RISK FACTORS

HYPERTENSION &
NON-MODIFIABLE
-Factors that cannot be changed.
HYPERTENSION ▪ FAMILY HISTORY
-family members (parents, siblings,
➢ Sustained elevated, systemic, arterial blood pressure;
grandparents who are suffering from
diastolic elevation more serious, reflecting pressure
HPN)
on arterial wall, during resting phase of cardiac
▪ AGE
cycle.
-The older people get the more
➢ Persistent elevation of blood pressure for 2 or more
susceptible they are to HPN.
consecutive reading.
▪ SEX
❖ CLASSIFICATION -Male are more susceptible to
hypertension.
(According to type and Severity)
▪ ETHNIC GROUP
1.) SYSTOLIC & DIASTOLIC HYPERTENSION -African-American are mor susceptible
a.) Systolic HPN is a systolic BP of 140 mmHg or higher. in developing hypertension.
b.) Diastolic HPN is a diastolic BP of 90 mmHg or higher.
MODIFIABLE
2.) PRIMARY AND SECONDARY HYPERTENSION
a.) PRIMARY/ESSENTIAL/IDIOPHATHIC HPN- occurs in 90- -Factors that can be changed.
95% of patients; etiology unknown; diastolic pressure ≥
▪ STRESS
mmHg, and, other causes of hypertension are absent.
-Increased workload or activity. Lack of
b.) SECONDARY HPN- occurs in remaining 5-10% usually
rest.
renal, endocrine, neurogenic or cardiac in origin.
▪ OBESITY
3.) WHITE-COAT HYPERTENSINON
-Increased LDL can contribute in
-HPN in a person who is actually normotensive except
developing HPN.
when her/his BP is measured by a healthcare
▪ DIET
professional. (psychologically influenced.)
-Too much consumption of fatty
4.) MALIGNANT HYPERTENSION
foods/sodium rich food (e.g., Fast foods)
-Uncontrolled and may arise from both types and certain
▪ SEDENTARY LIFESTYLE
drugs.
-Inactive type of lifestyle.
▪ E.g., Anesthesia
▪ SUBSTANCE/DRUG USE
-Cigarette Smoking
- An emergency condition characterized by diastolic BP
-Alcohol
above 120 mmHg.
-Birth Control Pills
5.) LABILE (PREHYPERTENSIVE)
-Caffeine
- A fluctuating blood pressure increased during stress,
otherwise normal or near normal. ADDITIONAL INFO:
SYSTOLIC DIASTOLIC IDIO-unknown (the cause of idiopathic hypertension is
(mmHg) (mmHg) unknown.)
TEST- serum test is conducted to determine the causes of
Normal <120 <80 hypertension. (e.g., Blood cholesterol test, kidney and liver
PreHPN 120-139 80-89 function, ECG)
Stage I 140-159 90-99 LABILE- fluctuating
Stage II ≥160 ≥100
 ❖ PATHOPHSIOLOGY
RENIN-ANGIOSTENSIN-ALDOSTERONE SYSTEM
➢ Drop in BP stimulates release of RENIN from thew
kidney.
➢ This RENIN will convert ANGIOTENSINOGEN (produced
by the liver) into ANGIOTENSIN 1.
➢ Once ANGIOTENSIN 1 reaches the lungs it will be
converted by the ACE (Angiotensin Converting
Enzyme) into ANGIOTENSIN II.
➢ Angiotensin II stimulates the hypothalamus in order
for us to feel thirsty which makes us drink more
water.
➢ It causes vasoconstriction. This vasoconstriction
together with more water will result to increase in
BP.
➢ ANGIOTESTIN II influences the ADRENAL CORTEX to
release ALDOSTERONE.
➢ The hormone ALDOSTERONE stimulates the kidney to
retain sodium.
➢ Retained SODIUM + WATER results to increase in BP.
REMEMBER:
“WHERE WATER GOES SODIUM FOLLOWS.”
ARTERIAL BARORECEPTOR SYSTEM
➢ Sympathetic Nervous System is activated there will
be an increase in the heart rate including heart
contractility.
➢ Parasympathetic Nervous System is activated there
will be a decrease in heart rate and contractility.
➢ There are Baroreceptor found on the aortic arch and
carotid sinus.
➢ Baro-means pressure they monitor the BP in the
vessels
➢ Baroreceptors influence the Cardiovascular System in
coordination with the brain when to increase or
decrease the BP.
➢ An example of this is when the sympathetic nervous
system is activated causing an increase in BP the
Baroreceptors are the ones to detect them and
signals the brain about the changes.
 ➢ Once the brain receives the signal it will stimulate ▪ DIETARY FAT MODIFICATION
the parasympathetic system via the Cardioinhibitory ▪ EXERCISE
Center of the vasomotor area through the CN 9 -30 minutes exercise a day
Glossopharyngeal and CN 10 Vagus nerve and ▪ RELAXATION TECHNIQUES
stimulate the heart and blood vessels to ▪ SMOKING CESSATION
decrease the HR and contractility to decrease -Smoking can aggravate
the blood pressure. hypertension
➢ Baroreceptors can adapt to what is happening
to CVS. (e.g., can consider 140/90 mmHg as ANTIHYPERTENSIVE DRUGS
normal).
1. ALPHA-ADRENEGIC BLOCKER
Action: decrease peripheral vascular resistance;
❖ CLINICAL MANIFESTATION relaxes smooth muscle of bladder/prostate
Drugs: Medication that ends in “SIN”
SUBJECTIVE: ➢ Alfurosin
➢ Doxarosin
▪ HEADACHE ➢ Prazosin
-usually occurs at the back of the head occiput area. ➢ Tamsulosin
▪ LIGHT HEADEDNESS ➢ Terazosin
▪ TINNITUS ➢ Silodosin
-ringing of the ear 2. CENTRAL ALPHA AGONISTS
▪ EASY FATIGABILITY Action: decrease the release of adrenergic hormones
-decrease in circulating blood due to constricted from the brain (medulla oblongata) which decreases
blood vessels (vasoconstriction) peripheral vascular resistance and reduce cardiac
▪ VISUAL DISTURBANCE contractility.
-Occurs in severe hypertensive patients they can Drugs:
visualize floating spots or flashing lights. ➢ Clonidine (Catapress)
▪ PALPITATION ➢ Guanabenz (Wytensin)
▪ BRIEF LAPSES IN MEMORY ➢ Methyldopa (Aldomet)
-Rarely occurs.
Consideration: take last dose of the day at bedtime to
OBJECTIVE: minimize drowsiness during the day.
3. BETA-ADRENERGIC BLOCKERS
▪ BP GREATER THAN 140/90 Action: these drugs exert antihypertensive effects by:
▪ RETINAL CHANGES • REDUCING CONTRACTILITY
-occurs in latter stage of hypertension. • REDUCING RELEASE OF RENIN
▪ POSSIBLE HEMATURIA • REDUCING THE CARDIAC OUTPUT
-presence of blood in the urine. Drugs: medication that ends in “OLOL”
▪ CARDIAC HYPERTROPHY ➢ Metoprolol
➢ Propanol
❖ MEDICAL MANAGEMENT ➢ Nadolol
4. VASODILATORS
▪ LIFESTYLE MODIFICATION Action: Direct relaxation of vascular smooth muscle.
-Reduction of fast-food intakes Drugs:
▪ WEIGHT REDUCTION ➢ Hydralazine (Apresoline)
-Advised for Obese or overweight -Drug of choice for patients with pregnancy
patients. induced hypertension
▪ SODIUM RESTRICTION ➢ Nitroprussides
 Consideration: GENERAL CONSIDERATIONS ON
-Asses for peripheral edema of the hands and feet
-take with food (these medication can irritate gastric ANTIHYPERTENSIVE MEDICATIONS:
mucosa)
-review of BP Pressure monitoring (blood)
5. CALCIUM-CHANNEL BLOCKERS (CALCIUM ANTAGONISTS)
Rise slowly
Action: Inhibit the entry of calcium into the heart and
vascular smooth muscle Eating must be considered
• DECREASE CARDIAC OUTPUT
Stay on medication
• DILATE BLOOD VESSELS
• LOWERS BLOOD PRESSURE Skipping or stopping is a “No-no”
Drugs: VND Undesirable response assessment
➢ Verapamil
➢ Nifedipine Remind to exercise
➢ Diltiazem Eliminate smoking
6. ACE INHIBITORS
Action: Suppress RAAS (RENIN-ANGIOTENSIN-
ALDOSTERONE SYSTEM) by blocking conversion of
ANGIOTENSIN I to ANGIOTENSIN II.
Drugs: medication that ends in “PRIL”
➢ Enalapril
➢ Captopril (given sublingually; fast acting)
➢ Lisinopril
➢ Benazepril
Consideration: First dose-watch for hypotension ang
loss of taste
7. ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs)
Action: block the vasoconstrictive effect of RAAS
(RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM) by
blocking ANGIOTENSIN II receptor site.
Drugs: medication that ends with “SARTAN”
➢ Azilsartan
➢ Candesartan
➢ Losartan
➢ Olmesartan

ADDITIONAL INFO:
Always check for the patient’s blood pressure before
administering antihypertensive medications.