Hypertension

By Sir Numan
 Objective:
• At the end of presentation the students will
be able to
• Define hypertension
• Discuss the etiology of hypertension
• Discuss the risk factor contributing in the
development of hypertension
• Discuss pathophysiology and clinical
manifestation of HTN
• Discuss pharmacological and non
pharmacological management of HTN
• Enlist the nursing intervention of HTN
 Definition:
• Hypertension is defined as a consistent
constant elevation of the systolic or distolic
pressure above 140/90 mm Hg.
Or
• Hypertension is defined as systolic blood
pressure (SBP) of 140 mmHg or greater,
diastolic blood pressure (DBP) of
90 mmHg or greater, or taking any
antihypertensive medication.
 Types

• Essential hypertension(primary)
– 95%
– No underlying cause

• Secondary hypertension
– Underlying cause
 Essential (primary) hypertension

• Essential (primary) hypertension occurs

when you have abnormally high blood
pressure that's not the result of a medical
condition. This form of high blood pressure
is often due to obesity, family history and
an unhealthy diet.
 Secondary hypertension
It develops as a consequence of a particular
underlying disease or condition . It is
eleveted BP with a specific cause that
often can be identified and corrected.
This type of hypertension count for less than
of 5% of hypertension in adult but more
than 80% of hypertension in children's.
The causes of secondary hypertension include
the following

• Congenital narrowing of aorta

• Renal artry stenosis
• Endocrine disorder such as
pheochromocytoma (excess secretion of
catecholamines)
• Neurologic disorder such as brain tumor
and head injury
• Medication such as sympathetic stimulant
(cocain,NSAID,oral contraceptive pills)
 Target Organ Damage
 Heart
• Left ventricular hypertrophy
• Angina or myocardial infarction
• Heart failure
 Brain
• Stroke or transient ischemic attack
 Chronic kidney disease
 Peripheral arterial disease
 Retinopathy
 Blood Pressure Classification

BP SBP DBP
Classification mmHg mmHg
Normal <120 and <80
Pre-hypertension 120–139 or 80–89

Stage 1 140–159 or 90–99

Hypertension
Stage 2 >160 or >100
Hypertension
 ETIOLOGY
The etiology of hypertension can be
classified as either primary or secondary

Primary: primary hypertension count for

more then 90% of all cases and has no
known causes although it is theorized that
genetic factor, hormonal changes, in
alteration and sympathetic tone all may
play a role in its development
 Pathophysiology:
Blood pressure is the force exerted by blood against
the wall of blood vessel and must be adequate to
maintain tissue perfusion during activity and rest
the maintenance of normal BP and tissue
perfusion requires the integration of both systemic
factors and local peripheral vascular effects.
Arterial BP(ABP) is primarily of function of cardiac
out put (CO) and systemic vascular
resistance(SVR) the relationship is summarized by
the following equation
 CONT....
ABP=CO*SVR
Cardiac out put is the total blood flow through the
systemic or pulmonary circulation per min.
SVR (systemic vascular resistance) is the force
opposing the movement of blood within the blood
vessel.
Radius of small artery and arterioles is the principal
factor determining vascular resistance. A small
change in the radius of arteriole create a major
change in the SVR. If SVR is increased and CO
remain constant or increases ABP well increase.
The mechanism that regulate BP can effect either
CO or SVR or both.
Who are at risk ?
 Hypertension: Predisposing factors
• Advancing Age
• Sex (men and postmenopausal women)
• Family history of cardiovascular disease
• Sedentary life style & emotional and psycho-
social stress
• Smoking ,High cholesterol diet, Low fruit
consumption
• Obesity & wt. gain
• Co-existing disorders such as diabetes, and
hyperlipidaemia
• High intake of alcohol
 CLINICAL MANIFESTATION:
• Hypertension is called the silent killer because it is a disease usually
occur without any symptom. A patient with severe hypertension may
experience a variety of symptom these symptom include.
• Fatigue
• Reduce activity tolerance
• Dizziness
• Angina
• Dyspnea
• headache
• Blurred vision
• Spontaneous nose bleeding
• Depression
Diagnosis
 Laboratory Tests
 Routine Tests
• Electrocardiogram
• Urinalysis
• Blood glucose,
• Serum potassium, creatinine, or the corresponding estimated GFR, and
calcium
• Lipid profile, after 9- to 12-hour fast, that includes high-density and
low-density lipoprotein cholesterol, and triglycerides
 Optional tests
• Measurement of urinary albumin excretion or albumin/creatinine ratio
 More extensive testing for identifiable causes is not generally indicated
unless BP control is not achieved
 Measuring
Blood Pressure
• Patient seated quietly for at least
5minutes in a chair, with feet on the
floor and arm supported at heart
level

•An appropriate-sized cuff (cuff bladder encircling at least

80% of the arm)

•At least 2 measurements

 Measuring Blood Pressure
• Systolic Blood Pressure is the point at which the
first of 2 or more sounds is heard

• Diastolic Blood Pressure is the point of

disappearance of the sounds.

• Ambulatory BP Monitoring - information about

BP during daily activities and sleep.

Continue…
Why to treat ?
 Pharmacological management

Class of drug Example Initiating dose Usualmaintenance

dose

Diuretics Hydrochlorothiazide 12.5 mg o.d. 12.5-25 mg o.d.

-blockers Atenolol 25-50 mg o.d. 50-100 mg o.d.

Calcium Amlodipine 2.5-5 mg o.d. 5-10 mg o.d.
channel
blockers

-blockers Prazosin 2.5 mg o.d 2.5-10mg o.d.

ACE- inhibitors Ramipril 1.25-5 mg o.d. 5-20 mg o.d.

Angiotensin-II Losartan 25-50 mg o.d. 50-100 mg o.d.

receptor blockers
Non pharmacological treatment
• Intake of salt less than 5-6 g per day
• Prevention of obesity
• Alcohol less then 30 g per day
• Stop smoking
• physical activity
• psychical relaxation
 Diseases Attributable to
Hypertension
Heart Left Ventricular
Gangrene of the
Failure Hypertrophy Myocardial
Lower Extremities
Infarction
Aortic Coronary Heart
Aneurym Disease
HYPERTENSION
Hypertensive
Blindness encephalopathy

Chronic Cerebral
Stroke Preeclampsia/ Hemorrhage
Kidney
Eclampsia
Failure
Adapted from Dustan HP et al. Arch Intern Med. 1996; 156: 1926-1935
 A nursing care plan for hypertension
includes
• Assessing the patient's medical history,
blood pressure, and potential risk factors.
It also involves setting goals, implementing
interventions like lifestyle modifications,
medication management, and regularly
monitoring blood pressure.
 Nursing intervention:
• To educate the patient about
• Diet
• Diesease process
• Health behaviour
• Medication
• prescribed activity
• treatment regime
 Reference:
• www.BT besawanthapa.com
Medical surgical Nursing book
 Take home message --------------

• Hypertension is a major cause of morbidity and mortality,

and needs to be treated
• It is an extremely common condition; however it is still
under-diagnosed and undertreated
• Aim of the management is to save the target organ from
the deleterious/harmful effect
• Besides pharmacology we have other choices and one
has to be acquainted/familiar with that choice
• Life style modification should always be encouraged in
all Hypertensive patients
ANEURYSM
 Objectives
• At the end of this presentation the students
will be able to:
• Define aneurysm.
• Enlist types, causes, and signs & symptoms
of aneurysm.
• Describe pathophysiology of aneurysm.
• Discus medical diagnosis & treatment for
aneurysm.
• Make nursing diagnosis & interventions for
aneurysm.
 Aneurysm
• An aneurysm is an abnormal widening or
ballooning of a portion of an artery due to
weakness in the wall of the blood vessel.
 Differentiate berry's aortic and
dissecting aneurysm
Characteristic Aortic Aneurysm Aortic Dissection
A tear or separation of
A weakening and bulging
Definition the layers of the aortic
of the aortic wall
wall
Often caused by a
Often caused by
sudden tear in the aortic
degenerative changes in
wall, which can result
Causes the aortic wall, such as
from high blood
atherosclerosis or
pressure, trauma, or
genetic factors
other factors
Often asymptomatic until Severe and sudden
they rupture or expand chest or back pain is a
Symptoms significantly, but common symptom,
symptoms may include sometimes described as
chest or back pain "tearing" or "ripping"

Hypertension, smoking, Hypertension, connective

Risk Factors atherosclerosis, family tissue disorders, genetic
 cont
Characteristic Aortic Aneurysm Aortic Dissection
Extension of the
Rupture is a significant
dissection, rupture,
Complications risk, which can be life-
organ malperfusion, and
threatening
potential complications
Emergency surgery is
often required, with the
Monitoring and
type of procedure
Treatment management of risk
depending on the
factors, surgical repair
location and extent of the
dissection
Mortality is high if not
promptly treated, and
Generally better if
long-term prognosis
Prognosis detected early and
depends on the extent of
managed appropriately
the dissection and its
complications
 Causes and risk factors
• Causes is unknown. Some aneurysms are
present at birth (congenital).
• Defects in some of the parts of the artery wall
may be responsible.
• Common locations for aneurysms include:
– The major artery from the heart (the aorta)
– The brain (cerebral aneurysm)
– In the leg behind the knee popliteal artery aneurysm)
– Intestine (mesenteric artery aneurysm)
– An artery in the spleen (splenic artery aneurysm)
 Cont….
• High blood pressure, atherosclerotic disease,
high cholesterol, and cigarette smoking may
raise your risk of certain types of aneurysms.
 Pathophysiology
• The most striking histopathological changes
of aneurysmatic aorta are seen in tunica
media and intima. These include
accumulation of lipids in foam cells,
extracellular free
cholesterol crystals, calcifications, thrombosis
, and ulcerations and ruptures of the layers.
• However, the degradation of tunica media by
means of proteolytic process seems to be the
basic pathophysiologic mechanism of the
aneurysm development.
 Types of aneurysm
• Abdominal aortic aneurysm
• Cerebral aneurysm
• Thoracic aortic aneurysm
 Symptoms
• The symptoms depend on the location of the
aneurysm. If the aneurysm occurs near the
body's surface, pain and swelling with a
throbbing mass is often seen.
• Aneurysms within the body or brain often
cause no symptoms.
• If an aneurysm ruptures, pain, low blood
pressure, a rapid heart rate, and
lightheadedness may occur. The risk of death
after a rupture is high.
 Diagnosis
• The health care provider will perform a
physical exam.
• Tests used to diagnose an aneurysm
include:
• CT scan
• Ultrasound
 Treatment
• Treatment depends on the size and location of
the aneurysm. Doctor may only recommend
regular check-ups to see if the aneurysm is
growing.
• Surgery may be done. The type of surgery and
when you need it depends on your symptoms
and the size and type of aneurysm.
 cont
• Surgery may involve a large (open)
surgical cut. However, some patients may
have endovascular embolization. A stent is
a tiny tube used to prop open a vessel or
reinforce it's wall. This procedure can be
done without a major cut, so you recover
faster than you would with open surgery.
 Nursing diagnosis
• Acute pain related to aneurysm.
• Ineffective tissue perfusion
(cardiopulmonary) related to aortic
insufficiency.
• Risk for deficient fluid volume related to
compromised regulatory mechanisms.
• Anxiety related to threat to health status.
 Nursing interventions
• Establish and maintain a patent airway as needed.
• Administer supplemental oxygen as ordered.
• Position the patient to promote pulmonary drainage and
prevent upper airway obstruction.
• If surgery can’t be performed immediately, institute
aneurysm precautions to minimize the risk of bleeding.
• Turn the patient often. Encourage deep breathing and leg
movement.
• Apply elastic compression boots to the patient’s legs to
reduce the risk of deep vein thrombosis.
• Provide emotional support to the patient and his family.
 References
• Hauser SC. Vascular diseases of the
gastrointestinal tract. In:Goldman L, Schafer AI,
eds. Cecil Medicine. 24th ed. Philadelphia, Pa:
Saunders Elsevier; 2011:chap 145.
• Isselbacher EM. Diseases of the aorta. In:
Goldman L, Schafer AI, eds. Cecil Medicine. 24th
ed. Philadelphia, Pa: Saunders Elsevier;
2011:chap 78.
• Zivin JA. Hemorrhagic cerebrovascular disease.
In: GoldmanL, Schafer AI, eds. Cecil Medicine.
24th ed. Philadelphia, Pa: Saunders Elsevier;
2011:chap 415.
Thank you