Hypertension PDF
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This document provides a comprehensive overview of hypertension, including its definition, causes, types, risk factors, and complications. It covers both primary and secondary hypertension, along with associated conditions and potential treatments. The document also explores the different types, causes, and risk factors associated with hypertension.
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# Definition of Hypertension - Blood pressure is the force exerted by blood against the walls of the blood vessels. - The pressure depends on the work being done by the heart and the resistance of the blood vessels. - Hypertension is marked by an intermittent or sustained elevation of systolic or d...
# Definition of Hypertension - Blood pressure is the force exerted by blood against the walls of the blood vessels. - The pressure depends on the work being done by the heart and the resistance of the blood vessels. - Hypertension is marked by an intermittent or sustained elevation of systolic or diastolic pressure. **When the heart pumps blood through the arteries, the blood puts pressure on the artery walls. This is known as blood pressure.** # Hypertension ## Another Definition - Hypertension is (high blood pressure) is a disease of vascular regulation in which the mechanisms that control arterial pressure within the normal range are changed. - It is a silent killer. # High Blood Pressure: A Global Public Health Problem - Leading cause of **morbimortality** per year with 9.4 million deaths related to high blood pressure. - 1.13 billion patients suffering from high blood pressure globally and 1.5 billion by 2025. - Only 1 out of every 2 people with high blood pressure is diagnosed and only 10% take treatment to control it. - 65% of people over the age of 59 have high blood pressure. ## Simple Steps to Prevent High Blood Pressure - Eat a balanced diet. - Reduce stress and avoid tobacco products. # Classification of Hypertension ## a. Essential or Primary Hypertension (90% of cases) - Unknown specific cause. - May be due to: - Hormonal factors. - Genetic factors. - Environmental factors such as high salt, low potassium diet, chronic stress. ## b. Secondary Hypertension (9% of cases) - High blood pressure may be a consequence of another disorder or a side effect of medications. - The common causes of secondary hypertension include: - Reno vascular disease. - Renal diseases. - Neurological disorders. - Dysfunction of thyroid, parathyroid or pituitary glands. ## c. Malignant Hypertension (1% of cases) - It is common in younger adults and women who have toxemia of pregnancy. - It is occurring when blood pressure increases extremely quickly if diastolic is over 130 and should be treated in hospital. - In this case, blood pressure increases extremely fast and affects the vital organs. # Types of Hypertension - 1. **Isolated systolic hypertension (ISH)** is just the rise of systolic blood pressure. - Causes: - Increased LV stroke volume (SV) (SV is the volume of blood ejected during ventricular contraction for each stroke of the heart) due to Hyperdynamic circulation. - Decreased aortic compliance due to aortic atherosclerosis. - 2. **Systolic and diastolic hypertension** is the rise of systolic and diastolic blood pressure (Rise of SBP and DBP). - Causes of systolic and diastolic hypertension: - Essential or primary hypertension (accelerated - malignant, white coat - masked - resistant). - Secondary hypertension. # Accelerated Hypertension - Called malignant hypertension and occurs when blood pressure is elevated extremely and affects vital organs. - Clinical manifestation according to its effect on vital organs and which vital organ affected. - Treatment: antihypertensive. - Nursing care focuses on monitoring blood pressure and observation of complications. # Types of Hypertension and General Risk Factors - Two types of systolic/diastolic hypertension: - 1. Primary hypertension. - 2. Secondary hypertension. ## Risk Factors - Age between 30 - 70 years. - Race black. - Overweight, sleep apnea. - Diabetes mellitus. - Metabolic syndrome. - Family history. - Smoking. - Sedentary life style. # Risk Factors - **Non-Modifiable Risk Factors:** - Age. - Gender. - Genetic factors. - Ethnicity. - **Modifiable Risk Factors:** - Obesity. - Salt intake. - Potassium intake. - Saturated fats. - Alcohol. - Dietary fiber. - Smoking. - Stress. - Physical activity. - Socio-economic status. # The Commonest Diseases that Cause Hypertension - 1. **Renal hypertension** - Diseases associated with renal ischemia. - 2. **Endocrinal hypertension:** hyper-function of adrenal cortex. # Causes and Risk Factors of Hypertension ## Essential (Primary) Hypertension - Unknown cause. - Age: it occurs in middle and old age. - Predisposing factors: - Genetics. - Obesity. - Stress. - Salt sensitivity: 60% of hypertensive are salt sensitive. - Smoking. ## Secondary Hypertension ### 1. Renal Causes - **a. Renal parenchymal:** - GN: acute and chronic. - Chronic pyelonephritis - collagen diseases: e.g., systemic lupus erythematosus (SLE), polyarteritis nodosa (PAN) means vasculitis. - Metabolic: as diabetes nephropathy, gouty nephropathy. - **b. Renal vascular:** Renal artery stenosis. ### 2. Endocrinal causes: - **Pituitary:** acromegaly. - **Thyroid:** hyperthyroidism, hypothyroidism, hyperparathyroidism. - **Adrenal gland:** - Adrenal cortex: e.g. pheochromocytoma. - Adrenal medulla: e.g. Cushing syndrome. - **Drugs:** catecholamine, corticosteroids, cyclosporine, carbenoxolone. - **Miscellaneous:** coarctation of the aorta, toxemia of pregnancy, polycythemia vera, polyarteritis nodosa. # Stages of Hypertension | Blood Pressure Category | Systolic mm Hg (upper #) | Diastolic mm Hg (lower #) | |---|---|---| | Normal | Less than 120 | Less than 80 | | Prehypertension | 120 - 139 | 80 - 89 | | High Blood Pressure (Hypertension) Stage 1 | 140 - 159 | 90 - 99 | | High Blood Pressure (Hypertension) Stage 2 | 160 or higher | 100 or higher | | Hypertensive Crisis (Emergency care needed) | Higher than 180 | Higher than 110 | # Mechanisms of Regulation of Blood Pressure and Hypertension 1. **Renin angiotensin system:** - Decreased arterial pressure in the kidneys. - Decreased sodium in the blood. - Renin triggers the release of **angiotensinogen**, which is converted to **angiotensin I** by **ACE**. - Angiotensin I is converted to **angiotensin II**. - Angiotensin II causes vasoconstriction and increases blood volume, leading to increased blood pressure. - It also stimulates the release of aldosterone, which increases sodium and water retention, further contributing to elevated blood pressure. 2. **Systemic vasoconstriction** - Increase cardiac output. 3. **Increased sympathetic tone** # Changes of the Heart in a Hypertensive Patient | Condition | Description | |---|---| | No Hypertension | Heart pumping normally. Blood flows easily through vessels. | | Hypertension | Heart pumping harder. Blood may not flow easily through vessels. | # Systems Involved in Development & Maintenance of Hypertension - **Sympathetic nervous system**. - **Endothelial function:** - Increase peripheral vascular resistance. - **Cardiac function:** - Cardiac output. - **Renal effects:** - Increase renin response. - Increase sodium and water retention. # Clinical Manifestations - Usually asymptomatic. - Headache. - Dizziness. - Blurred vision when greatly elevated. - Nose bleeds. - Clinical Picture: - **Benign hypertension:** A mild form of HTN that runs a slow, long, and usually asymptomatic course. - **Symptoms:** - Asymptomatic (the majority of patients). - Headache, tinnitus, dizziness, palpitation, and epistaxis (a minority of patients). # Signs of Hypertension **General Signs of Hypertension:** - Pulse increased volume. - Blood pressure persistent elevation above 140/90 mmHg. **By Assessment:** - **Eyes:** Fundus examination of eyes reveals signs of hypertensive retinopathy. - **Cardiac:** - **Pericardial examination:** Signs left ventricular hypertrophy with a heavy apex. - **Auscultation:** - S2 accentuated means S2 is louder than S1. - Systolic ejection click. - Systolic ejection murmur due to relative aortic stenosis (AS). - Soft early diastolic murmur due to functional aortic regurgitation (AR). - S4 over mitral area. # Signs of Hypertension ## Hypertensive Urgency - Severe form of hypertension with rapid rise of blood pressure above 220 systole and above 120 diastole. - Not associated with target organ damage. ## Hypertensive Emergency - Severe form of hypertension with rapid rise of blood pressure above 220 systole and above 120 diastole. - Associated with target organ damage. - **Cardiovascular (CVS): ** - Acute pulmonary edema. - AMI. - **Central nervous system (CNS): ** - Cerebral hemorrhage. - Hypertensive encephalopathy. - **Kidney:** Acute renal failure. # Types of Hypertensive Emergency - 1. **Accelerated hypertension:** - Associated with retinopathy (hemorrhage and exudate). - 2. **Malignant hypertension:** - Associated with retinopathy (papilledema). # Signs and Symptoms of Hypertension - **Fatigue or confusion.** - **Chest pain.** - **Trouble breathing.** - **Severe headache.** - **Vision problems.** - **Irregular heartbeat or pounding in your chest, neck, or ears.** - **Blood in your urine.** # Hypertension Symptoms - Dizziness. - Headache. - Heart palpitation. - Nosebleed. - Short breath. - Anger. - Red face. - Visual problems. - Fatigue. - Insomnia. - Sore knee. - Raised temperature. # Laboratory Investigation and Diagnostic Study - Urine creatinine: urea level. - Serum potassium. - ECG. - Chest X-rays. - Renal duplex. # Specific Laboratory Investigation - **For the diagnosis of the cause (in secondary HTN):** - Renal investigations: urine, renal functions, renal imaging. - Endocrinal investigations: lab tests for hormones, imaging. - Neurological investigations: CT, MRI brain. - Blood: CBC. - **For the diagnosis of complications:** - Cardiac investigations: CXR, ECG, echocardiography. - Neurological investigations: CT, MRI brain. - Renal investigations: urine, renal functions, renal imaging. - **For detection of associated risk factors of atherosclerosis.** # Management of Hypertension ## I. Preventive Management ## II. Curative Management ### a. Non-Pharmacological Management (Life Style Modification and Complementary Therapy) ### b. Pharmacological Management (Treatment with Drugs) ### c. Nursing Management # Preventive Management - Lose weight. - Regular aerobic exercise. - Sodium intake 2.4g or less per day. - Decrease cholesterol in diet. - Decrease coffee intake. - Initiate drug therapy. # Approximate SBP# Reduction - **Weight:** 5-20 mmHg/10kg reduction in weight - **Sodium consumption:** 2-8 mmHg - **Physical activity:** 4-9 mmHg - **Healthy diet:** 8-14 mmHg - **Alcohol consumption:** 2-4 mmHg - **Smoking:** 3-5 mmHg # Management for Hypertension - **1. Diet Medication.** - **2. Exercise.** - **3. Anti Hypertensive Meds.** - **4. Lifestyle Medication.** - **5. Smoking Cessation.** # Treatment of Hypertension - Generally, non-drug treatment especially early, mild cases, such as: - Modifications in diet such as: - Salt restriction. - More intake of fruits, vegetables and less fat. - Modifications in lifestyle can control it such as: - Regular daily physical activity. - Moderate alcohol consumption. - Stress reduction. - If this is not effective, treatment progresses in steps to include various types of anti-hypertensive. - Drugs are usually started one at a time, at a low dose. Side effects are usually minor. Medications such as: - Diuretics including thiazides. - Beta blockers and alpha blockers. - Calcium-channel blocker. - Vasodilators. # Nursing Management of Hypertension - **When routine blood pressure screening reveals elevated pressure:** - Make sure the apparatus is suitable for arm circumference. - Take the blood pressure in both arms at sitting, standing and laying position asking pt. if he smoked or drank a beverage containing caffeine or was emotionally upset before the test. - **If the patient is hospitalized with hypertension:** - Find out if he was taking his prescribed anti-hypertensive medication. - Administer diuretics and hypertensive drugs as ordered. - **Health education for hypertensive patients:** - Teach the patient to use a self-monitoring blood pressure and record the reading twice weekly and take the blood pressure at the same time hour each time with the same type of activity. - To encourage compliance with anti-hypertensive therapy, warn the person that uncontrolled hypertension may cause stroke and heart attack, he keeps the record of the drugs he takes and the effectiveness of each, and to discuss with the doctor during the follow-up visit. - Explain that suddenly stopping drug therapy is dangerous and report any adverse effect advice patient to avoid any medication containing harmful vasoconstrictors. - Continue to monitor the patient blood pressure and compliance with treatment, provide positive reinforcement and psychosocial support, as needed to the physician immediately. - Advice patient to avoid any medication containing harmful vasoconstrictors. - For people who smoke, describe the effects of smoking on health. - Continue to monitor the patient blood pressure and compliance with treatment, provide positive reinforcement and psychosocial support, as needed. # The Correct Way to Measure Blood Pressure - **Before you reading:** - No food or drink for 30 minutes. - Empty your bladder. - **During the reading:** - No talking. - Arm resting at chest height. - Cuff against bare skin. - Back is supported. - Sit with feet flat on the floor. # Summary of Pharmacologic Treatment - Diuretics. - ACE inhibitors. - Calcium antagonists. - Beta and alpha receptor blocker agents. # Summary of Nursing Management - **Assessment:** - Measurement of blood pressure. - Provide basic education for patient and family. - Encourage self-management. # Complications - Damage from high blood pressure: - Stroke. - Heart attack. - Blindness. - Heart failure. - Kidney disease/failure. - Sexual dysfunction. # Main Complications of Persistent High Blood Pressure - **Brain:** - Cerebrovascular accident (strokes). - Hypertensive encephalopathy, confusion, headache, convulsions. - **Blood:** Elevated sugar levels. - **Retina of eye:** Hypertensive retinopathy. - **Heart:** - Myocardial infarction (heart attack). - Hypertensive cardiomyopathy, heart failures. - **Kidneys:** Hypertensive nephropathy, chronic renal failure. # Review Questions - 3. What are risk factors? - Age between 30 and 70. - Family history. - Unhealthy diet. - Using tobacco. - Obesity. - Smoking. - Diabetes mellitus. - Stress. - 4. What are the complications of hypertension? - 1. Retinopathy. - 2. Accelerated hypertension (malignant hypertension) BP over 200/120. - 3. Stroke, cerebral hemorrhage and aneurysm. - 4. Kidney damage due to decrease RBF. - 5. Heart failure and left ventricular hypertrophy. - 6. Metabolic syndrome. - 7. Dementia. # Conclusion of Lecture - 1. Define hypertension. - 2. Classify types of hypertension. - 3. List risk factors of hypertension. - 4. Describe signs and symptoms of hypertension. - 5. Perform diagnostic tests of hypertension. - 6. Apply treatment for hypertensive patients. - 7. Design nursing management for hypertensive patients.