Hypertension Assessment and Management

Study Notes

Hypertension (HTN) is defined as a systolic blood pressure greater than 140 mm Hg and a diastolic pressure greater than 90 mm Hg.
Diagnosis is based on the average of two or more accurate blood pressure measurements taken during two or more contacts with a healthcare provider.
BP = CO x PR (peripheral resistance), CO = HR x SV.
Prolonged high blood pressure damages blood vessels, particularly in target organs like the heart, kidneys, brain, and eyes.

The classification system is based on the average of two or more properly measured, seated readings taken on each of two or more office visits.
Refer to Table 31-1 for specific ranges (Normal, Prehypertension, Stage 1 Hypertension, and Stage 2 Hypertension) by systolic and diastolic values.

Primary (Essential) Hypertension: Accounts for 90-95% of cases; cause is not identified.
Secondary Hypertension: Accounts for 5-10% of cases; caused by underlying conditions like renal disease, narrowing of renal arteries, hyperaldosteronism, certain medications (like prednisone), or pregnancy.

Physiological factors include sodium intake, nephron function, stress, and genetic predisposition.
Pathological factors include sympathetic nervous system overactivity, renin-angiotensin system issues, cell membrane alterations, and hyperinsulinemia.

History and Physical Examination: Complete patient history, including detailed risk factors.
Retinal examination
Laboratory tests:
- Urinalysis
- Blood chemistry (Na, K, creatinine, fasting glucose)
- Cholesterol levels
ECG
Echocardiography (left ventricular hypertrophy)

Goal: Prevent complications by achieving and maintaining blood pressure at 140/90 mm Hg or lower.
Lifestyle Modifications:
- Weight reduction (BMI 18.5-24.9 kg/m²)
- DASH diet (fruits, vegetables, low-fat dairy products)
- Reduced sodium intake (≤100 mmol/day)
- Regular physical activity (at least 30 minutes most days of the week)
- Moderate alcohol consumption
- Stress management
Pharmacological Therapy: Medication use to decrease peripheral resistance, blood volume, and heart contraction rate.
- Initial treatment is often a thiazide diuretic, with gradual increase in dosage if necessary.
- Often multiple medications are required for control.
- Lifestyle modifications must be maintained with medications.

History and risk factors: Detailed patient history.
Target organ damage: Assessing for symptoms related to organ damage (e.g. angina, shortness of breath, altered vision, etc.)
Cardiovascular assessment: Apical and peripheral pulses.

Patient education: Lifestyle modifications and disease management.
Support for adherence to treatment regimen.
Collaboration with medical team and follow-up care; emphasizes control over cure and reinforces lifestyle changes.
Monitoring and managing potential complications.

Knowledge and adherence: Reports knowledge of disease management, maintains blood pressure at <140/90 mm Hg, and adheres to the self-care program.
Absence of complications: no symptoms of related conditions such as angina, palpations, visible vision loss or changes, stable BUN and creatinine levels

Occur in patients with poorly controlled, undiagnosed, or discontinued medications.
Hypertensive Emergency: Blood pressure >180/120 mm Hg, requires immediate lowering to prevent target organ damage.
Hypertensive Urgency: Blood pressure is very high but no evidence of immediate or progressive target organ damage; normalization within 24-48 hours is goal.
Needs close monitoring of BP and cardiovascular status.