Wa0027

HYPERTENSION
Mohammed Ibrahim Osman
BSc N- El Imam El Mahadi university 2006
MSc in MSN- khartoum university 2011
PhD student in shandi university
Leuctural in medical surgical nursing department /

mohammed.osman75@yahoo.com 08/02/2020 1
HYPERTENSION
(High blood pressure )
Definition :

is defined as a systolic blood pressure greater than 140 mm Hg and a diastolic
pressure greater than 90 mm Hg based on measured accurately two or more
times.

BP= CO ( HRXSV) X PVR
Pathophysiolgy

Predominant mechanisms of control are:
1. central nervous system (CNS)
2. renin-angiotensin-aldosterone system (RAAS)
3. extracellular fluid volume.


they cause HTN by increasing cardiac output and peripheral vascular resistance.
Types of hypertension
1. Primary HTN ( essential )

2. Secondary HTN
Primary or essential hypertension :
 Is about 95 % of patients.
 Unknown causes
 But there are :
1. Hyperactivity of CNS leads to vasoconstriction thus Increasing HR and peripheral vascular
resistance)
2. Excessive sodium intake, .
3. Genetic
Secondary hypertension:
 Is Only 5% of patients:
 Cause :
1. Renal diseases
2. heart diseases
3. Medications (Oral contraceptives , steroids )
 4. Endocrine disturbances:
 Pheochromocytoma) a tumor of adrenal gland that causes release - epi and
norepinephrine and a rise in BP (
 Cushing's syndrome leads to an increase in adrenocortical steroids (causing sodium
and fluid retention) and hypertension.
 Hyperthyroidism causes increased cardiac output.
Risk Factors of HTN
 Non modifiable :
1. Age between 30 and 70
2. Gender ( male – female )
3. Race - Afro-American
4. Family history
 Modifiable :
1. Overweight,
2. Smoking
3. Diabetes mellitus
4. Metabolic syndrome
5. Excessive salt intake
Clinical Manifestations of HTN
 Usually is asymptomatic: (silent killer)

 Headache .
 Dizziness .
 Blurred vision.
 High BP reading
 Palpitation
 Weakness
 Muscle cramps.
Complications of HTN
1. Angina pectoris and MI
2. Left ventricular hypertrophy and heart
failure
3. Renal failure
4. stroke
5. Retinopathy and blindness
6. Malignant hypertension
Diagnostic Evaluation
- BP measurements in out patient

- RFT and electrolytes
- ECG - left ventricular hypertrophy, ischemia)
- Chest X-ray - cardiomegaly
- Renal scan to detect renal vascular diseases
- Renal duplex imaging to identify renal artery stenosis
Management of HTN
 The goal is to :
 maintain normal blood pressure and prevent complications ( RF, ST, HF) by
1. Non pharmacological management
2. Pharmacological management
Non pharmacological management of HTN
 By Lifestyle modifications
- Lose weight
- Limit alcohol intake
- Get regular aerobic exercise
- Reduce sodium intake
- Daily allowances of K , Ca ,Mg in diet
- Stop smoking
- Reduce dietary saturated fat and cholesterol
- Reduce coffee intake
Pharmacological management of HTN
 The medications work in theses ways :

1. decrease peripheral resistance
2. decrease blood volume
3. decrease the strength and rate of myocardial contraction
Pharmacological management:
 Diuretcs
 β blockers
 α-Receptor blocker (dilating peripheral blood vessels )
 Central alpha agonists (diminishing sympathetic out flow, lowering PR
 Peripheral adrenergic agents ( e.g enderal , atenolol)
 Combined alpha and beta blocker
 ACE inhibitors
 Angiotensin 11antagonist
 Calcium channel blockers- nifidipine
 Direct vasodilators – hydralaize
Nursing Assessment
1. Nursing History & physical examination
2. Nursing diagnosis
Nursing Diagnoses
 Deficient Knowledge about disease process , treatment and complication
 P.E.O.C:
 The client will have adequate knowledge about HTN .
: NURSING IMPLEMENTATION
1. Assess the knowledge of the patient.

2. Take BP in both arms in lying, sitting positions.
3. Explain affect of HTN on other systems .
4. Regular follow-up
5. Explain the pharmacologic control of hypertension.
6. Teach patient how to measure BP twice weekly .
7. Do not stop antihypertensive therapy
PATIENT TEACHING
Teach patient how to measure BP twice weekly .

Do not stop antihypertensive therapy
Regular follow up .
Warn about un controlled BP (stroke , HA, RF).
Avoid high-sodium intake
Avoid over-the-counter drugs
Reduce stress
 Regular aerobic exercise program,
 reducing saturated fat.
Stop smoking and alcohol
 Teach to call doctors if there are :
 Headache
 Dizziness
 Epistaxises
Thank you
mohammed.osman75@yahoo.com 20
08/02/2020

Wa0027

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HYPERTENSION

Mohammed Ibrahim Osman

BSc N- El Imam El Mahadi university 2006

MSc in MSN- khartoum university 2011

PhD student in shandi university

Leuctural in medical surgical nursing department /

pressure greater than 90 mm Hg based on measured accurately two or more

1. central nervous system (CNS)

2. renin-angiotensin-aldosterone system (RAAS)

3. extracellular fluid volume.

1. Primary HTN ( essential )

 Usually is asymptomatic: (silent killer)

- BP measurements in out patient

 The medications work in theses ways :

1. Nursing History & physical examination

1. Assess the knowledge of the patient.

Teach patient how to measure BP twice weekly .

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