Understanding Hypertension

• Hypertension is when blood pushes too hard against artery walls.

Unit Outcomes

• Comprehend the pathophysiology of hypertension.
• Understand the etiology of hypertension.
• Compare hypertension risk factors and prevention methods.
• Recognize the clinical signs of hypertension.
• Summarize diagnostic procedures and treatments employed by healthcare teams for patients with hypertension.
• Tailor patient care for hypertension across different life stages.
• Utilize the nursing process to deliver culturally sensitive care for hypertensive individuals.

Hypertension Basics

• Blood pressure is the force of blood against artery walls.
• When the heart pumps normally blood flows easily through vessels.
• When the heart pumps harder and there is hypertension, blood does not flow easily through vessels.
• High pressure displays a strong flow, whereas low pressure has a minimal flow.

Hypertension Facts

• Hypertension is called "The Silent Killer" due to its devastating consequences that develop over time.
• Over 50% of individuals over 65 use prescription drugs because of hypertension.
• Hypertension affects 29-31% of adults.
• Hypertension rates rise as obesity rates increase.
• 3-6 visits are needed for persistent elevation over several months to determine hypertension.

Blood Pressure Guidelines

• Normal blood pressure is less than 120/80 mmHg.
• Elevated blood pressure is 120-129/less than 80 mmHg.
• Stage 1 hypertension is 130-139/80-89 mmHg.
• Stage 2 hypertension is 140+/90+ mmHg.
• A hypertensive crisis is 180+/120+ mmHg.

Pathophysiology

• Systolic pressure: The top number in blood pressure readings that measures arteries' pressure as the heart beats, normal when less than 120 mmHg in healthy adults.
• Diastolic pressure: The bottom number in blood pressure readings that measures artery pressure while the heart is at rest between beats, normal when less than 80 mmHg in healthy adults.

Factors Affecting Arterial Circulation

• Blood pressure
• Blood flow
• Peripheral Vascular Resistance (PVR)

Types of Hypertension

• Primary hypertension (Essential hypertension): Has no known cause (idiopathic), involving complex interactions with various factors; accounts for 95% of hypertension cases.
• Secondary hypertension (Nonessential hypertension): Is caused by kidney disease, drug use, endocrine disorders, etc.

Clinical Manifestations

• Early stages are usually asymptomatic.
• Hypertension is marked by elevated BP.
• Symptoms include headache on awakening, nocturia, confusion, nausea, vomiting, visual disturbances and retinal changes.

Hypertensive Emergency

• It involves a sudden, acute elevation in BP.
• Systolic pressure exceeds 180 mmHg, or diastolic pressure exceeds 120 mmHg, potentially causing organ damage.
• It's also known as malignant hypertension or hypertensive crisis.
• Treatment includes direct-acting IV vasodilators such as IV beta blockers or nitroprusside (Nipride), and diuretics.
• Treatment within 1 hour is crucial to prevent damage to the heart, kidneys, and blood vessels; monitor closely.
• Clinical manifestations include headache, confusion, swelling of the optic nerve (papilledema), blurred vision, restlessness, and motor or sensory deficits.

Complications

• Stroke: High blood pressure (HBP) can cause blood vessels in the brain to burst or clog more easily.
• Vision Loss: HBP can strain the vessels in the eyes.
• Heart Failure: HBP can cause the heart to enlarge and fail to supply blood to the body.
• Heart Attack: HBP damages arteries that can become blocked.
• Kidney Disease/Failure: HBP can damage the arteries around the kidneys and interfere with their ability to effectively filter blood.
• Sexual Dysfunction: HBP can be erectile dysfunction in men or lower libido in women.

Diagnostic Tests

• Renal Function Studies and Urinalysis: Measure creatinine clearance, BUN, and presence of proteinuria or hematuria.
• Blood Chemistry Panel: Assess electrolytes, glucose, and lipids (HDL, LDL).
• Scans for Secondary Hypertension: Include CT scans, renal ultrasounds, and renal arteriography.

Hypertension Medications- MUST KNOW!

• Diuretics: Prevent sodium and water reabsorption.
• Adrenergic Inhibitors: Beta-blockers block sympathetic impulses to the heart and blood vessels.
• Calcium Channel Blockers: Inhibit calcium ion flow, relax blood vessels, and vasodilate.
• ACE Inhibitors: Block angiotensin I from converting to angiotensin II.
• Angiotensin II Receptor Blockers (ARBs): Prevent the action of angiotensin II.
• Direct Vasodilators: Used in hypertensive crisis.

Common First-Line Medications

• Diuretics (e.g., Furosemide or hydrochlorothiazide): Preferred for systolic hypertension in older adults, relatively safe, well-tolerated, inexpensive.
• Beta-Blockers (e.g., Metoprolol): Initial treatment for heart failure, coronary heart disease, or diabetes; reduces complications like heart failure and stroke.

Additional Hypertension Medications

• ACE Inhibitors and ARBs (e.g., Lisinopril or Losartan): Commonly used initially for hypertension, particularly in patients with diabetes, heart failure, history of MI, or chronic kidney disease; promote vasodilation and reduce PVR.
• Alpha1-Adrenergic Blockers (e.g., Terazosin).
• Calcium Channel Blockers (e.g., Diltiazem): Some suppress heart function.

Drug Regimens

• Treatment typically starts with a single antihypertensive drug at a low dose.
• The dose is gradually increased until optimal BP control is achieved.
• Stage 2 hypertension requires a more aggressive approach to minimize the risk of MI, heart failure, and stroke.
• Immediate hospitalization is needed when BP > 200/120 mmHg.
• Step-down therapy is considered after one year of successful treatment.

Lifestyle Modifications

• Weight loss
• Dietary changes
• Restricted alcohol and cigarette use
• Increased physical activity
• Stress reduction
• Complementary health approaches to reduce feelings of distress and anxiety.

Nursing Actions: Implementation

• Promote Health Maintenance: -Knowledge of the disease and its management is vital. -Identify factors that contribute to hypertension. -Assist the patient in developing a realistic health maintenance plan. -Help the patient and family identify strengths and weaknesses in maintaining health.

• Promote Adherence: -Discuss reasons for nonadherence and actively listen without judgment. -Evaluate knowledge regarding hypertension, is effects, and it's treatment. -Assist in developing realistic short-term goals for lifestyle alterations. -Help the patients identify cues and develop reminders for medication and exercise. -Reassure the patients that relapse is common.

• Promote Balance in Nutrition: -Assess usual daily food intake records. -Help determine realistic weight and monitor the patient's weight. -Recommend participation in approved weight-loss programs. -Refer to a dietician.

• Maintain Fluid Volume -Monitor intake and output. -Check daily weights. -Monitor and peripheral edema. -Discuss the relationship between sodium intake and fluid retention, and refer to the dietician. -Explain the importance of maintenance to treatment and volume status.

Best Proven Nonpharmacological Interventions for Prevention and Treatment of Hypertension

• Weight Loss: Losing weight and body fat. -Impact on Hypertension SBP: -5 mm Hg -Impact on Normotension: -2/3 mm Hg -Ideal Goal: Ideal Body Weight
• DASH Dietary Patter: Diet rich in fruits, vegetables, whole grains, and low-fat dairy products with a reduced content of saturated and total fat. -Impact on Hypertension SBP: -11 mm Hg -Impact on Normotension: -3 mm Hg
• Dietary Sodium Reduction: Reduced intake of Dietary Sodium. -Impact on Hypertension SBP: -5/6 mm Hg -Impact on Normotension: -2/3 mm Hg -Ideal Goal: More than 1000-mg/d reduction in most adults.
• Dietary Pottasium Reduction: Enhanced Intake of Dietary Potassium -Impact on Hypertension SBP: -4/5 mm Hg -Impact on Normotension: -2 mm Hg -Ideal Goal: For adults with normal blood pressure; Aim for 3500-5000 mg/d by consumption of a diet rich in potassium.
• Aerobic exercises: 90-150min/wk -Impact on Hypertension SBP: -5/8 mm Hg -Impact on Normotension: -2/4 mm Hg -Ideal Goal: 65-75% heart rate reserve
• Dynamic Resistance exercises: 90-150min/wk -Impact on Hypertension SBP: -4 mm Hg -Impact on Normotension: -2 mm Hg -Ideal Goal: 50%-80% 1 rep maximum , six exercises, 3 sets/exercise, 10 repetitions/set
• Isometric resistance exercises: 4 x 2 minutes, 1 minutes of rest between exercises. 30%-40% maximum voluntary contraction, 3 sessions/wk and 8-10 wk -Impact on Hypertension SBP: -5 mm Hg -Impact on Normotension: -4 mm Hg
• Alchol consumption: reduce alcohol; men- less than 2 drinks daily/ women- less than 1 drink daily -Impact on Hypertension SBP: -4 mm Hg -Impact on Normotension: -3 mm Hg

Nursing Interventions: Focus on TEACHING

• Diet: -Heart Healthy -Increase Dietry potassium with diuretics.
• Medications: -Compliance -Parameters -Side Effects