HYPERTENSI

ON
- Sustained, elevated, systemic, arterial
blood pressure; diastolic elevation more
serious, reflecting pressure on arterial
wall during resting phase of cardiac cycle
- Persistent elevation of blood pressure
for 2 or more consecutive readings
 CLASSIFICATIONS
(according to type and degree of severity)

1. Systolic and Diastolic Hypertension

a. Systolic HPN is systolic BP of 140 mmHg or
higher
b. Diastolic HPN is diastolic BP of 90 mmHg or
higher
2. Primary and Secondary HPN
a. Primary/Essential/Idiopathic HPN – occurs in
90-95% of patients; etiology unknown; diastolic
pressure is > 90 mmHg, and other causes of
hypertension are absent
b. Secondary HPN – occurs in remaining 5-10%
usually of renal, endocrine, neurogenic or
cardiac in origin
3. “White-Coat” Hypertension
- HPN in a person who is actually
normotensive except when his/her BP is
measured by a healthcare professional
4. Malignant Hypertension
- Uncontrollable and may arise from both types and
certain drugs (e.g., anesthesia)
- An emergency condition characterized by diastolic
BP above 120 mmHg
5. Labile (prehypertensive)
- A fluctuating blood pressure increases during
stress, otherwise normal or near normal
Risk Factors:
Non-modifiable

• Family history

• Age

• Sex

• Ethnic group
Modifiable
• Stress

• Obesity

• Diet

• Sedentary Lifestyle

• Substance/Drug Use:
▪ Cigarette Smoking
▪ Alcohol
▪ Birth Control Pills
▪ Caffeine
Pathophysiology:
Four control systems that play major roles in
maintaining blood pressure

1. Arterial baroreceptor system

2. Regulation of body fluid volume

3. Renin-Angiotensin-Aldosterone system

4. Vascular Autoregulation
Clinical Manifestations:
Subjective:
• Headache

• Lightheadedness

• Tinnitus

• Easy fatigability

• Visual disturbances

• Palpitations

• Brief lapses in memory

Clinical Manifestations:

Objective
• BP greater than 140/90

• Retinal changes

• Possible hematuria

• Cardiac hypertrophy
Medical Management:

• Lifestyle modification

• Weight reduction

• Sodium restriction

• Dietary fat modification

• Exercise

• Relaxation techniques

• Smoking cessation
 ANTIHYPERTENSIVE DRUGS
1. Alpha-Adrenergic Blockers
- Action: decreases peripheral vascular resistance;
relaxes smooth muscle of bladder/prostate
- Drugs: Medications that end in SIN

2. Central Alpha Agonists

- Action: decrease the release of adrenergic hormones
from the brain (medulla oblongata) which decreases
peripheral vascular resistance and reduces cardiac
contractility
- Drugs: Clonidine (Catapres); Guanabenz (Wytensin);
Methyldopa (Aldomet)
Consideration: Take last dose of the day at bedtime to
minimize drowsiness during the day
3. Beta-Adrenergic Blockers
- Action: these drugs exert antihypertensive effects by:
▪ Reducing contractility
▪ Reducing release of renin
▪ Reducing the cardiac output
- Drugs: medications that end in “olol” (e.g., Metropolol,
Propanolol, Nadolol)
4. Vasodilators
- Action: Direct relaxation of vascular smooth muscle
Drugs: Hydralazine (Apresoline); Nitroprusside
Considerations:
▪ Assess for peripheral edema of the hands and feet
▪ Take with food
▪ Review of BP
5. Calcium-Channel Blockers (Calcium Antagonists)
- Action: Inhibit the entry of calcium into the heart and
vascular smooth muscle
▪ Decreases cardiac output
▪ Dilate blood vessels
▪ Lowers blood pressure

- Drugs:
▪ Verapamil
▪ Nifedipine
▪ Diltiazem
5. ACE Inhibitors
- Action: Suppress RAAS by blocking conversion of AI to
AII
- Drugs: PRIL
Consideration: First dose – watch for hypotension and loss
of taste

6. ARBs
- Block the vasoconstrictive effect of RAAS by blocking
receptor sites of AII
- Drugs: SARTAN
 GENERAL CONSIDERATIONS ON
ANTIHYPERTENSIVE MEDICATIONS:
Pressure monitoring (blood)
Rise slowly
Eating must be considered
Stay on medications
Skipping or stopping is a “No-no”
Undesirable responses assessment
Remind to exercise
Eliminate smoking