorationin kidney / liver function and cardiac problems. Hypertension can also damage vision, causestrokes and more.Here are some of the common hypertension symptoms to be aware of.Recurrent / persistent headachesVision problems including blurring of visionGiddinessConvulsionsTremors in the hands or other body partsWalking difficulties (formally called ataxia)INTRODUCTIONHypertension is one of the most common worldwide diseases afflicting humans. Because of theassociated morbidity and mortality and the cost to society, hypertension is an important publichealth challenge. Over the past several decades, extensive research, widespread patienteducation, and a concerted effort on the part of health care professionals have led to decreasedmortality and morbidity rates from the multiple organ damage arising from years of untreatedhypertension. Hypertension is the most important modifiable risk factor for coronary heart disease(the leading cause of death in North America), stroke (the third leading cause), congestive heartfailure, end-stage renal disease, and peripheral vascular disease. Therefore, health careprofessionals must not only identify and treat patients with hypertension but also promote ahealthy lifestyle and preventive strategies to decrease the prevalence of hypertension in thegeneral population.Pre-hypertension – Systolic blood pressure (SBP) 120-139 or diastolic blood pressure(DBP)80-89Stage I HTN SBP 140-159 or DBP 90-99Stage II HTN SBP >160 or DBP >100Hypertensive crises encompass a spectrum of clinical presentations where uncontrolled BPsleads to progressive or impending target organ dysfunction (TOD). The clinical distinctionbetween hypertensive emergencies and hypertensive urgencies depends on the presence of acute TOD and not on the absolute level of the BP.Hypertensive emergencies represent severe HTN with acute impairment of an organ system (eg,
 
central nervous system [CNS], cardiovascular, renal). In these conditions, the BP should belowered aggressively over minutes to hours.Hypertensive urgency is defined as a severe elevation of BP, without evidence of progressivetarget organ dysfunction. These patients require BP control over several days to weeks.CausesThe most common hypertensive urgency is a rapid unexplained rise in BP in a patient withchronic essential HTN.Other causes:Renal parenchymal disease – Chronic pyelonephritis, primary glomerulonephritis, tubulointerstitialnephritis (accounts for 80% of all secondary causes)Systemic disorders with renal involvement – Systemic lupus erythematosus, systemic sclerosis,vasculitidesRenovascular disease – Atherosclerotic disease, fibromuscular dysplasia, polyarteritis nodosaEndocrine – Pheochromocytoma, Cushing syndrome, primary hyperaldosteronismDrugs – Cocaine, amphetamines, cyclosporin, clonidine withdrawal, phencyclidine, diet pills, oralcontraceptive pillsDrug interactions – Monoamine oxidase inhibitors with tricyclic antidepressants, antihistamines,or tyramine-containing foodCNS – CNS trauma or spinal cord disorders, such as Guillain-Barré syndromeCoarctation of the aortaPreeclampsia/eclampsiaPostoperative hypertensionPhysicalVitalsBP should be measured in both the supine position and the standing position (assess volumedepletion).BP should also be measured in both arms (a significant difference suggests an aortic dissection).ENT: The presence of new retinal hemorrhages, exudates, or papilledema suggests ahypertensive urgency.Cardiovascular – Evaluate for the presence of heart failure.Jugular venous distensionCracklesPeripheral edemaAbdomen – Abdominal masses or bruitsCNSLevel of consciousnessVisual fieldsFocal neurologic signsTakayasu arteritis is a granulomatous vasculitis of unknown etiology that commonly affects thethoracic and abdominal aorta. It causes intimal fibroproliferation of the aorta, great vessels,pulmonary arteries, and renal arteries and results in segmental stenosis, occlusion, dilatation, andaneurysmal formation in these vessels. Takayasu arteritis is the only form of aortitis that causesstenosis and occlusion of the aorta.Takayasu disease has also been referred to as pulseless disease and aortic arch syndrome.During the acute inflammatory stage, Takayasu disease causes a low-grade temperature,tachycardia, pain adjacent to the inflamed arteries (eg, carotodynia), and easy fatigability in 50%
 
of patients. Carotid and clavicular bruits, asymmetric upper-extremity blood pressures,hypertension, diminished or absent upper-extremity pulses, and ischemic symptoms can suggestthe diagnosisANATOMY & PHYSIOLOGYCentral Nervous SystemMedulla Oblongata; relays motor and sensory impulses between other parts of the brain and thespinal cord. Reticular formation (also in pons, midbrain, and diencephalon) functions inconsciousness and arousal. Vital centers regulate heartbeat, breathing (together with pons) andblood vessel diameter.Hypothalamus; controls and intergrates activities of the autonomic nervous system and pituitarygland. Regulates emotional and behavioral patterns and circadian rhythms. Controls bodytemperature and regulates eating and drinking behavior. Helps maintain the waking state andestablishes patterns of sleep. Produces the hormones oxytocin and antidiuretic hormone.Cardiovascular SystemBaroreceptor, pressure-sensitive sensory receptors, are located in the aorta, internal carotidarteries, and other large arteries in the neck and chest. They send impulses to the cardiovascular center in the medulla oblongata to help regulate blood pressure. The two most importantbaroreceptor reflexes are the carotid sinus reflex and the aortic reflex.Chemoreceptors, sensory receptors that monitor the xhemical composition of blood, are locatedclose to the baroreceptors of the carotid sinus and the arch of the aorta in small structures calledcarotid bodies and aortic bodies, respectively. These chemoreceptors detect changes in bloodlevel of O2, CO2, and H+.Renal SystemRenin-Angiotensin-Aldosterone system. When blood volume falls or blood flow to the kidneysdecreases, juxtaglomerular cells in the kidneys secrete renin into the bloodstream. In sequence,renin and angiotensin converting enzyme (ACE) act on their substrates to produce the activehormone angiotensin II, which raises blood pressure in two ways. First, angiotensin II is a potentvasoconstrictor; it raises blood pressure by increasing systemic vascular resistance. Second, itstimulates secretion of aldosterone, which increases reabsorption of sodium ions and water bythe kidneys. The water reabsorption increases total blood volume, which increases bloodpressure.Antidiuretic hormone. ADH is produced by the hypothalamus and released from the posterior pituitary in response to dehydration or decreased blood volume. Among other actions, ADHcauses vasoconstriction, which increases blood pressure.Atrial Natriuretic Peptide. Released by cells in the atria of the heart, ANP lowers blood pressureby causing vasodilation and by promoting the loss of salt and water in the urine, which reducesblood volume.NURSING ASSESSMENTPresent Health HistoryThe present health history started 7 days prior to confinement at PCMC when the patient,experienced general body weakness, vomiting and elevated blood pressure. She was admitted atDuque’s Clinic for 3 days but no BP monitoring was done. After 3 days, she was transferred to

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