TITLE: HYPERTENSION
TARGET CLIENT: Nursing Students
GENERAL OBJECTIVES: At the end of the discussion, the students will be able to understand and gain knowledge regarding the discussion which is all about
hypertension.
Specific Objectives
At the end of the
discussion, the students
will be able to:
i. Define Hypertension
ii. Categorize
the various classification
By: Frances Hannah V. Bumanglag
Content Time Allotment Methodology
What is Hypertension? 5-10 minutes Lecture-Discussion Method
- Hypertension, also known as high or raised blood pressure, is a
condition in which the blood vessels have persistently raised pressure.
Blood is carried from the heart to all parts of the body in the vessels.
Each time the heart beats, it pumps blood into the vessels. Blood
pressure is created by the force of blood pushing against the walls of
blood vessels (arteries) as it is pumped by the heart. The higher the
pressure, the harder the heart has to pump.
Incidence:
- According to the World Health Organization (WHO), hypertension
causes 7 million deaths every year while 1.5 billion people suffer due to its
complication.
- In the Philippines, according to Department of Health (DOH)
hypertension prevalence in adult population (18 years old and above)
increased from 11% to 28% in 2013, with high incidence reported in Cavite.
Classification of Blood Pressure for Adults 10-15 minutes
 of blood pressure for
adults

Hypertensive crisis
- A blood pressure measurement higher than 180/120 mmHg is an
emergency situation that requires urgent medical care.
- Hypertensive crisis is an umbrella term for hypertensive urgency and
hypertensive emergency. These two conditions occur when blood pressure
becomes very high, possibly causing organ damage.
iii. Differentiate primary Etiology 5- 10 minutes
hypertension from Primary hypertension
secondary - This is also called essential hypertension. This when there is no known
hypertension cause for high blood pressure. This is the most common type of
hypertension. This type of blood pressure usually takes many years to
develop. It probably is a result of lifestyle, environment, and how the body
changes as we age.

Secondary hypertension
- This is when a health problem or medicine is causing high blood pressure.

By: Frances Hannah V. Bumanglag

 This tend to appear suddenly and cause higher blood pressure than does
primary hypertension. Things that can cause secondary hypertension
include:
- Kidney problems.
- Sleep apnea.
- Thyroid or adrenal gland problems.
- Medications (e.g. oral contraceptive pills and NSAID)
- Illegal drugs (e.g. cocaine and amphetamines)
iv. Enumerate risk Non-modifiable Risk Factors 15-20 minutes
factors of  Family History- High blood pressure tends to run in families. Men with
hypertension both parents with hypertension or men with one parent who was
hypertensive before the age of 55 years old had much higher risk of
developing hypertension especially at a younger age.
 Age- The risk of high blood pressure increases as a person age. Until
about age 64, high blood pressure is more common in men. Women are
more likely to develop high blood pressure after age 65. Although high
blood pressure is most common in adults, children may be at risk, too.
For some children, high blood pressure is caused by problems with the
kidneys or heart. But for a growing number of kids, poor lifestyle habits,
such as an unhealthy diet, obesity and lack of exercise, contribute to high
blood pressure.
 Gender- More common in men than women. Women more likely to
develop hypertension after menopause.
 Race or ethnicity- Black people develop high blood pressure more often
than white people, Hispanics, Asians, Pacific Islanders, American
Indians, or Alaska Natives do. Compared with white people, black people
also develop high blood pressure earlier in life.

By: Frances Hannah V. Bumanglag

  Diabetes Mellitus- Two third of adults who have diabetes also have
hypertension. The risk of developing hypertension when someone has a
familiar background of diabetes and obesity is 2 to 6 times greater than
person without this family history. Diabetes damages arteries and makes
them targets for hardening, called atherosclerosis. That can cause high
blood pressure, which if not treated, can lead to trouble including blood
vessel damage, heart attack, and kidney failure.
 Other chronic diseases- High cholesterol; Kidney diseases; Sleep
apnea. Hypertension combined with other chronic diseases greatly
increases risk for complications. Hypertension (high blood pressure) and
diabetes are common chronic diseases and both are risk factors for
coronary artery disease.

Modifiable Risk Factors

 Weight- Overweight or obesity, if we have higher body mass index, our
body need more blood to supply nutrients and oxygen the tissues. As the
blood volume circulation increases it will increase the pressure in the
artery walls.
 Stress- High levels of stress can lead to a temporary increase in blood
pressure. The body produces a surge of hormones when in a stressful
situation. These hormones temporarily increase blood pressure by
causing the heart to beat faster and blood vessels to narrow.
 Unhealthy diet- Over time, excessive salt intake can lead to high blood
pressure (hypertension), which stiffens and narrows the blood vessels.
Blood and oxygen flow to key organs decreases. So the heart tries
harder to pump blood throughout the body, which further increases blood
pressure.

By: Frances Hannah V. Bumanglag

  Addictions:
Cigarette- has nicotine content that cause vasoconstriction that impedes
the blood flow going to the other parts of the body. Every puff of cigarette
smoke causes a slight, temporary increase in blood pressure. The chemicals
in tobacco are also known to damage the lining of the arterial walls.
Alcoohol intake- Moderate to excessive alcohol consumption is linked to
raised blood pressure and an increased risk of stroke. The regular
consumption of 3-4 alcoholic drinks per day increases the risk of
hypertension and reduce the action of antihypertensive therapy.
 Sedentary lifestyle- A sedentary lifestyle is a major risk factor for heart
and blood vessel (cardiovascular) disease. For example, people who are
less active and less physically fit have a 30%-50% greater frequency
(incidence) of hypertension (high blood pressure) than their more active
peers.
v. Enumerate the signs What are the symptoms of high blood pressure? 10-15 minutes
and symptoms of
hypertension Myth: People with high blood pressure will experience symptoms, like
nervousness, sweating, difficulty sleeping or facial flushing.
Truth: High blood pressure is a largely symptomless “silent killer.” If a person
ignores his or her blood pressure because they think a certain symptom or
sign will alert them to the problem, they are taking a dangerous chance with
their life,

These are the signs and symptoms of hypertension:

1. Blured Vision – Hypertension can damage the blood vessels in the
retina. Retina is located at the back part of the eye which is

By: Frances Hannah V. Bumanglag

 responsible for focusing the object that we see in order to have a
clearer and better view of the image. If there is an increase pressure
inside our blood vessels in the eyes, these blood vessels thicken
resulting impending blood flow to the retina thus problems in vision
occurs. Blured vision sometimes result in dizziness.
2. Dizziness – Dizziness is one of the symptoms that can be experience
by a person who has uncontrolled hypertension. Dizziness occurs due
to narrowing of blood vessel inside the brain thus insufficient blood
blow and inadequate oxygen to brain cells.
3. Fatigue – This usually is result of abnormal blood flow leading to
inadequate oxygen to different cells and vital parts of the body like
heart, brain and kidney.
4. Irregular heart beat- This is also known as palpitation. It is usually felt
as a strong then weak and rapid heartbeats. Normally the heart beats
at a normal rate and rhythm but in order to compensate for decrease
blood supply to parts of the body due to vasoconstriction, the heart
needs to pump faster and harder in order to have a normal blood flow.
5. Headache and nape pain- Headache is characterized as generalized
or hair bond type pain that is most severe in the morning and
diminishes throughout the day. It is cause by the build-up of pressure
in the cranium. High blood pressure or hypertension can also trigger
pain in the nape of neck due to increase pressure in the blood vessels,
which passes through the neck region.
6. Chest pain and difficulty of breathing- The blood contains 3
components which are RBC, WBC and platelets. These components
are essential especially to RBC which is considered as the oxygen
carrier. RBC is responsible for spreading oxygen needed in the body

By: Frances Hannah V. Bumanglag

 which passes through our blood vessels. But if our own blood vessels
were damaged and obstructed, there will be an increase pressure thus
impending the blood flow. When there is inadequate blood flow within
our body, oxygen will not also be delivered within our cells resulting
difficulty of breathing and further result to chest pain if left unmanaged.
vi. Identify the COMPLICATIONS: 5-10 minutes
complications of  HEART ATTACK / STROKE
hypertension High blood pressure can cause hardening and thickening of the
arteries (atherosclerosis) which can lead to heart attack, stroke or
other complications.
 HEART FAILURE
To pump blood against the higher pressure in the vessels, the heart
has to work harder. Eventually, the thickened muscle may have a hard
time pumping enough blood to meet body’s needs.
 ANEURYSM
Increase blood pressure can cause the blood vessel to weakened and
bulge forming an aneurysm if an aneurysm is ruptures, it can be life
threatening.
 KIDNEY FAILURE
A weak and narrowed blood vessels in the kidney can prevent the
organs to function normally.
vii. Recall the tools used How is high blood pressure measured? 15- 20 minutes
in taking blood - High blood pressure is measured with a blood pressure monitor. This is a
pressure and how common test for all doctor visits.
to take blood
pressure What is blood pressure?

By: Frances Hannah V. Bumanglag

 measurements  The pressure that your blood exerts against the arteries as it is pumped
through the body by the heart.
 The pressure in the arteries increases when the heart beats and
decreases while it is resting.

Tools used to measure blood pressure

 Sphygmomanometer- (blood pressure cuff) that fits over a person's
arm and is inflated using an attached bulb. The purpose of the cuff is to
temporarily stop blood flow. It also has a dial that measures pressure in
the cuff. A valve lets air out of the cuff.
Parts of Sphygmomanometer:
 Dial- used to read blood pressure
 Cuff- used to temporarily stop blood flow
 Pump- inflates the cuff to stop blood flow
 Valve- lets air out of the cuff, allowing it to deflate

 Stethoscope- is the other tool used to measure blood pressure. It is an

iconic medical tool used to amplify a patient's heartbeat as heard from
the heart directly or as the pulse from an artery. When used with a blood
pressure cuff, you can hear the blood flowing through the brachial artery
(in the arm) in order to measure blood pressure.

Blood pressure is measured in mmHg (millimeters of mercury) and

given as a fraction:
systolic pressure / diastolic pressure

 Systolic Pressure- the systolic pressure measures the force generated

By: Frances Hannah V. Bumanglag

 on the arterial walls by the contraction of the ventricles (left ventricle is
what is actually being measured).
 Diastolic pressure- measures the time after the ventricles contract and
the chambers of the heart are refilling with blood.

Procedure:
 Sit comfortably with arm supported at heart level
 Snugly wrap the sphygmomanometer cuff around
the upper arm, one inch above the elbow
 Place the stethoscope just above the crease of the
elbow
 Pump the cuff to around 180-200 mmHg
 While listening with the stethoscope, slowly open
the valve to let the pressure fall
 When you first hear the beat of the blood flow, that is the systolic
pressure
 When you last hear the beat of the blood flow, that is the diastolic
pressure
viii. Identify Pharmacologic Management 20-30 minutes
pharmacologic,  Diuretics. Diuretics, sometimes called water pills, are medications that
non-pharmacologic and help the kidneys eliminate sodium and water from the body. These drugs
nursing management for are often the first medications tried to treat high blood pressure. There
hypertension are different classes of diuretics, including thiazide, loop and potassium
sparing. Diuretics commonly used to treat blood pressure include
chlorthalidone, hydrochlorothiazide (Microzide) and others. A common
side effect of diuretics is increased urination, which could reduce
potassium levels. If a patient have a low potassium level, physician may

By: Frances Hannah V. Bumanglag

 add a potassium-sparing diuretic — such as triamterene (Dyazide,
Maxide) or spironolactone (Aldactone) — to the treatment.
 Angiotensin-converting enzyme (ACE) inhibitors. These medications
— such as lisinopril (Prinivil, Zestril), benazepril (Lotensin), captopril and
others — help relax blood vessels by blocking the formation of a natural
chemical that narrows blood vessels.
 Angiotensin II receptor blockers (ARBs). These medications relax
blood vessels by blocking the action, not the formation, of a natural
chemical that narrows blood vessels. ARBs include candesartan
(Atacand), losartan (Cozaar) and others.
 Calcium channel blockers. These medications — including amlodipine
(Norvasc), diltiazem (Cardizem, Tiazac, others) and others — help relax
the muscles of the blood vessels. Some slow the heart rate. Calcium
channel blockers may work better for older people and people of African
heritage than do ACE inhibitors alone. Don't eat or drink grapefruit
products when taking calcium channel blockers. Grapefruit increases
blood levels of certain calcium channel blockers, which can be
dangerous.
 Alpha blockers. These medications reduce nerve signals to blood
vessels, lowering the effects of natural chemicals that narrow blood
vessels. Alpha blockers include doxazosin (Cardura), prazosin
(Minipress) and others.
 Alpha-beta blockers. Alpha-beta blockers block nerve signals to blood
vessels and slow the heartbeat to reduce the amount of blood that must
be pumped through the vessels. Alpha-beta blockers include carvedilol
(Coreg) and labetalol (Trandate).
 Beta blockers. Also known as beta-adrenergic blocking agents, are

By: Frances Hannah V. Bumanglag

 medications that reduce blood pressure. Beta blockers work by blocking
the effects of the hormone epinephrine, also known as adrenaline. These
medications reduce the workload of the heart and widen blood vessels,
causing the heart to beat slower and with less force. Beta blockers
include acebutolol, atenolol (Tenormin) and others. Beta blockers aren't
usually recommended as the only medication prescribed, but they may
be effective when combined with other blood pressure medications.
 Aldosterone antagonists. These drugs also are considered diuretics.
Examples are spironolactone and eplerenone (Inspra). These drugs
block the effect of a natural chemical that can lead to salt and fluid
buildup, which can contribute to high blood pressure. They may be used
to treat resistant hypertension.
 Renin inhibitors. Aliskiren (Tekturna) slows the production of renin, an
enzyme produced by the kidneys that starts a chain of chemical steps
that increases blood pressure. Due to a risk of serious complications,
including stroke, a patient shouldn't take aliskiren with ACE inhibitors or
ARBs.
 Vasodilators. These medications include hydralazine and minoxidil.
They work directly on the muscles in the walls of the arteries, preventing
the muscles from tightening and the arteries from narrowing.
 Central-acting agents. These medications prevent your brain from
telling the nervous system to increase the heart rate and narrow the
blood vessels. Examples include clonidine (Catapres, Kapvay),
guanfacine (Intuniv) and methyldopa.

Non-Pharmacologic Management
 Follow the DASH Diet.

By: Frances Hannah V. Bumanglag

 The U.S. National Heart Lung and Blood Institute (NHLBI) recommends the
DASH diet for people with high blood pressure. DASH, or "Dietary
Approaches to Stop Hypertension," has been specially designed to help
people lower their blood pressure.
 eating fruits, vegetables, and whole grains
 eating low-fat dairy products, lean meats, fish, and nuts
 eliminating foods that are high in saturated fats, such as processed
foods, full-fat dairy products, and fatty meatsweight loss for overweight or
obese patients with a heart healthy diet
 Quitting smoking- Cigarette has nicotine content that cause
vasoconstriction that impedes the blood flow going to the other parts of
the body. Every puff of cigarette smoke causes a slight, temporary
increase in blood pressure. The chemicals in tobacco are also known to
damage blood vessels.
 Sodium restriction and potassium supplementation within the diet-
The combination of a low sodium/high potassium diet may lower blood
pressure by affecting cardiac output. The more potassium you eat, the
more sodium you lose through urine. Potassium also helps to ease
tension in the blood vessel walls, which helps further lower blood
pressure.
 Increased physical activity with a structured exercise program-
Engage in aerobic exercise at least 30 minutes daily for most days
(range of approximate SBP reduction, 4-9 mm Hg). Physical activity is
another important lifestyle change for managing high blood pressure.
Doing aerobics and cardio for 30 minutes with a goal of five times a week
is a simple way to add to a healthy heart routine. These exercises will get
the blood pumping.

By: Frances Hannah V. Bumanglag

  Limit alcohol intake. Men should be limited to no more than 2 and
women no more than 1 standard alcohol drink(s) per day. Moderate to
excessive alcohol consumption is linked to raised blood pressure and an
increased risk of stroke.

Nursing Management
Nursing Assessment
 Nursing assessment must involve careful monitoring of the blood
pressure at frequent and routinely scheduled intervals.
 If patient is on antihypertensive medications, blood pressure is assessed
to determine the effectiveness and detect changes in the blood pressure.
 Complete history should be obtained to assess for signs and symptoms
that indicate target organ damage.
 Pay attention to the rate, rhythm, and character of the apical and
peripheral pulses.

Nursing Diagnosis
Based on the assessment data, nursing diagnoses may include the following:
 Deficient knowledge regarding the relation between the treatment
regimen and control of the disease process.
 Noncompliance with the therapeutic regimen related to side effects of the
prescribed therapy.
 Risk for activity intolerance related to imbalance between oxygen supply
and demand.
 Risk-prone health behavior related to condition requiring change in
lifestyle.

By: Frances Hannah V. Bumanglag

 Nursing Goals
The major goals for a patient with hypertension are as follows:
 Understanding of the disease process and its treatment.
 Participation in a self-care program.
 Absence of complications.
 BP within acceptable limits for individual.
 Cardiovascular and systemic complications prevented/minimized.
 Disease process/prognosis and therapeutic regimen understood.
 Necessary lifestyle/behavioral changes initiated.
 Plan in place to meet needs after discharge.

Nursing Interventions
The objective of nursing care focuses on lowering and controlling the blood
pressure without adverse effects and without undue cost.
 Encourage the patient to consult a dietitian to help develop a plan for
improving nutrient intake or for weight loss.
 Encourage restriction of sodium and fat
 Emphasize increase intake of fruits and vegetables.
 Implement regular physical activity.
 Advise patient to limit alcohol consumption and avoidance of tobacco.
 Assist the patient to develop and adhere to an appropriate exercise
regimen.
ix. Enumerate follow-up Follow-up Care for Hypertension 10-15 minutes
recommendations
for patient The most important element in the management of high blood pressure is
treatment follow-up care.
 Check with a health care provider periodically to make sure that blood

By: Frances Hannah V. Bumanglag

 pressure is in the recommended range. If it is not, treatment should be
adjusted. In fact, patients with high blood pressure should see their
providers at least once per year and more frequently during medication
adjustment phases.
 In low-risk adults with elevated BP or stage 1 hypertension with low
Atherosclerotic cardiovascular disease (ASCVD) risk, BP should be
repeated after 3-6 months of nonpharmacologic therapy.
 Adults with stage 1 hypertension and high ASCVD risk (≥10% 10-year
ASCVD risk) should be managed with both nonpharmacologic and
antihypertensive drug therapy with repeat BP in 1 month.
 Adults with stage 2 hypertension should be evaluated by a primary care
provider within 1 month of initial diagnosis, and be treated with a
combination of nonpharmacologic therapy and 2 antihypertensive drugs
of different classes with repeat BP evaluation in 1 month.
 For adults with a very high average BP (e.g., ≥160 mm Hg or DBP ≥100
mm Hg), prompt evaluation and drug treatment followed by careful
monitoring and upward dose adjustment is recommended.

By: Frances Hannah V. Bumanglag