Hypertension

HYPERTENSION

Hypertension is defined as high end persistent high in systolic and Diastolic blood pressure. Hypertension is the medical term for high blood pressure. The definition of high blood pressure changed in 2017, when the American College of Cardiology and the American Heart Association revised their hypertension guidelines

As blood is pumped out of the left ventricle into the aorta, the circulating blood exerts pressure on the walls of the blood vessels; this is referred to as the blood pressure (Nicol et al. 2008). Blood pressure varies in different vessels, and in clinical practice the systemic arterial pressure is measured. Blood pressure varies throughout the day. It is often lower during sleep and higher during periods of activity.

Several factors affect blood pressure, including cardiac output, circulating blood volume, peripheral resistance, stress, hormones and drugs.

A blood pressure between 120 and 129 mm Hg for the top (systolic) number and more than 80 mm Hg (diastolic) for the bottom number is considered elevated.

HYPERTENSION STAGES

Under the new 2017 guidelines, all blood pressure measurements over 120/80 mm Hg are considered elevated. Now blood pressure measurements are categorized as follows:

• Normal: systolic less than 120 mm Hg and diastolic less than 80 mm Hg

• PRE hypertension : systolic between 120-129 mm Hg and diastolic less than 80 mm Hg

• Stage 1: systolic between 130-139 mm Hg or diastolic between 80-89 mm Hg

• Stage 2: systolic at least 140 mm Hg or diastolic at least 90 mm Hg

CAUSES

There are two types of high blood pressure.

• Primary (essential) hypertension

Despite years of research on hypertension, a specific cause isn’t known (idiopathic) . It’s thought to be a combination of genetics, diet, lifestyle, and age. This type of high blood pressure, called primary (essential) hypertension, tends to develop gradually over many years.

• Secondary hypertension

Some people have high blood pressure caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, including:

➡️ Obstructive sleep apnea

➡️ Kidney disease

➡️ Adrenal gland tumors

➡️ Thyroid problems

➡️ Certain defects a person is born with (congenital) in blood vessels

➡️ Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs Illegal drugs, such as cocaine and amphetamines

SIGNS AND SYMPTOMS OF HYPERTENSION

➡️ Headache

➡️ Dizziness

➡️ Blurred vision

➡️ Nausea and vomiting

➡️ Chest pain

➡️ Shortness of breath

RISK FACTORS

High blood pressure has many risk factors, including:

AGE . The risk of high blood pressure increases as you age. Until about age 64, high blood pressure is more common in men. Women are more likely to develop high blood pressure after age 65.

RACE . High blood pressure is particularly common among people of African heritage, often developing at an earlier age than it does in whites. Serious complications, such as stroke, heart attack and kidney failure, also are more common in people of African heritage.

FAMILY HISTORY . High blood pressure tends to run in families.

BEING OVERWEIGHT OR OBESE . The more you weigh, the more blood you need to supply oxygen and nutrients to your tissues. As the amount of blood blow through your blood vessels increases, so does the pressure on your artery walls.

NOT BEING PHYSICALLY ACTIVE . People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight.

USING TOBACCO . Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow and increase your risk of heart disease. Second hand smoke also can increase your heart disease risk.

TOO MUCH SALT (SODIUM ) IN YOUR DIET . Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure.

TOO LITTLE POTASSIUM IN YOUR DIET . Potassium helps balance the amount of sodium in your cells. A proper balance of potassium is critical for good heart health. If you don't get enough potassium in your diet, or you lose too much potassium due to dehydration or other health conditions, sodium can build up in your blood.

DRINKING TOO MUCH ALCOHOL. Over time, heavy drinking can damage your heart. Having more than one drink a day for women and more than two drinks a day for men may affect your blood pressure.

STRESS . High levels of stress can lead to a temporary increase in blood pressure. Stress-related habits such as eating more, using tobacco or drinking alcohol can lead to further increases in blood pressure.

CERTAIN CHRONIC CONDITIONS . Certain chronic conditions also may increase your risk of high blood pressure, including kidney disease, diabetes and sleep apnea.

COMPLICATIONS

➡️ Heart Attack

➡️ Stroke

➡️ Aneurysm

➡️ Heart Failure

➡️ Kidney Damage

➡️ Vision Loss

➡️ Peripheral Artery Disease

➡️ dementiaErectile

➡️ Dysfunction

HYPERTENSIVE EMERGENCY

Hypertensive emergency is a situation in which blood pressure must be lowered immediately (not necessarily to less than 140/90 mm Hg) to halt or prevent damage to the target organs. Conditions associated with hypertensive emergency include acute myocardial infarction, dissecting aortic aneurysm, and intracranial hemorrhage. Hypertensive emergencies are acute, life threatening blood pressure elevations that require prompt treatment in an intensive care setting because of the serious target organ damage that may occur. The medications of choice in hypertensive emergencies are those that have an immediate effect. Intravenous vasodilators, including sodium nitroprusside (Nipride, Nitropress), nicardipine hydrochloride (Cardene), fenoldopam mesylate (Corlopam), enalaprilat (Vasotec I.V.), and nitroglycerin (Nitro-Bid IV, Tridil), have an immediate action that is short lived (minutes to 4 hours), and they are therefore used as the initial treatment.

HYPERTENSIVE URGENCY

Hypertensive urgency is a situation in which blood pressure must Be lowered within a few hours. Severe perioperative hypertension Is considered a hypertensive urgency. Hypertensive urgencies are Managed with oral doses of fast-acting agents such as loop diuretics (bumetanide [Bumex], furosemide [Lasix]), beta-blockers propranolol (Inderal), metoprolol (Lopressor), nadolol (Corgard), Angiotensin-converting enzyme inhibitors (benazepril [Lotensin], Captopril [Capoten], enalapril [Vasotec]), calcium antagonists (diltiazem [Cardizem], verapamil [Isoptin SR, Calan SR, Covera HS]), Or alpha2-agonists, such as clonidine (Catapres) and guanfacine

MEDICAL MANAGEMENT

PHARMACOTHERAPY: Drugs used in the treatment of hypertension are based on reducing the peripheral resistance of the blood vessels or reducing the cardiac output. This group of drugs includes:

➡️ Calcium channel blocker

➡️ Beta adrenergic blocker

➡️ ACEI (Angiotensin receptor blocker)

➡️ Angiotensin II receptor blocker (ARBs)

➡️ Diuretics

➡️ Alpha Blockers

➡️ Central acting sympathoplegics

➡️ Vasodilators

NUTRITIONAL MANAGEMENT

DASH( dietary approach to stop hypertension)

Advancements in clinical nutrition led to the development of a Dietary Approach to Stop Hypertension (DASH) diet. These dietary approaches to dealing with hypertension are moderate carbohydrate eating plans that emphasize on an increased intake of vegetables, fruits and low fat dairy products, with the simultaneous reduction in the consumption of products with high saturated fat co

ntent, cholesterol and total fat including red meats, sweets and other types of added sugar. It emphasizes the intake of foods rich in certain nutritional content such as proteins, high fiber foods, and those rich in macro nutrients like as potassium, calcium, and magnesium such as beans, whole grains, nuts and other low-fat dairy products. 

NURSING MANAGEMENT

➡️Assess the patient’s health care literacy (language, reading, comprehension). Assess culture and culturally specific information

needs.

➡️Teach the importance of assessing BP at frequent intervals and adhering to the prescribed medication therapy.

➡️ Provide teaching guidelines on the importance of exercise, stress Reduction, weight loss (if appropriate), decreased alcohol intake, and a Less than 2 g/day sodium diet. Review how to read food labels and Choose low sodium foods. Refer to a nutritionist and exercise program, If appropriate.

➡️Teach medication actions, administration times, side effects, adverse Effects, and the importance of taking as prescribed. Include drug-drug, Food-drug, and herb-drug interactions.

➡️Teach the importance of seeking medical evaluation if BP reading is Greater than 200/100 mm Hg or less than 90/60 mm Hg, or if Headache, dizziness, lightheadedness, or blurred vision occurs.

NURSING DIAGNOSIS

➡️Deficient KNOWLEDGE Related to unfamiliarity with the need for frequent blood pressure (BP) checks, Adherence to antihypertensive therapy, and lifestyle changes evidenced by raised blood pressure.

➡️Ineffective tissue perfusion related increase peripheral vascular resistant evidence by increasing in blood pressure

➡️ Anxiety related to unknown outcome of the disease condition evidence by patients verbalization.