HYPERTENSION

□Abnormal elevation of SBP and DBP

□SBP- above 120mmHG, DBP-above
90mmHG
□Normal: <120/80 (looking at systolic &
diastolic)
□ AKA SILENT KILLER.
SBP DBP
□The first number, □ The second number, measures
measures the pressure the pressure in your arteries
in your arteries when when your heart rests between
beats.
your heart beats.
□ 60- 80 mmHg, Less than
□Less than 120mmHg, 90mmHg
90-120 mmHg
 TYPES OF HYPERTENSION
Essential/Primary HPN
□Accounts for 90%-95% of all cases
□Cause in unknown
□Stress related
Secondary HPN
□Due to known cause
□Renal failure, Hyperthyroidism, Pheochromocytoma, CKD,
etc
 TYPES OF HYPERTENSION
Malignant HPN
□Severe, rapid progressive elevation of BP
Labile HPN
□Intermittent elevated BP
Resistant HPN
□A HPN that does not respond to usual treatment
 TYPES OF HYPERTENSION
White Coat HPN
□Elevation of BP ONLY during clinic visits
Hypertensive Crisis
□Situation that requires immediate reduce of blood
pressure
□BP-above180/120mmHG
 Organs in involved in HPT
•Cardiac system:
congestive heart failure
•brAin: stroke
•Kidneys: renal failure
•Eyes: visual changes
 Causes of Hypertension
□ Race (black males)
□ Increased consumption of
salt/alcohol
□ Smoking/stress
□ K+ level and vitamin d level
low
□ Family health
□ Advanced aged
□ Cholesterol high
□ Too much caffeine intake
□ Obese
□ Restricting activity
□ Sleep apnea
 Secondary Hypertension
□ Pregnancy, Cushing Syndrome,
□ Chronic Renal Failure
□ Diabetes
□ Hyperthyroidism
□ Pheochromocytoma
□ Coarctation of the aorta
 Common Signs and Symptoms
□ Headache-occiput area □Tinnitus
□ Blurry vision □Nocturia
□ Chest Pain □Unsteadiness
□ Nose bleeds □Vomiting
□ Ringing in the ears
□ Dizzy
 Nursing Interventions
□Assess: measure blood pressure, MAP, ask about family
history, and any sensory changes
□Evaluate: blood pressure reading, dietary intake, body mass
index (overweight)
□Stress reduction through effective coping strategies
□Educate about HPN and medication therapy
 Patient Teaching
□Limiting sodium, and low saturated fat
□Avoid alcohol and caffeine in diet and smoking
□Start an exercise program for weight loss,
□Importance of medication compliance,
□Measuring blood pressure regularly and keeping a
record of it and bringing it to the doctor’s office.
□Advise the client not to stop medication abruptly
 Pharmacology for Hypertension
Thiazide Diuretics
□End in “iazide” HCTZ (hydrochlorothiazide), Diuril
(Chlorothiazide)
□First line drugs to control mild hypertension
□Work by removing water and sodium through the
kidneys
□Examples: K wasting diuretics, Loop Diuretics, Potassium
Sparring,
 K wasting diuretics
Thiazides
▪ends with “iazides”chlorothiazides,Hydrochlorothiazides,
▪Promote the excretion of sodium, K and water.
▪Promote calcium absorption
▪Use cautiously in clients with DM
▪SE: Hypokalemia, hypercalcemia, hypomagnesemia,
hyperglycemia
▪Contraindicated in renal failure
 NURSING INTERVENTIONS
IN THIAZIDES
•Monitor VS and serum electrolytes
disturbances especially signs of hypokalemia
•Check daily weights
•Monitor UO
•Administer early in the morning
•Instruct client to slowly change position-
Orthostatic hypotension
 NURSING INTERVENTIONS
IN THIAZIDES
▪ Check blood sugar regularly
▪ Use sunblock when in direct sunlight
▪ Take it with foods
▪ Instruct the client to eat rich in K
 Loop Diuretics
□Bumetanide, Ethacrynic acid, Lasix, Torsemide
□Acts on ascending loop of Henle
□Inhibit reabsorption of sodium, water, K , calcium and Mg
□SE: hypokalemia, hyponatremia, hypercalcemia,
hypomagnesemia, rash, ototoxicity, photosensitivity
□Furosemide is contraindicated if the client has
sensitivity to sulfonamides
 Nursing Interventions in LOOP
•Assess VS, electrolytes, weight and UO
•Administer FUROSEMIDE SLOWLY for at least
2 minutes
•Check serum K when client is taking DIGOXIN.
HYPOKALEMIA enhances the action of
DIGITALIS
•Administer the drug EARLY in the MORNING and
with FOOD
 Potassium Sparring
□Spironolactone, amiloride, triamterene
□Promote sodium and water excretion and
K retention
□Main SE: HYPERKALEMIA, anorexia,
nausea vomiting and diarrhea
 Nursing Interventions in
Potassium Sparring
□Assess VS, electrolytes, weight and output
□Observes signs of hyperkalemia
□Administer early in the morning
□Take it with foods
□Avoid K rich food and supplement
□Observe SE: rash dizziness, or weakness
 ACE Inhibitors (Angiotension -Converting
Enzyme Inhibitors)
□End in “PRIL” – Lisinopril, captopril, ramipril, perindopril,
fosinopril, enalapril
□Prevent vasoconstriction by blocking Angiotensin 1 and 2
□Avoid potassium substitutes or supplement
□Compliance very important due to rebound
hypertension
□Taken 1 hr before meal
 ACE Inhibitors (Angiotension
-Converting Enzyme Inhibitors)
•Should not be given during pregnancy- it
reduces placental blood flow
•Should not be taken with K sparring Diuretics
•SE: dry cough/taste changes, Hyperkalemia
 ARBS (Angiotensin-Receptor Blockers)

□drugs that end in “sartan” ex: Losartan, Irbesartan,

Telmisartan
□Works by causing vasodilation by blocking aldosterone and
Angiotensin II
□Same side effects as ACEI (except dry cough)
□Increase k+ level
 Calcium Channel Blockers
□end in “dipine” Amlodipine, and Nicardipine, 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
 Beta blockers
▪end in “lol” ex: Labetalol, Metoprolol, atenolol,
▪Affects epinephrine and norepinephrine which
blocks the sympathetic nervous system of the
heart
▪Reduces the heart rate, contractility, renin release and
helps dilates vessel which lowers blood pressure
 NURSING INTERVENTIONS
•Monitor VS-BP and Pulses
•Monitor BUN, creatinine and LDL
•Instruct the client to change the
position gradually
•Instruct the client to report the SE
 NURSING INTERVENTIONS
□ Use cautiously: Not for patients with asthma and
COPD
□ Monitor Glucose levels in diabetics because it
conceals the signs of hypoglycemia
□ Monitor heart rate and for orthostatic hypotension
□ Contraindication: Second and third degree heart block,
cardiogenic shock, CHF, sinus bradycardia.
 (GUIDELINES IN MANAGE BLOOD
PRESSURE, AHA)
▪ Weight loss
▪ Healthy diet-fruits,
vegetables, whole grains, low
fat products
▪ Moderate alcohol
▪ Reduce intake of
dietary sodium-<1500
mg/dat
▪ Enhance intake of
dietary potassium
▪ Exercise- aerobic activity at
least 90-150 minutes/week
▪ Dynamic resistance training-
exercises that includes joint
movement such as biceps
curl, squats
▪ Isometric resistance training-it
causes the muscles to produce
force, create no change in
length of the muscle