Hypertension Definition and Classification

Hypertension Definition and Classification

• Hypertension is defined as a systolic blood pressure (SBP) of 140 mm Hg or higher, or a diastolic blood pressure (DBP) of 90 mm Hg or higher, averaged over two or more accurate measurements taken 1-4 weeks apart by a healthcare provider.
• It's sometimes called the "silent killer" because it often has no noticeable symptoms until significant damage occurs.
• Hypertension can be primary (unidentified cause, majority of cases) or secondary (related to identifiable causes like kidney disease, renal artery stenosis, hyperaldosteronism, certain medications, or pregnancy).

Hypertension Risk Factors

• Risk factors are detailed in Chart 31-1 on pages 2405-2406 of the text.

Hypertension Pathophysiology

• Several factors contribute to hypertension, including:
  • Increased sympathetic nervous system activity.
  • Increased renal reabsorption of sodium, chloride, and water.
  • Increased renin-angiotensin-aldosterone system activity, leading to expanded extracellular fluid and increased systemic vascular resistance.
  • Decreased vasodilation of arterioles.
  • Resistance to insulin action (linked to type 2 diabetes, hypertriglyceridemia, obesity, and glucose intolerance).
  • Activation of innate and adaptive immune responses contributing to renal inflammation and dysfunction.

Hypertension Clinical Manifestations

• Often, there are no noticeable symptoms other than elevated blood pressure readings.
• Severe hypertension (with target organ damage) can present with:
  • Retinal and eye diseases
  • Kidney damage
  • Heart disease
  • Stroke
  • Peripheral arterial disease

Hypertension Assessment and Diagnostics

• A thorough history and physical examination are crucial, including looking for target organ damage.
• Laboratory tests might include:
  • Urinalysis
  • Blood tests (sodium, potassium, creatinine, fasting glucose, total and HDL cholesterol levels)
  • 12-lead ECG
  • Echocardiography to assess left ventricular hypertrophy

Hypertension Medical Management

• Treatment aims to prevent complications and death by maintaining blood pressure below 140/90 mm Hg (or below 150/90 mm Hg in patients over 60 or 80).
• Lifestyle modifications (detailed in Table 31-2) and medication therapy are used (as detailed in Figure 31-2 on page 2407). Specific medications include diuretics, beta-blockers, ACE inhibitors, and others.

Hypertension Nursing Process

• Nursing Diagnoses: Common diagnoses include knowledge deficit regarding treatment and disease management, and noncompliance related to medication side effects.
• Nursing Interventions: Strategies focus on:
  • Increasing patient knowledge.
  • Promoting adherence to the therapeutic regimen.
  • Supporting home, community-based, and transitional care.
  • Monitoring and managing potential complications.

Hypertensive Crises

• Hypertensive emergencies involve acutely high blood pressure causing life-threatening target organ damage. Rapid reduction in blood pressure is needed (aiming for a decrease of 20-25% in the first hour).
• Hypertensive urgencies involve elevated blood pressure without immediate target organ damage, requiring normalization within 24-48 hours, using slower reduction strategies.

This quiz covers the definition, classification, and risk factors of hypertension. Understand the difference between primary and secondary hypertension, as well as the various factors contributing to this condition. It's essential for anyone studying health or medicine to grasp these fundamental concepts.