HYPERTENSION

BY: Brenda Anderson

Objectives:
After 10-15 minutes of lecture discussion
everyone will be able to:
1.
2.
3.
4.
5.
6.
7.
8.
9.

Define hypertension
Understand the pathophysiology of hypertension
Understand how to Take accurate blood pressure
measurements
Identify the causes and risks factors for hypertension
Enumerate signs and symptoms of hypertension
Enumerate current therapeutic interventions for
hypertension
Identify the different classifications of hypertension
Differentiate hypertensive emergency from
hypertensive urgency.
Formulate two nursing diagnosis

1. What is hypertension?
Is a condition in which the average of at
least two or more readings on different
dates is above prehypertensive levels of
either 120 to 139 over 80 to 89

2. Pathophysiology. Of HPN

Blood pressure (BP) is the pressure exerted by circulating blood

upon the walls of blood vessels
Vascular resistance refers to the resistance that must be overcome
to push blood through the circulatory system and create flow
Cardiac output (CO) is a term used in cardiac physiology that
describes the volume of blood being pumped by the heart, in
particular by a left or right ventricle, per unit time
stroke volume (SV) is the volume of blood pumped from the left
ventricle of the heart per beat.
Heart rate is the speed of the heartbeat measured by the number of
contractions of the heart per unit of time typically beats per
minute (bpm)
Myocardial Contractility refers to the ability for self-contraction,
especially of the muscles of the heart.

Contn

3. Taking accurate BP
measurements
1.
2.
3.
4.

5.

Use auscultatory method with properly calibrated and

validated BP instrument.
Seat patient quietly for at least 5 minutes in a chair (not
on exam. table) with feet on the floor and arm
supported at heart level.
Use appropriate-sized cuff in which cuff bladder
encircles at least 80% of the arm.
Take at least two BP measurements
-SBP = first two or more sounds heard
-DBP = disappearance of the sounds
Provide patients, verbally and in writing, their specific
BP reading.

4. Identify the causes and risks factors

for hypertension
I.

II.

Nonmodifiable
a. Family history of hypertension
b. Age
c. Race and Ethnicity 5M of 26M living in the US are
hypertensive
d. Diabetes Mellitus
Modifiable
a. Weight reduction
b. Meal planning
1. Salt intake, Caffiene
2. intake of K, Magnesium and Calcium
c. Alcohol Consumption
d. Exercise
e. Smoking

5. Enumerate signs and symptoms of

hypertension
Often hypertension causes no signs or
symptoms other than elevated blood pressure
readings. As a result, hypertension is referred to
as the silent killer.
S/Sx: headache, bloody nose, severe anxiety, or
shortness of breath.
Most signs and symptoms of hypertension stem
from long-term damaging effects on the large
and small blood vessels of the heart, kidneys,
brain, and eyes. These effects are known as the
target organs disease.

6. Enumerate current therapeutic

interventions for hypertension

Diuretics increase urine output by inhibiting

sodium and water reabsorption by the kidney.

Thiazide and thiazide like Chlorothiazide (diuril)

>increase urine output by promoting Na, Cl and
water excretion
Loop Diuretics e.g Furosemide (Lasix)
>act on Ascending Loop of Henle to cause Na and
water loss, also causes loss of K, Mg, Ca
Potassium sparing diuretics e.g Spironolactone
(aldactone)
>mild diuretic; can be used as combination therapy ;
promote Na and water excretion and potassium
retention by the kidney.

Continuation.

Sympatholytics
- Beta blockers e.g Metoprolol (Lopressor)
>decrease sympathetic nervous system resulting in
decreased blood pressure, heart rate, contractility, CO,
and renin activity.
- Alpha1 blockers e.g Prazosin (Minipress)
> blocks effects of sympathetic nervous system on
smooth muscle of blood vessels resulting in
vasodilation and decreased blood pressure.
- Combined Alpha and Beta Blockers
- Central Acting Alpha2 agonists
- Adrenergic neuron blockers
- ACE inhibitors

Identify the different classifications of

hypertension

Primary or Essential Hypertension

- 90-95%
- is the chronic elevation of blood pressure from an unknown cause.
Secondary Hypertension
- has a known cause
- in other words is a sign of another problem, such as kidney
abnormality, a tumor of the adrenal gland or a congenital defect of
the aorta.
- when the cause is treated before permanent structural changes
occur blood pressure usually returns to normal.
Isolated Systolic Hypertension
- is a systolic pressure of 140mmHg or greater and diastolic
pressure of 90 mmHg or less
- occurs mainly in elderly, although it can occur at any age.

Hypertensive Emergency vs.

Hypertensive urgency

Hypertensive Emergency
- is a severe type of hypertension characterized by elevations in
SBP greater than 180mmHg and DBP greater than 120mmHg that
are complicated by risk for or progression of target-organ
dysfunction (example: MI, HF, and dissecting aortic aneurysm)
- people at risk: untreated patients, fail to comply with anti-HPN
therapy or stop their medication abruptly.
Hypertensive Urgency
- occur in a situations when there is severe elevation of BP as in
hypertensive emergency but without target-organ dysfunction
progression.
- manifestations: severe headaches, nosebleeds, SOB, and severe
anxiety.

Nursing Diagnosis
1. Deficient knowledge related to disease
process and treatment regimen
2. Potential for ineffective regimen
management related to complexity of
therapy, cost of medications, lack of
symptoms, side effects of medications,
need to alter long-term lifestyle habits.