Hypertension: Risk Factors and Manifestations

Hypertension: Risk Factors

• Modifiable risk factors are those that can be changed, examples include alcohol/tobacco use, diabetes, obesity, high levels of low-density lipoprotein (LDL) cholesterol, sedentary lifestyle, stress, and salt intake.
• Nonmodifiable risk factors are those that cannot be changed, such as ethnicity, gender, age, and family history.
• Black populations have the highest prevalence of hypertension worldwide, and develop hypertension at a younger age.
• Women have a higher incidence of hypertension than men, especially after menopause.
• Hispanic populations are less likely to receive treatment for hypertension and have lower rates of blood pressure control.

Hypertension: Clinical Manifestations

• Hypertension is often referred to as the "silent killer" because it can be asymptomatic until it causes severe damage to organs.
• Common symptoms of hypertension include fatigue, dizziness, palpitations, angina (chest pain), and dyspnea (shortness of breath).
• Hypertension can affect target organs such as the brain, kidneys, eyes, and heart.

Hypertension: Complications

• Complications of hypertension include coronary artery disease (CAD), left ventricular hypertrophy (LVH), heart failure (HF), atherosclerosis, stroke, peripheral vascular disease (PVD), and chronic kidney disease (CKD).

Hypertension: Diagnostics

• Diagnostics for hypertension aim to rule out other underlying causes.
• Commonly performed diagnostic tests include a comprehensive history and physical examination, urinalysis (to assess renal function), blood sugar levels, complete blood count (CBC) and basic metabolic panel (BMP), lipid profile, and electrocardiogram (ECG).

Hypertension: Interprofessional Care

• The primary nursing goal for hypertension is health promotion across all populations.
• DASH diet (Dietary Approaches to Stop Hypertension) is a recommended dietary approach that emphasizes low-fat foods, whole grains, fish, poultry, beans, and reduced sodium intake (less than 2,300 mg/day).
• Physical activity is recommended for 30 minutes per day, five days a week.
• Lifestyle modifications for hypertension include quitting tobacco and alcohol, managing stress, maintaining a healthy weight, and managing blood sugar and cholesterol levels.

Hypertension: Pharmacology

• Medications for hypertension target either cardiac output or systemic vascular resistance.
• Diuretics reduce blood volume and lower blood pressure by affecting stroke volume. They can cause frequent urination as a side effect.
• ACE Inhibitors (Angiotensin-Converting Enzyme Inhibitors) and ARBs (Angiotensin II Receptor Blockers) lower blood pressure by reducing cardiac output. Common examples include drugs ending in "-pril" and "-sartan", respectively.
• Beta Blockers lower blood pressure by reducing heart rate. They may also affect libido and cause erectile dysfunction.
• Calcium Channel Blockers lower blood pressure by affecting systemic vascular resistance. Common examples include drugs ending in "-dipine".
• Combination medications are common for managing hypertension.
• Nursing considerations include monitoring blood pressure and heart rate before administering medications, monitoring for orthostatic hypotension, understanding medication parameters and routes of administration, and promoting medication adherence.
• Older adults are more sensitive to side effects, especially hypotension.

Hypertensive Crisis

• Hypertensive crisis occurs when blood pressure is significantly elevated, with systolic blood pressure greater than 180 mmHg and/or diastolic blood pressure greater than 120 mmHg.
• Hypertensive urgency refers to a hypertensive crisis without target organ damage.
• Hypertensive emergency refers to a hypertensive crisis with evidence of target organ damage.
• Manifestations of hypertensive crisis include encephalopathy, brain hemorrhage, myocardial infarction (MI), heart failure (HF), acute renal failure (ARF), aortic aneurysm.
• Management of hypertensive crisis includes hospitalization, intravenous antihypertensive medications, monitoring blood pressure, and assessing urine output hourly.

Hyperlipidemia

• Hyperlipidemia refers to elevated total cholesterol levels, commonly assessed through a lipid profile.
• Screening recommendations include assessment every five years for those over 20 years old, and every one to two years for people with coronary artery disease, a family history of hyperlipidemia, or diabetes.
• Treatment for hyperlipidemia aims to lower low-density lipoprotein (LDL, "bad" cholesterol) levels below 70 mg/dL in high-risk patients and below 130 mg/dL in low-risk patients.
• Medications for hyperlipidemia include statins such as atorvastatin, niacin, simvastatin (Zocor), and rosuvastatin (Crestor). Statins inhibit cholesterol synthesis in the liver and increase the number of LDL receptors.
• Lifestyle modifications are important for improving lipid profiles.

Heart Failure

• Definition: Heart failure is the inability of the heart to provide sufficient blood to meet the oxygenation needs of the body.
• Left-sided heart failure is the most common type.
• Systolic (LV) failure refers to a weakened left ventricle with reduced ejection fraction (less than 40%).
• Ejection fraction is a measurement of how much blood the left ventricle pumps out with each beat.
• Nursing assessments focus on changes in lung sounds, skin vital signs, dyspnea, orthopnea, sputum amount and characteristics, and mental status.

Stroke

• Ischemic stroke occurs as a result of a blockage in an artery supplying blood to the brain.
• Embolic stroke is caused by a traveling blood clot from the heart or body. Atrial fibrillation is a common cause of embolic strokes.
• Thrombotic stroke occurs when a blood clot forms in an artery in the brain.
• Transient ischemic attack (TIA) is a temporary blockage of blood flow to the brain.

Ischemic Stroke Causes

• Major risk factors for ischemic stroke include high blood pressure, cardiac abnormalities (atrial fibrillation, heart defects), high cholesterol, diabetes mellitus, obesity, alcohol use disorder, genetic predisposition.

CVA Signs and Symptoms

• Stroke symptoms include numbness or weakness in the face, arm, or leg, particularly on one side of the body; confusion or trouble speaking or understanding speech; disturbances in vision; difficulty walking, dizziness, or balance problems; and sudden, severe headache with no known cause.

FAST (Face, Arm, Speech, Time)

• FAST is a mnemonic for remembering the key signs of stroke.
• Time is critical for managing strokes and preventing complications.

Stroke Protocol and Treatment

• Emergency room care: Treatment for stroke aims to restore blood flow to the affected area of the brain. This includes:
  • Performing a non-contrast computed tomography (CT) scan of the head immediately.
  • Administering intravenous thrombolysis (tPA) if eligible within 60 minutes of arrival.
  • Managing blood pressure.
  • Avoiding heparin therapy to prevent bleeding.

Ischemic Stroke Medications

• Antiplatelet medications prevent blood clots from forming. Common antiplatelet medications include:
  • Aspirin 81 mg (Aggrenox).
  • Dipyridamole (Persantine)
  • Ticlopidine or Clopidogrel (Plavix)
• Anticoagulants are used for patients with atrial fibrillation. Common anticoagulants include:
  • Warfarin (Coumadin)
  • Rivaroxaban (Xarelto)
  • Dabigatran (Pradaxa)
  • Apixaban (Eliquis)
• Statins are used to lower cholesterol levels. Examples include:
  • Simvastatin (Zocor)
  • Lovastatin (Mevacor)

Interventions for Stroke

• The primary intervention for ischemic stroke is thrombolysis (either intravenous or intra-arterial).
• Other interventions include transluminal angioplasty, balloon and stenting to improve blood flow, carotid endarterectomy to remove atherosclerotic lesions.

Safe Oral Intake

• Nursing care after stroke includes evaluation for food and fluid intake.
• Swallowing and gag reflex should be assessed by a nurse or speech therapist.
• Feeding strategies include sitting upright during meals, feeding on the non-affected side, placing food in line of vision, tucking the chin slightly, no distractions while eating, double swallows, oral hygiene after meals, and a modified diet based on individual needs.

Prevention of Ischemic Stroke

• Primary prevention aims to prevent the first stroke. It focuses on modifiable risk factors such as hypertension, diabetes, high cholesterol, smoking, and obesity.
• Secondary prevention aims to prevent recurrent strokes in individuals who have already experienced a stroke.
• Tertiary prevention focuses on minimizing long-term disabilities associated with stroke.