Hypertension Overview and Risk Factors

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.

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.