This document discusses hypertension (high blood pressure) including: 1. It defines hypertension as persistent high blood pressure that can damage vessels and organs like the heart, brain, kidneys, and eyes. 2. It identifies risk factors for primary (essential) hypertension such as age, heredity, sex, race, obesity, sodium intake, alcohol, stress, and other conditions. 3. It describes potential complications of uncontrolled hypertension like heart disease, heart failure, stroke, kidney damage, and retinal damage. 4. It provides an overview of hypertension diagnosis, treatment including lifestyle changes and medications, management, and nursing considerations.

1. Hypertension
George Ann Daniels MS, RN

2. What is Blood Pressure
• Components of B/P • Systolic
– Force while the heart
– Pressure of blood pumps
against the walls of the – Pressure as the heart pushes
arteries the blood out to the body
– Normal >130
– The elasticity of the
artery walls • Diastolic
– Force between heart pumps
– The volume and – Pressure as the heart begins
thickness of the blood to fill with blood
– Normal >85
• Systolic over diastolic
• 120/80

3. What is Hypertension
• Is the result of persistent
high arterial blood
pressure which may cause
damage to the vessels and
arteries of the
– Heart
– Brain
– Kidneys
– Eyes
• B/P > 140/90

4. Damage to arteries
• HTN arterial walls thicken
– Narrowing the opening inside the artery and
reduces/block blood flow
• Persistent HTN arterial walls become rough
– Easy for plaque is collect inside the artery
– Decreased/blocked blood flow
– Plaque can become mobile
• Fatty emboli

6. Classifications of Hypertension
• Primary
– Essential HTN
• Slow onset
• Asymptomatic
– Malignant
• Sudden onset
• Rapid development of symptoms
• Accelerated progression

7. Risk Factors R/T Primary
Hypertension
• Age/Heredity
• Sex
• Race
• Obesity
• Stimulants
• Sodium
• Alcohol
• Stress
• Hyperlipidemia
• Diabetes
• Socioeconomic Status

8. Secondary Hypertension
• Underlying cause that impairs peripheral blood
flow, alters cardiac output, or increases blood
viscosity
• Most common
– Renal failure
• Other causes
– Endocrine, Coarctation, neurological, sleep apnea,
medications/stimulants, PIH
• Treat cause and hypertension resolves

9. Clinical Manifestation
• Persistent
hypertension
• Fatigue
• Reduced activity
tolerance,
• Palpation
• Angina
• Dyspnea

10. Complications
• Hypertensive Heart Disease
– Coronary Artery Disease
• Hypertension is a major risk
factor for CAD
• Left Ventricular Hypertrophy
(LVH)
– Increased resistance in the
arteries
» Stiffness and
narrowing of vessels
» Left heart works
harder pumping
against higher
pressure
» Increases myocardial
work and 02
consumption

11. • Heart Failure
– Heart can no longer pump enough blood to
meet the metabolic needs of the body
– Contractility depressed
– Stroke volume and cardiac output decreases
– C/O
• SOB on exertion, paroxysmal nocturnal dyspnea
and fatigue

12. Complications Con’t
• Cerebrovascular Disease
(CVA)
– Most common cause
Atherosclerosis
– Portions of plaque or a blood
clot (forms on plaque) breaks
off
• Thromboembolism
• Travels to intracerebral
vessels
– Stops the flow of blood to
parts of the brain
– Aneurysms burst R/T
increased pressure
» Hemorrhage
» Brain tissue damage

13. • Peripheral Vascular
Disease (PVD)
– Hypertension speeds up
Atherosclerosis in the
peripheral blood vessels
• Aortic aneurysm
• Aortic dissection
• PVD
– C/O
• Intermittent claudication

14. • Nephrosclerosis
– End stage renal disease
– Renal dysfunction
• Ischemia
– Narrowed intrarenal
vessel
» Atrophy of tubules
» Destruction of
glomeruli
» Death of nephron
– Earliest symptom
• nocturia

15. • Retinal Damage
– Red flag
• Damage to retinal
vessels may indicate
vessel damage in the
heart, brain, and kidney
– C/O
• Blurred vision
• Retinal hemorrhage
• Loss of vision

16. Nursing Assessment Data
• Subjective Data FHP 6
– Past medical history/Family Cognitive/perception
history Blurred vision
– FHP 2 Nutrition
• Alcohol use, salt and fat paresthesia
intake, wt. gain/loss FHP 9 Sexual/Repro
– FHP 3 Elimination Impotence
• Nocturia
– FHP 4 Activity/Exercise FHP 10 Coping/stress
• Fatigue, Dyspnea on Stressful life events
exertion, palpitation,
angina, chest pain,
Noncompliance
intermittent claudication, knowledge deficit
muscle cramps, smoking
history, sedentary lifestyle financial

17. Objective Data
• Cardiovascular • Musculoskeletal
– Persisted elevated B/P – Truncal obesity
– Orthostatic change in B/P – Abnormal waist-hip
or pulse ratio
– Retinal changes
• Neurologic
– Abnormal heart sounds
– Diminished or absent – Mental status changes,
peripheral pulses – Localized edema
– Carotid, renal, ischial or
femoral bruits
– edema

18. Abnormal Diagnostic Test
• Lab • ECG
– UA, BUN, serum – Left Ventricular
Creatinine hypertrophy
• Renal involvement
– Serum electrolytes • EEG
• Potassium – Ischemic heart disease
– Hyperaldosteronism
– Blood Glucose
– Serum cholesterol and
triglycerides
– Uric acid

19. Medications
• Diuretics
– Suppresses renal tubular re-
absorption of sodium
• Diuril
– Loop diuretics
• Bumex, Lasix, Demadex
– Potassium supplement
– Potassium sparing diuretic
• Aldactone

20. • Beta Blockers
– Blocks sympathetic
• Peripheral Inhibitors
stimulation, decreases renin – Relaxes smooth muscle,
secretions, decreases cardiac decreases peripheral
output. resistance, decreases
• Tenormin, Lopressor, heart rate, and B/P
Corgard, Inderal • Resperine
• Alpha Inhibitors • Vasodilators
– Decreases peripheral vascular
– Relaxation of arteriolar
resistance,
smooth muscle,
– Vasodilator
vasodilatation, decreases
• Catapres
cardiac output, decreases
• Central Inhibitors peripheral resistance
– Decreases cardiac output, • Apresolilne, Nipride
peripheral resistance, and
heart rate
• Aldomet, Tenex

21. • Calcium Channel • Angiotension-
Blockers Converting Enzyme
– Inhibits calcium into Inhibitors
smooth muscle cells, – Decreases peripheral
vasodilatation, decreases vascular resistance
peripheral resistance, • Lotension, Captoen,
increases cardiac output Vasotec, Prinivil,
• Norvasc, Cardizem, Accupril
Plendil

22. Expected Outcomes
• Patient will achieve and maintain desired B/
P
• Patient will understand, accept, and
implement the therapeutic plan for B/P
• Patient will experience minimal or no side
effects from therapy
• Patient will exhibit a confident ability to
manage and cope with hypertension.

23. Plan of Care
• Health Promotion • Teaching
– Life style modifications – Hypertension
• Diet • Family/patient
• Regular physical activity – Correct technique for taking
B/P
• Avoid smoking and
chewing – ID Risk factors and
• Relaxation S& S
techniques/stress – Screening programs
management – Drug therapy
• Drug Therapy • Recommendations for
follow-up
– Box 31-13

24. Hypertensive Crisis
• Severe and abrupt
elevation in B/P
– Diastolic of 120-130
• Non-compliant
patients
• Cocaine or crack users
• PCP, LSD
• Causes listed in table
31-15

25. Types of Hypertensive Crisis
• Hypertensive Emergency
– Develops over hours to days
– Evidence of damage to acute target organ
• CNS
– Hypertensive encephalopathy, intracranial or subarachnoid
hemorrhage, acute left ventricular failure with pulmonary
edema, myocardial infarction, renal failure, and dissecting
aortic aneurysm
• Hypertensive Urgency
– Develops over days to weeks
– No evidence of target organ damage

26. Assessment data
• Sudden rise in arterial pressure seen in Hypertensive
Encephalopathy
– HA, Nausea, Vomiting, Seizures, Confusion, Stupor, Coma
– Other common
• Blurred vision and transient blindness
• Renal insufficiency
– Minor to complete renal shut down
• Rapid cardiac decomposition
– Unstable angina to MI
– Pulmonary edema
• Chest pain and dyspnea
• Neurological
– Change in LOC

27. Diagnostic
• Mean arterial pressure (MAP)
– DBP plus pulse pressure(SBP minus DBP)
– MAP = DBP + 1/3 Pulse Pressure
– Goal decrease MAP 10-20% in the first 1-2
hours
– Patients with aortic dissection, unstable angina,
or sign of MI
• Must have SBP lowered to l00-120 mm Hg asap

28. Medications
• IV Meds for Hypertensive Emergency
– Vasodilators
• Nipride (most effective), Nitroglycerin, Hyperstat, Apresoline
– Alpha Inhibitors
• Regitine, Normodyne, Brevibloc
– Ace Inhibitors
• Vasotec
• Meds for Hypertensive Urgency
– Oral agents
• Capoten, Catapres

29. Plan of Care
• Hypertensive Emergency
– Administer IV meds with
rapid onset of action
– B/P Q 2-3 minutes
– Medication is titrated
according to B/P
– Prevent hypotension
• Stroke, MI, visual changes
– Monitor ECG
– Hourly output
– Bedrest
– Neurochecks

30. • Hypertensive Urgencies
– Sit quietly for 20-30 minutes
– Oral medications
– Encourage patient to verbalize fears R/T
hypertension
– Follow up in 24 hours

31. Pediatric Considerations
• Most common secondary
to a structural abnormality
or underlying pathologic
process
• Manifestations
– Adolescents/older children
• Frequent HA, dizziness,
visual changes
– Infants/young children
• Irritability, head
banging/head rubbing,
wake up screaming at
night

32. Treatment
• Diagnosis of underlying cause
• Surgery correction
• Life style changes
– Low salt diet, wt loss, exercise, avoid stress, avoid
smoking
– Avoidance of BCP
• Education
– Orthostatic hypotension
– Take drug as prescribed
– Awarness of side effects and what to do
– Avoid alcohol
– Stay on diet

33. The End