Hypertension Assessment & Management PDF

Assessment and Management of Patients With Hypertension  Hypertension (HTN) High Blood Pressure Defined as a systolic pressure greater than 140 mm Hg and a diastolic pressure greater than 90 mm Hg. Based on the average of two or more accurate blood pressure (BP) measure...

Assessment and Management of Patients With Hypertension  Hypertension (HTN) High Blood Pressure Defined as a systolic pressure greater than 140 mm Hg and a diastolic pressure greater than 90 mm Hg. Based on the average of two or more accurate blood pressure (BP) measurements taken during two or more contacts with a health care provider. ▪ BP= CO X PR (peripheral resistance), CO= HR X SV ▪ Prolonged blood pressure elevation gradually damages blood vessels thought the body. Particularly in target organs such as: Heart, Kidneys, Brain & Eyes. Classification of Blood Pressure for Adults Age 18 Years and Older  Hypertension— “The Silent Killer” About 30% of the adult population of the U.S. has hypertension. About 54% of adults with HTN do not have it under control. ▪ Primary Hypertension-(Essential HTN): 90% -95% unidentified cause. ▪ Secondary Hypertension: 5% to 10% Causes of Secondary HTN: Renal disease, narrowing of renal arteries, hyperaldosteronism, certain medications (prednisone), high BP can occur with pregnancy. Factors Involved in the Control of BP BP= CO X PR, CO= HR X SV  Major Risk Factors ❑ HTN accompanies other risk factors for atherosclerotic heart disease: ▪ High BP can be viewed as a sign, as a risk factor or as a disease. Smoking: increase risk of dying from heart disease Obesity Physical inactivity Dyslipidemia Diabetes Mellitus (DM) Microalbuminuria or GFR 180/120 mm Hg and must be lowered immediately to prevent damage to target organs Hypertensive Urgency – Blood pressure is very high but no evidence of immediate or progressive target organ damage  Hypertensive Emergency Reduce blood pressure 25% in first hour. Reduce to 160/100 over 6 hours. Then gradual reduction to normal over a period of days. Exceptions are ischemic stroke and aortic dissection. Medications – IV Vasodilators: Sodium nitroprusside, Nicardipine, Fenoldopam mesylate, Enalaprilat, Nitroglycerin Need very frequent monitoring of BP and cardiovascular status.  Hypertensive Urgency Elevated BP associated with sever headaches, nosebleeds, or anxiety. Patient requires close monitoring of blood pressure and cardiovascular status. Assess for potential evidence of target organ damage. The goal of treatment is to normalizing BP within 24 to 48 hours Medications – Fast-acting oral agents : Beta-adrenergic blocker— Labetalol; Angiotensin-converting enzyme inhibitor— Captopril; or Alpha2-agonist—Clonidine.