BONUS TOPIC: HYPERTENSION

HYPERTENSION (HTN)

DEFINITION:

Unfortunately, HTN is known as the SILENT KILLER. When a patient starts to have signs and symptoms
with hypertension, major organs have already been affected (a person can have it for years without
knowing it).

To remember organs in damaged by high BP: “CAKE”

Cardiac system - congestive heart failure (due to the overworking of the heart muscle which makes it
become enlarged)

brAin: stroke (increase pressure weakens blood vessels which can cause a clot to form or for them to
rupture)

Kidneys: renal failure (weakens and narrows the arteries to the kidneys and the kidneys don’t receive
proper perfusion)

Eyes: visual changes (damages blood vessels to the retina…blurred vision..can’t focus images)

Causes of Hypertension
Primary/Essential Hypertension: Secondary Hypertension:
RISK FACTORS Caused by a pre-existing issue. There is something
causing the person to have high blood pressure:

Race (black males)

Pregnancy
Increased consumption of salt/alcohol Chronic Renal Failure
Smoking/stress Diabetes

K+ level and vitamin d level low Hypo/hyperthyroidism

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BONUS TOPIC: HYPERTENSION

Family health Tumor on adrenal gland which cause

adrenaline/noradrenaline to be secreted increase BP)
Advanced aged
Congenital defect main artery of the body is super
Cholesterol high narrow and this leads to high blood pressure)

Too much caffeine intake

Obese

Restricting activity

Sleep apnea

ASSESSMENT

Remember, hypertension is silent killer. It is probably be without symptoms. But if it does, these are the
things we should take not:

• Headache*
• Blurry vision*
• Chest Pain*
• Nose bleeds
• Ringing in the ears
• Dizzy
*Most common symptoms

MANAGEMENT

Assess: measure blood pressure (obtain in both arms…make sure patient has been in a resting position for
5 minutes, no smoking, causes vasoconstriction), ask about family history, and if they have any sensory
changes

Evaluate: blood pressure reading, dietary intake, body mass index (overweight)

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BONUS TOPIC: HYPERTENSION

Educate: limiting sodium, alcohol and caffeine in diet, quit smoking (vasoconstriction), start an exercise
program (cardiovascular) for weight loss, importance of medication compliance (some patients think if
their blood pressure reading are good they don’t need to take their medication anymore), measuring blood
pressure regularly and keeping a record of it and bringing it to the doctor’s office.

NOTE: Vasoconstriction is the narrowing (constriction) of blood vessels by small muscles in their walls.
When blood vessels constrict, blood flow is slowed or blocked. Vasoconstriction may be slight or severe

ANTIHYPERTENSIVE MEDICATIONS
Typically, non-pharmalogical techniques are implemented for about 1 to 3 months while monitoring the
patient’s blood pressure, and then if not controlled, medications are started.

Thiazide Diuretics: End in “iazide” HCTZ (hydrochlorothiazide), Diuril (Chlorothiazide)

• Work by removing water and sodium through the kidneys WATCH BUN and CREATININE Levels.
• Not for patients in renal failure
• Watch patients who are taking Lithium (increases chances of Lithium toxicity)
• WASTE POTASSIUM…educate about potassium supplement compliance, and photosensitivity
ACE Inhibitors (Angiotension -Converting Enzyme Inhibitors): End in “PRIL” Lisinopril

• Prevent vasoconstriction by blocking Angiotension 1 and 2

• Educate pt about a dry cough/taste changes
• Avoid potassium substitutes or supplement…this drug causes potassium retention
• Compliance very important due to rebound hypertension
• Captopril (increased risk of bleeding) and Moexipril…take 1 hour BEFORE a meal

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BONUS TOPIC: HYPERTENSION
ARBS (Angiotension Receptor Blockers): drugs that end in “sartan” ex: Losartan (may be prescribed in
place of ACE inhibitors if patient can’t tolerate ACE Inhibitor)

• Works by causing vasodilation by blocking aldosterone and Angiotension

• Same side effects as ACEI (except dry cough)
• Increase k+ level
CCB (Calcium Channel Blockers): end in “dipine” Amlodipine, and Cardizem, Verapamil

• Slow the heart rate to decrease the work load on the heart and cause vasodilation which lowers
blood pressure
• Watch HR: bradycardia
• Watch pts who have CHF or AV blocks
BB: Beta blockers: end in “olol” ex: Labetalol, Metoprolol

• Affects epinephrine and norepinephrine which blocks the sympathetic nervous system of the heart
and this keeps the heart rate nice and low which helps dilates vessel which lowers blood pressure
• Not for patients with asthma and COPD because this medication blocks the receptors in the lungs
and causes bronchoconstriction
• Monitor Glucose levels in diabetics because it conceals the signs of hypoglycemia
• Monitor heart rate and for orthostatic hypotension

BLOOD PRESSURE STAGES

Lifestyle Without serious With serious
CATEGORY Systolic Diastolic Changes symptoms symptoms
NORMAL LESS AND LESS Encouraged NONE NONE
THAN THAN
120 80
PRE- 120- AND LESS YES ANTIHYPERTENSIVE ANTIHYPERTENSIVE
HYPERTENSION 129 THAN MEDS NOT MEDS
80 REQUIRED
STAGE 1 HTN 130- OR 80-89 YES
139 DRUG THERAPY NEEDED
STAGE 2 HTN 140 OR OR 90 OR YES
HIGHER HIGHER TWO-DRUG COMBINATION THERAPY
HYPERTENSIVE HIGHER HIGHER CONSULT DOCTOR IMMEDIATELY!
CRISIS THAN AND/OR
THAN YES BRING PATIENT TO THE HOSPITAL
180 120

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