Hypertension: Blood Pressure and Treatment

• Hypertension is the "silent" killer.

Blood Pressure Classifications

• Normal BP: SBP <120 mmHg and DBP <80 mmHg, treated with lifestyle modifications.
• Elevated BP: SBP 120-129 mmHg and DBP <80 mmHg, treated with lifestyle modifications.
• Stage 1 Hypertension: SBP 130-139 mmHg or DBP 80-89 mmHg, treated with lifestyle modifications, with medication if diabetic or with chronic kidney disease.
• Stage 2 Hypertension: SBP ≥140 mmHg or DBP ≥90 mmHg, treated with lifestyle modifications and medication.
• Blood pressure goals for patients already diagnosed with hypertension are to keep the BP < 130/90.

Non-Pharmacological Risk Factor Modification

• You should implement nutritional changes, increase activity, stop drinking and smoking, reduce stress and address or treat for obstructive sleep apnea..

Pharmacological Treatment

• Become familiar with 6 main drug classes from slide 20.
• Diuretics fall into this category, for example drugs are like -ide.
• Vasodilators exist
• Beta blockers end in -lol.
• ACE inhibitors end in -pril.
• ARBs end in -artan.
• Calcium channel blockers end in -dipine
• Treatment-resistant Hypertension: Patients are treated with three different antihypertensives but their BP is still above goal.

Patient Education

• Common class of OTC drugs that interact with prescribed antihypertensives.

Hypertensive Crisis

• Hypertensive Crisis criteria is SBP >= and/or DBP >=
• In hypertensive urgency, there is no evidence of target or end-organ damage.
• In hypertensive emergency, evidence of target or end-organ damage exists which could be one or more of 5 organs
• Organs that may be impacted are the heart, brain, kidney, peripheral arteries, and retina
• Heart issues may be LV hypertrophy, heart failure, prior MI, or angina along with 12-lead EKG, BNP and cardiac enzymes, and consider patient history.
• Brain issues may be stroke or TIA.
• Kidney issues may be acute kidney injury and elevated (lab value).
• Peripheral Artery compromise may be PAD or aneurysm.
• Retina compromise may be retinopathy and vision changes.
• Most common cause of Hypertensive Crisis is failure to adhere to home antihypertensive regimen

Aneurysms vs Dissections

• The arterial wall is weakened in aneurysms.
• The arterial wall is torn in dissections.
• Aneurysms are usually chronic or congenital.
• Dissections are usually sudden and have a higher mortality rate.
• The greatest nursing consideration for both is strict blood pressure control.

Peripheral Arterial Disease (PAD)

• The most common cause of PAD is atherosclerosis.
• Risk Factors: Modifiable, Nonmodifiable
• Clinical Manifestations: Pain increases with extremities positioned depending on what relives the pain
• Know the 6 P's
• Wounds are usually dry and have well-defined borders or ill-defined borders.
• The wound size is usually small or large affecting the tips of toes or ankles/lower leg.
• Collaborative Care: Pharmacological Therapy with antiplatelet/anticoagulation and lipid lowering agents (-statins)
• Risk Factor Modification
• Controlled Exercise: exercise to the point of pain, then rest, and resume activity- this promotes collateral circulation
• Pain management
• Surgical Options: grafting, bypass, amputation
• Patient Education: Avoid restrictive clothing; practice meticulous foot care to avoid any injuries (wear proper footwear at all times, examine feet daily for injuries, etc.).

Peripheral Venous Disease (PVD)

• The most common cause of PVD is vein incompetence.
• Patients with PVD are at increased risk of developing DVT
• Clinical Manifestations: Pain of extremities worsens with dependency and improves with elevation
• Wounds are usually wet and have ill-defined borders.
• The wound size is usually small or large affecting the tips of toes or ankles/lower leg.
• Collaborative Care: Elevate the legs and avoid leg dangling when seated, wear graduated compression stocking, and meticulous foot/leg care.
• Patient Education: know 6 points on slide 33.