Hypertension Overview and Risk Factors

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Questions and Answers

What is the definition of hypertension for a patient without diabetes using AOBP measurements?

130/80 mm Hg or higher

140/90 mm Hg or higher

135/85 mm Hg or higher (correct)

120/80 mm Hg or higher

Which factor is NOT associated with the development of hypertension?

Increased sympathetic nervous system activity

Increased renin-angiotensin system activity

Decreased vasodilation of the arterioles

Decreased insulin resistance (correct)

What percentage of Canadians living with hypertension have primary hypertension?

50%

75%

90%

95% (correct)

Which of the following is a common manifestation of hypertension?

Elevated blood pressure Signup and view all the answers

Which condition is a known pathological cause of secondary hypertension?

Cushing syndrome Signup and view all the answers

When might symptoms related to target organ damage be observed in hypertension?

Late and are serious Signup and view all the answers

Which of the following medications can potentially cause secondary hypertension?

Mineralcorticoids Signup and view all the answers

What is the main component that defines blood pressure?

Cardiac Output + Peripheral Resistance Signup and view all the answers

What is one of the primary goals when managing hypertension through lifestyle modifications?

Managing blood pressure effectively Signup and view all the answers

Which class of medications is often the first-line treatment for hypertension?

Thiazide diuretics Signup and view all the answers

What should be monitored in patients undergoing pharmacological therapy for hypertension?

Blood pressure response and potential side effects Signup and view all the answers

What complication may arise from untreated hypertension?

Myocardial infarction Signup and view all the answers

In hypertensive emergencies, what is the primary action required?

Lower blood pressure immediately Signup and view all the answers

Which dietary regimen is commonly recommended for managing hypertension?

DASH diet Signup and view all the answers

What should nursing care for hypertension patients prioritize?

Understanding of the disease process Signup and view all the answers

What common issue may contribute to noncompliance with hypertension treatment?

Lack of understanding of prescribed therapies Signup and view all the answers

Which medication class is not a type of diuretic used in hypertension management?

Central alpha2-agonists Signup and view all the answers

Which of the following factors should be assessed during the care of a patient with hypertension?

Cardiovascular health and symptoms of organ damage Signup and view all the answers

Study Notes

Hypertension

Blood pressure is the product of cardiac output (heart rate x stroke volume) and peripheral resistance.
Hypertension Canada defines hypertension as an average of two or more blood pressure readings of 135/85 mm Hg or higher.
For individuals with diabetes, the threshold for hypertension is 130/80 mm Hg or higher.
7.5 million Canadians live with hypertension, with 95% having primary hypertension (unknown cause).
Over 75% of adults over the age of 75 have hypertension.

Risk Factors for Hypertension

Increased sympathetic nervous system activity
Increased reabsorption of sodium, chloride, and water by the kidneys
Increased activity of the renin-angiotensin system
Decreased vasodilation of the arterioles
Insulin resistance

Manifestations of Hypertension

Typically asymptomatic, elevated blood pressure is the only indicator
Symptoms develop later in life and are related to target organ damage, such as:
- Retinal and eye changes
- Renal damage
- Myocardial infarction
- Cardiac hypertrophy
- Transient ischemic attack or stroke
- Peripheral vascular disease

Major Risk Factors for Cardiovascular Damage

Hypertension
Obesity
Physical inactivity
Dyslipidemia
Diabetes mellitus
Microalbuminuria or GFR < 60 for men, < 65 for women (or postmenopausal women)

Secondary Hypertension

Pathological Causes
- Kidney disease
- Narrowed main arteries in the kidneys
- Excess hormones from the adrenal glands, adrenal tumors
- Congenital coarctation of the aorta
- Brain tumors, encephalitis, psychological disturbances
- Arteriosclerosis
- Hyperaldosteronism
- Cushing syndrome
- Pregnancy (Gestational Hypertension)
Pharmacological Causes
- Estrogen, especially oral contraceptives
- Glucocorticoids
- Mineralocorticoids
- Sympathomimetics, cyclosporines, erythropoietin
- Appetite suppressants
- Cold medications
- Migraine medications

Patient Assessment

Comprehensive history and physical examination, including assessment of target organ damage symptoms.
Laboratory tests:
- Urinalysis
- Blood chemistry
- Cholesterol levels
- Electrocardiogram (ECG)

Lifestyle Modifications

Weight loss
Reduced alcohol intake
Reduced sodium intake
Regular physical activity
Dietary modifications:
- High in fruits, vegetables, and low-fat dairy
- DASH diet

Pharmacologic Therapy

Medications work to decrease peripheral resistance, blood volume, or the strength and rate of myocardial contraction.
Low doses are initiated, especially in older adults, with gradual increases if needed.
Multiple medications may be necessary to control blood pressure.
Lifestyle changes initiated to control BP must be maintained.

Medication Therapy for Hypertension

Diuretic and Related Drugs*
Thiazide diuretics
Loop diuretics
Potassium-sparing diuretics
Aldosterone receptor blockers
Central alpha2-agonists and other centrally acting drugs
Beta-blockers
- With intrinsic sympathomimetic activity
- With cardioselective and vasodilatory activity
Alpha-blockers*
Combined alpha- and beta-blockers
Vasodilators*
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin II receptor blockers
Calcium-channel blockers
- Nondihydropyridines
- Dihydropyridines
Direct renin inhibitors

Nursing Process: Management of Hypertension

Assessment:
- Assess history and risk factors
- Evaluate potential symptoms of target organ damage
- Assess cardiovascular function: apical and peripheral pulses
- Identify personal, social, and financial factors affecting treatment
- Identify knowledge deficits regarding disease process and treatment
- Assess noncompliance with prescribed treatment regimens
Planning
- Goals include understanding of the disease process and its treatment, participation in self-care, and absence of complications.
- Increase patient knowledge
- Support adherence to treatment regimen
- Facilitate necessary consultations and collaboration
- Ensure follow-up care
- Emphasize control rather than cure
- Reinforce and support lifestyle changes
- Acknowledge the lifelong nature of hypertension management

Gerontologic Considerations

Nonadherence to treatment regimens
Involve family members in care
Provide clear and concise instructions, considering potential reading difficulties
Consider monotherapy options

Hypertensive Crises

Hypertensive Emergency: Extremely elevated blood pressure necessitating immediate lowering to prevent target organ damage.
Hypertensive Urgency: Blood pressure above 180 mm Hg systolic and/or above 120 mm Hg diastolic.
Hypertensive Emergency: Requires rapid BP reduction to prevent organ damage.

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Description

This quiz explores the fundamentals of hypertension, including its definition, risk factors, and various manifestations. Learn about the thresholds for hypertension and the impact it has on individuals, especially the elderly and those with diabetes. Test your knowledge and understand the broader implications of high blood pressure in Canada.