Hypertension particularly in target organs such as the heart,

kidneys, brain, and eyes.

 most common chronic disease among adults
 as a systolic blood pressure (SBP) of 140 mm Hg
or higher or a diastolic blood pressure (DBP) of
90 mm Hg or higher, based on the average of
two or more accurate blood pressure
measurement
JNC 7 and ASH and ISH:
 blood pressure of less than 120/80 mm Hg
diastolic as normal
 120 to 139/80 to 89 mm Hg as prehypertension
 140/90 mm Hg or higher as hypertension
BP classification Systolic Diastolic
Normal <120 <80
Prehypertensio 120-139 80-89
n
Hypertension is accompanied with other risk factors
STAGE 1 140-159 90-99
for atherosclerotic disease
STAGE 2 >/-160 >/-100
Important side notes to remember:
 Primary hypertension (also called essential
hypertension), which is defined as high blood
pressure from an unidentified cause.
 secondary hypertension, which occurs when a
cause for the high blood pressure can be
Pathology
identified
 High blood pressure can also occur with
pregnancy; women who experience high blood
pressure during pregnancy are at increased risk
of ischemic heart disease, heart attacks,
strokes, kidney disease, diabetes, and death
from heart attack
 Hypertension is sometimes called the silent
killer because people who have it are often
symptom free
 Prolonged blood pressure elevation gradually
damages blood vessels throughout the body,
 The typical outcomes of prolonged,
uncontrolled hypertension are myocardial
infarction, heart failure, chronic kidney disease,
strokes, and impaired vision.
 Hypertrophy (enlargement) of the left ventricle
of the heart may occur as it works to pump
blood against the elevated pressure.
 is a multifactorial condition
Elevated pressure may indicate
 excessive dose of vasoconstrictive
medication,
 stress, or other problems
 risk factor for atherosclerotic cardiovascular
disease
1. dyslipidemia (abnormal blood lipid levels,
including high total
2. low-density lipoprotein [LDL]
3. triglyceride levels
4. low high-density lipoprotein)
5. obesity
6. diabetes
 Cardiac output is the product of the heart rate
multiplied by the stroke volume
 Hypertension can result from increases in
cardiac output, increases in peripheral
resistance (constriction of the blood vessels), or
both.
 there must also be a problem with the body’s
control systems that monitor or regulate
pressure
 tendency to develop hypertension is inherited

Many causes of hypertension have been suggested
 Increased sympathetic nervous system activity
 Increased renal reabsorption of sodium,
chloride, and water
 Increased activity of the renin–angiotensin–
Medical management
aldosterone system
 Decreased vasodilation of the arterioles
 Resistance to insulin action
 Activation of the innate and adaptive
components of the immune response
Gerontologic Considerations
 Structural and functional changes in the heart,
blood vessels, and kidneys contribute to
increases in blood pressure that occur with
aging
Clinical Manifestations
 Physical examination may reveal no
abnormalities
 retinal changes such as hemorrhages, exudates
(fluid accumulation), arteriolar narrowing, and
cotton-wool spots (small infarctions) occur
 severe hypertension, papilledema
 Left ventricular hypertrophy
 changes in the kidneys (indicated by increased
blood urea nitrogen [BUN] and serum creatinine
levels) may manifest as nocturia
 a transient ischemic attack (TIA) or stroke,
manifested by alterations in vision or speech,
dizziness, weakness, a sudden fall, or transient
or permanent paralysis on one side (hemiplegia)
Assessment and Diagnostic Findings
 urinalysis
 blood chemistry (i.e., analysis of sodium,
potassium, creatinine, fasting glucose, and total
and HDL cholesterol levels)
 12-lead electrocardiogram
 elevations in BUN and creatinine levels
 creatinine clearance
 renin level
 urine tests
 24-hour urine protein
1. Life Style modifications to prevent and manage
hypertension
 Weight reduction
 Adopt D.A.S.H. meaning DIETARY
APPROACHES TO STOP HYPERTENSION
diet (diet rich fruit and vegetables and
low fat dairy products, Lean meat, fish,
poultry, nuts seeds, and dry beans)
 Dietary sodium reduction (reduce
dietary sodium intake to <2400 mg
sodium daily)
 Physical activity (engage in physical
aerobic activity such as brisk walking)
 Limit consumption of alcohol to <2
drinks
2. Pharmacologic Therapy
 African American patients and all
patients 60 years of age and older with
stage I hypertension - a calcium
channel blocker or a thiazide diuretic
 Patients with stage I hypertension who
are not African American and are less
than 60 - angiotensin-converting
enzyme inhibitor (ACE-I) or an
angiotensin receptor blocker
To promote adherence to the regimen,
clinicians try to prescribe the simplest
treatment schedule possible, ideally one pill
once each day. The pill may be a single
agent or two or more agents combined into
a single pill

Gerontologic Considerations
 Isolated systolic hypertension is the most
common type of hypertension in adults older
than 50 years of age
 If medications are needed to achieve the blood
pressure goal of less than 150/90 mm Hg in the
older adult patient, the starting dose should be
the lowest available and then gradually
increased with a second medication from a
different class added if control is difficult to
achieve.
 Older adults must have more awareness of
possible drug interactions is critical
 In addition, older adults are at increased risk for
the side effects of hyperkalemia and orthostatic
hypotension, putting them at increased risk for
falls and fractures
Hypertensive Crises
 Two classes : hypertensive emergency and
hypertensive urgency
Can occur on patients:
 may occur in patients whose hypertension has
been poorly controlled,
 whose hypertension has been undiagnosed
 in those who have abruptly discontinued their
medications
Hypertensive emergency is a situation in which blood
pressures are extremely elevated and must be lowered
quickly (not necessarily to less than 140/90 mm Hg) to
halt or prevent damage to the target organs
 acute, life-threatening blood pressure
elevations that require prompt treatment in an
intensive care setting
Conditions associated with a hypertensive emergency
 hypertension of pregnancy
 acute myocardial infarction
 dissecting aortic aneurysm
 intracranial hemorrhage
Medical management:
1. Intravenous vasodilators, including sodium
nitroprusside (Nitropress), nicardipine
(Cardene), clevidipine (Cleviprex), enalaprilat
(Vasotec), and nitroglycerin
2. Assessing the patient’s fluid volume status.
 If there is volume depletion secondary
to natriuresis caused by the elevated
blood pressure, then volume
replacement with normal saline can
prevent large sudden drops in blood
pressure
Hypertensive urgency describes a situation in which
blood pressure is very elevated but there is no evidence
of impending or progressive target organ damage
 Headaches
 Nosebleeds
 anxiety
Medical management:
1. oral agents: beta-adrenergic blockers (i.e.,
labetalol [Trandate]), ACE inhibitors (i.e.,
captopril [Capoten]), or alpha2-agonists (i.e.,
clonidine [Catapres]
2. close hemodynamic monitoring of the patient’s
blood pressure and cardiovascular status
3. Taking vital signs every 5 minutes is
appropriate if the blood pressure is changing
rapidly; taking vital signs at 15- or 30- minute
intervals in a more stable situation may be
sufficient.