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Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the blood pressure is chronically elevated. Hypertension is defined as a sustained elevation in the mean arterial pressure. It is often an asymptomatic disorder characterized by persistent elevation of blood pressure associated with the thickening and loss of elasticity in the arterial walls.

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Human resources: Time and effort of the nurse and family members

2. Enumerate

classifications hypertension

the of

Hypertension can be classified either primary or secondary. Primary hypertension indicates that no specific medical cause can be found to explain a patient's condition. It is also called essential hypertension or idiopathic hypertension. About 90 % of all hypertensive have primary hypertension. Secondary hypertension indicates that the high blood pressure is a result of (i.e., secondary to) another condition, such as kidney disease or tumours.

3 mins Material resources: Visual aids; special papers, low cost supplies Expenses for teaching aids

3. Identify

the classification of BP and categories of hypertension for adults 18 and older factors

Normal is classified with a blood pressure of <120 mmHg systolic and <80 mmHg diastolic. Pre-hypertension is classified with a blood pressure of 102-139 mmHg systolic and 80-89 mmHg diastolic. Stage 1 hypertension is classified with a blood pressure of 140-159 mmHg systolic and 9099mmHg diastolic. The risk of hypertension is 5 times higher in the obese as

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4. Contributing of factors

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compared to those of normal weight and up to two-thirds of cases can be attributed to excess weight. More than 85% of cases occur in those with a BMI>25. Sodium sensitivity Sodium is an environmental factor that has received the greatest attention. Approximately one third of the essential hypertensive population is responsive to sodium intake. This is due to the fact that increasing amounts of salt in a person's bloodstream causes cells to release water (due to osmotic pressure) to equilibrate concentration gradient of salt between the cells and the bloodstream; increasing the pressure on the blood vessel walls. Role of renin Renin is an enzyme secreted by the juxtaglomerular apparatus of the kidney and linked with aldosterone in a negative feedback loop. The range of renin activity observed in hypertensive subjects tends to be broader than in normotensive individuals. In consequence, some hypertensive patients have been defined as having lowrenin and others as having essential hypertension. Low-renin hypertension is more common in African Americans than white Americans, and may explain why African Americans tend to respond better to diuretic therapy than drugs that interfere with the renin-angiotensin system. High Renin levels predispose to Hypertension: Increased Renin Increased Angiotensin II Increased Vasoconstriction, Thirst/ADH and Aldosterone Increased Sodium Resorption in the Kidneys (DCT and CD) Increased Blood Pressure. Some authorities claim that potassium might both prevent and treat hypertension.

Insulin resistance Insulin is a polypeptide hormone secreted by cells in the islets of langerhans, which are contained throughout the pancreas. Its main purpose is to regulate the levels of glucose in the body antagonistically with glucagon through negative feedback loops. Insulin also exhibits vasodilatory properties. In normotensive individuals, insulin may stimulate sympathetic activity without elevating mean arterial pressure. However, in more extreme conditions such as that of the metabolic syndrome, the increased sympathetic neural activity may over-ride the vasodilatory effects of insulin. Insulin resistance and/or hyperinsulinemia have been suggested as being responsible for the increased arterial pressure in some patients with hypertension. This feature is now widely recognized as part of syndrome X, or the metabolic syndrome. Genetics Hypertension is one of the most common complex disorders, with genetic heritability averaging 30. Data supporting this view emerge from animal studies as well as in population studies in humans. Most of these studies support the concept that the inheritance is probably multifactorial or that a number of different genetic defects each have an elevated blood pressure as one of their phenotypic expressions. Age Over time, the number of collagen fibers in artery and arteriole walls increases, making blood vessels stiffer. With the reduced elasticity comes a smaller cross-sectional area in systole, and so a raised mean arterial blood pressure.

Liquorice Consumption of liquorice (which can be of potent strength in liquorice candy) can lead to a surge in blood pressure. People with hypertension or history of cardiovascular disease should avoid liquorice raising their blood pressure to risky levels. Frequently, if liquorice is the cause of the high blood pressure, a low blood level of potassium will also be present. Hypertension is usually found incidentally by healthcare professionals measuring blood pressure during a routine checkup. In isolation, it usually produces no symptoms although some people report headaches, fatigue, dizziness, blurred vision, facial flushing, transient insomnia or difficulty sleeping due to feeling hot or flushed, and tinnitus during beginning onset or before hypertension diagnosis. Hypertension is often confused with mental tension, stress and anxiety. While chronic anxiety and/or irritability is associated with poor outcomes in people with hypertension, it alone does not cause it. Accelerated hypertension is associated with somnolence, confusion, visual disturbances, and nausea and vomiting (hypertensive encephalopathy).

5. Identify the signs and

symptoms hypertension of

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6. Enumerate the ways on how hypertension can be diagnosed

Diagnosis in adults as made when an average of two or more diastolic readings on at least two subsequent visits is between 80-90 mmHg or when the average on multiple systolic BP on two or more subsequent visits is between 120-139 mmHg. Tests are undertaken to identify possible causes of secondary hypertension, and seek evidence for end-organ damage to the heart itself or the eyes (retina) and kidneys. Diabetes and raised cholesterol levels being additional risk factors for the development of

cardiovascular disease are also tested for as they will also require management. Blood tests commonly performed include:

Creatinine (renal function) - to identify both underlying renal disease as a cause of hypertension onset of and conversely hypertension causing kidney

damage. Also a baseline for later monitoring the possible side-effects of certain antihypertensive drugs. 7. List the nonpharmacological and non-pharmacological management for hypertension

Electrolytes (sodium, potassium) Glucose - to identify diabetes mellitus Cholesterol 21 mins

Lifestyle modification (nonpharmacologic treatment) Weight reduction and regular aerobic exercise (e.g., jogging) are recommended as the first steps in treating mild to moderate hypertension. Regular mild exercise improves blood flow and helps to reduce resting heart rate and blood pressure. These steps are highly effective in reducing blood pressure, although drug therapy is still necessary for many patients with moderate or severe hypertension to bring their blood pressure down to a safe level.

Reducing dietary sugar intake Reducing sodium (salt) in the diet is proven very effective: it decreases blood pressure in about 60 percent

of people (see above). Many people choose to use a salt substitute to reduce their salt intake.

Additional dietary changes beneficial to reducing blood pressure includes the DASH which diet (dietaryapproaches is rich in fruits and to stop hypertension),

vegetables and low fat or fat-free dairy foods. This diet is shown effective based on research sponsored by the US National Institutes of Health.[citation

In addition, an

increase in daily calcium intake has the benefit of increasing dietary potassium, which theoretically can offset the effect of sodium and act on the kidney to decrease blood pressure. This has also been shown to be highly effective in reducing blood pressure.

Discontinuing tobacco use and alcohol consumption has been shown to lower blood pressure. The exact mechanisms are not fully understood, but blood pressure (especially systolic) always transiently increases following alcohol and/or nicotine consumption. Besides, abstention from cigarette smoking is important for people with hypertension because it reduces the risk of many dangerous outcomes of hypertension, such as stroke and heart attack. Note that coffee drinking (caffeine ingestion) also increases blood pressure transiently, but does not produce chronic hypertension.

Reducing stress, for example with relaxation therapy, such as meditation and other mindbody relaxation techniques, by reducing environmental stress such as high sound levels and over-illumination can be an additional

method used,



hypertension. paced

Jacobson's breathing,

Progressive Muscle Relaxation and biofeedback are also particularly, device-guided although meta-analysis suggests it is not effective unless combined with other relaxation techniques. Medications Unless hypertension is severe, lifestyle changes such as those discussed in the preceding section are strongly recommended before initiation of drug therapy. Adoption of the DASH diet is one example of lifestyle change repeatedly shown to effectively lower mildly-elevated blood pressure. If hypertension is high enough to justify immediate use of medications, lifestyle changes are initiated concomitantly. There are many classes of medications for treating hypertension, together called antihypertensives, which by varying means act by lowering blood pressure. Evidence suggests that reduction of the blood pressure by 5-6 mmHg can decrease the risk of stroke by 40%, of coronary heart disease by 15-20%, and reduces the likelihood of dementia, heart failure, and mortality from vascular disease. The aim of treatment should be blood pressure control to <140/90 mmHg for most patients, and lower in certain contexts such as diabetes or kidney disease (some medical professionals recommend keeping levels below 120/80 mmHg). Each added drug may reduce the systolic blood pressure by 5-10 mmHg, so often multiple drugs are necessary to achieve blood pressure control. Commonly used drugs include: ACE inhibitors such as creatine captopril, enalapril,

fosinopril (Monopril), lisinopril (Zestril), quinapril, ramipril (Altace) Angiotensin II receptor antagonists: eg, telmisartan (Micardis, Pritor), irbesartan (Avapro), losartan (Cozaar), valsartan (Diovan), candesartan (Amias) Alpha blockers such as prazosin, or terazosin. Doxazosin has been shown to increase risk of heart failure, and to be less effective than a simple diuretic, so is not recommended. Beta blockers such as atenolol, labetalol, metoprolol (Lopressor, Toprol-XL), propranolol. Calcium channel blockers such as nifedipine (Adalat) amlodipine (Norvasc), diltiazem, verapamil Direct renin inhibitors such as aliskiren (Tekturna) Diuretics: eg, bendroflumethiazide, chlortalidone, hydrochlorothiazide (also called HCTZ) Combination products (which usually contain HCTZ and one other drug)


Black, MEDICAL SURGICAL NURSING. 8TH edition. Elsevier Pte Ltd. Singapore, 2008 al. PUBLIC HEALTH NURSING IN THE PHILIPPINES. 10th edition. National League of Philippine Government Nurses, Incorporated. Philippines, 2007