ENGLISH LETTERS

HIGH BLOOD PRESSURE (HYPERTENSION)

Name : Zakiatul Munawaroh

NPM : 1280200081

Leacturer : Ki Agus Baluqiah, M.Pd

PROGRAM STUDI ILMU KEPERAWATAN

FAKULTAS ILMU KESEHATAN

UNIVERSITAS MUHAMMADIYAH BENGKULU

2012 / 2013
1. DEFINITION
 High blood pressure (BP) or hypertension is a medical condition in which the
blood pressure is chronically elevated. Hypertension is the most important modifiable
risk factor for coronary heart disease (CHD), stroke, congestive heart failure (CHF),
end-stage renal disease and peripheral vascular disease.

Hypertension (HTN) or high blood pressure, sometimes called arterial

hypertension, is a chronic medical condition in which the blood pressure in
the arteries is elevated. This requires the heart to work harder than normal to circulate
blood through the blood vessels. Blood pressure is summarised by two
measurements, systolic and diastolic, which depend on whether the heart muscle is
contracting (systole) or relaxed between beats (diastole) and equate to a maximum
and minimum pressure, respectively. Normal blood pressure at rest is within the range
of 100-140mmHg systolic (top reading) and 60-90mmHg diastolic (bottom reading).
High blood pressure is said to be present if it is persistently at or above
140/90 mmHg.

Systolic blood pressure Diastolic blood pressure

Normal Less than 120 mm/hg Less than 80 mm/hg

Pre Hypertension 120 to 139 mm/hg 80 to 89 mm/hg

High BP stage 1 140 to 159 mm/hg 90 to 99 mm/hg

High BP stage 2 160 or higher 100 or higher

2. SIGN AND SYMPTOMS

Hypertension is rarely accompanied by any symptoms, and its identification is

usually through screening, or when seeking healthcare for an unrelated problem. A
proportion of people with high blood pressure report headaches (particularly at
the back of the head and in the morning), as well
as lightheadedness, vertigo, tinnitus (buzzing or hissing in the ears), altered vision
or fainting episodes. These symptoms however are more likely to be related to
associated anxiety than the high blood pressure itself.

On physical examination, hypertension may be suspected on the basis of the

presence of hypertensive retinopathy detected by examination of the optic
fundus found in the back of the eye using ophthalmoscopy. Classically, the severity of
the hypertensive retinopathy changes is graded from grade I–IV, although the milder
types may be difficult to distinguish from each other. Ophthalmoscopy findings may
also give some indication as to how long a person has been hypertensive.

3. CAUSE

A. Primary hypertension

Primary (essential) hypertension is the most common form of hypertension,

accounting for 90–95% of all cases of hypertension. In almost all contemporary
societies, blood pressure rises with aging and the risk of becoming hypertensive in
later life is considerable. Hypertension results from a complex interaction of genes
and environmental factors. Numerous common genetic variants with small effects on
blood pressure have been identified as well as some rare genetic variants with large
effects on blood pressure but the genetic basis of hypertension is still poorly
understood. Several environmental factors influence blood pressure. Lifestyle factors
that lower blood pressure include reduced dietary salt intake, increased consumption
of fruits and low fat products (Dietary

B. Secondary hypertension

Secondary hypertension results from an identifiable cause. Renal disease is

the most common secondary cause of hypertension. Hypertension can also be caused
by endocrine conditions, such as Cushing's
syndrome, hyperthyroidism, hypothyroidism,acromegaly, Conn's
syndrome or hyperaldosteronism, hyperparathyroidism and pheochromocytoma.

Other causes of secondary hypertension include obesity, sleep

apnea, pregnancy, coarctation of the aorta, excessive liquorice consumption and
certain prescription medicines, herbal remedies and illegal drugs.[6][27]

4. PATHOPHYSIOLOGY

In most people with established essential (primary) hypertension, increased

resistance to blood flow (total peripheral resistance) accounting for the high pressure
while cardiac output remains normal. There is evidence that some younger people
withprehypertension or 'borderline hypertension' have high cardiac output, an
elevated heart rate and normal peripheral resistance, termed hyperkinetic borderline
hypertension. These individuals develop the typical features of established essential
hypertension in later life as their cardiac output falls and peripheral resistance rises
with age. Whether this pattern is typical of all people who ultimately develop
hypertension is disputed. The increased peripheral resistance in established
hypertension is mainly attributable to structural narrowing of small arteries and
arterioles, although a reduction in the number or density of capillaries may also
contribute.

Hypertension is also associated with decreased peripheral venous

compliance which may increase venous return, increase cardiac preload and,
ultimately, cause diastolic dysfunction. Whether increased
active vasoconstriction plays a role in established essential hypertension is unclear.

Pulse pressure (the difference between systolic and diastolic blood pressure) is
frequently increased in older people with hypertension. This can mean that systolic
pressure is abnormally high, but diastolic pressure may be normal or low — a
condition termed isolated systolic hypertension. The high pulse pressure in elderly
people with hypertension or isolated systolic hypertension is explained by
increased arterial stiffness, which typically accompanies aging and may be
exacerbated by high blood pressure.

Many mechanisms have been proposed to account for the rise in peripheral
resistance in hypertension. Most evidence implicates either disturbances in renal salt
and water handling (particularly abnormalities in the intrarenal renin-angiotensin
system) and/or abnormalities of the sympathetic nervous system. These mechanisms
are not mutually exclusive and it is likely that both contribute to some extent in most
cases of essential hypertension. It has also been suggested that endothelial
dysfunction and vascularinflammation may also contribute to increased peripheral
resistance and vascular damage in hypertension.

5. PREVENTION

Much of the disease burden of high blood pressure is experienced by people

who are not labelled as hypertensive. Consequently, population strategies are required
to reduce the consequences of high blood pressure and reduce the need for
antihypertensive drug therapy. Lifestyle changes are recommended to lower blood
pressure, before starting drug therapy. The 2004 British Hypertension Society
guidelines proposed the following lifestyle changes consistent with those outlined by
the US National High BP Education Program in 2002 [55] for the primary prevention of
hypertension :

a. Maintain normal body weight for adults (e.g. body mass index 20–25 kg/m2)

b. Reduce dietary sodium intake to <100 mmol/ day (<6 g of sodium chloride or
<2.4 g of sodium per day)
c. Engage in regular aerobic physical activity such as brisk walking (≥30 min
per day, most days of the week)

d. Limit alcohol consumption to no more than 3 units/day in men and no more

than 2 units/day in women

e. Consume a diet rich in fruit and vegetables (e.g. at least five portions per day)

To avoid a hypertension diagnosis, make these healthy lifestyle choices:

1. Maintain a healthy weight

When it comes to hypertension prevention, your weight is crucial, says

Dr. Ogedegbe. People who are overweight should try to lose weight, and
people of normal weight should avoid adding on any pounds. If you are
carrying extra weight, losing as little as 10 pounds can help prevent high
blood pressure. Talk with your doctor about the best weight for you.

2. Eat a balanced diet

Eating healthful foods can help keep your blood pressure under
control. Get plenty of fruits and vegetables, especially those rich in potassium,
and limit your intake of excess calories, fat, and sugar. Consider following the
Dietary Approaches to Stop Hypertension, or DASH, diet, which has been
shown to help manage blood pressure.

3. Cut back on salt

For many people, eating a low-sodium diet can help keep blood
pressure normal. "The higher the sodium intake, the higher the blood
pressure," says Ogedegbe. You can cut back on your total salt intake by
 avoiding high-sodium packaged and processed foods and not adding extra salt
to your meals. "I tell people to stay away from salt shakers," adds Ogedegbe

4. Exercise regularly

Get moving to prevent hypertension. "Physical activity is crucial,"

says Ogedegbe. The more exercise you get, the better, but even a little bit can
help control blood pressure. Moderate exercise for about 30 minutes three
times a week is a good start.

5. Limit the alcohol

Drinking too much alcohol can lead to high blood pressure. For
women, that means no more than one drink a day, and for men, no more than.

6. Monitor your blood pressure

Make sure that you have your blood pressure measured regularly,
either at your doctor's office or at home. High blood pressure often occurs
with no symptoms, so only blood pressure readings will tell you if your blood
pressure is on the rise. If your doctor determines that you have
prehypertension — blood pressure in the range of 120-139/80-89 millimeters
of mercury (mmHg) that puts you at increased risk of developing
hypertension — your doctor may recommend extra steps as a safeguard.

7. Cut back on caffeine

The role caffeine plays in blood pressure is still debatable. Drinking

caffeinated beverages can temporarily cause a spike in your blood pressure,
but it's unclear whether the effect is temporary or long lasting. To see if
caffeine raises your blood pressure, check your pressure within 30 minutes of
 drinking a cup of coffee or another caffeinated beverage you regularly drink.
If your blood pressure increases by five to 10 points, you may be sensitive to
the blood pressure raising effects of caffeine.

8. Reduce your stress

Stress or anxiety can temporarily increase blood pressure. Take some

time to think about what causes you to feel stressed, such as work, family,
finances or illness. Once you know what's causing your stress, consider how
you can eliminate or reduce stress. If you can't eliminate all of your stressors,
you can at least cope with them in a healthier way. Take breaks for deep-
breathing exercises. Get a massage or take up yoga or meditation. If self-help
doesn't work, seek out a professional for counseling.

9. Get support from family and friends

Supportive family and friends can help improve your health. They may
encourage you to take care of yourself, drive you to the doctor's office or
embark on an exercise program with you to keep your blood pressure low.
Talk to your family and friends about the dangers of high blood pressure.

If you find you need support beyond your family and friends, consider
joining a support group. This may put you in touch with people who can give
you an emotional or morale boost and who can offer practical tips to cope
with your condition.

10. Avoid tobacco products and secondhand smoke

On top of all the other dangers of smoking, the nicotine in tobacco

products can raise your blood pressure by 10 mm Hg or more for up to an
hour after you smoke. Smoking throughout the day means your blood pressure
may remain constantly high.

You should also avoid secondhand smoke. Inhaling smoke from others
also puts you at risk of health problems, including high blood pressure and
heart disease.