2. Learning Outcome
Students will gain an understanding of
hypertension, its disease process and
management, and will apply that
understanding to planned patient care.

3. Learning Objectives
By the end of this module students will
• Compare and Contrast prehypertension, stage
I and stage II parameters according to JNC 7
Guidelines
• Differential between essential and secondary
hypertension
• Describe effects of uncontrolled hypertension
on body organs

4. Learning Objectives
• Name a minimum of four causes of secondary
hypertension
• Define the term "silent killer“
• Create a nursing care plan for a hypertensive
patient using the nursing process and
following the provided rubric

5. Outline
• JNC guidelines for prehypertension and stage I
& II Hypertension
• Types of hypertension
• Risk factors
• Organ damage
• Treatment

6. Introduction

7. Introduction
• Nearly 60 million Americans, or 1 in 4 adults,
have high blood pressure
• High blood pressure contributes to the deaths
of almost 30 individuals every hour of every
day
• An additional 45 million adults, or 22% of the
population, have prehypertension
• Many individuals don’t even know they have
hypertension
the JNC 7 report. JAMA. 2003;289:2560-72.

8. Manifestations of Hypertension
• Usually no symptoms other than elevated
blood pressure
• Symptoms are related to organ damage and
are seen late and are very serious

9. Parameters According to JNC 7
• Seventh Report of the Joint National
Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood
Pressure (JNC 7)
U . S . D E PA RT M E N T O F H E A LT H A N D H U M A N S E RV I C E S
National Institutes of Health
National Heart,Lung,andBlood Institute
http://www.nhlbi.nih.gov/guidelines/hypertension/phycard.pdf

10. What is High Blood Pressure?
JNC 7 Guidelines for Patients Age ≥18 Years
Systolic BP Diastolic BP
BP classification
(mmHg) (mmHg)
Normal <120 and <80
Prehypertension 120–139 or 80–89
Stage 1 hypertension 140–159 or 90–99
Stage 2 hypertension >160 or >100
JNC, Joint National Committee; DBP, diastolic blood pressure; HTN,
hypertension; SBP, systolic blood pressure.
http://www.nhlbi.nih.gov/guidelines/hypertension/phycard.pdf

11. JNC 7 Parameters
Key: SBP = systolic blood pressure DBP = diastolic blood pressure

12. Types of Hypertension
• Essential 90% - 95%
– Cause is unknown
• Secondary 5% - 10%
– High blood pressure that
is caused by another
medical condition or
medication

13. Secondary Hypertension Causes
• Chronic kidney disease
• Disorders of the adrenal gland
(pheochromocytoma or Cushing syndrome)
• Pregnancy (preeclampsia)
• Medications such as birth control pills, diet pills,
some cold medications, and migraine
medications
• Narrowed artery that supplies blood to the
kidney (renal artery stenosis)
• Hyperparathyroidism

14. Risk Factors
• Factors that cannot be changed
–Family history of high blood pressure
–Family history of premature CVD
–Diabetes
–Race (African American)

15. Lifestyle Risk Factors
• Weight (body mass index > 30 kg/m2)
• Stress
• Sedentary lifestyle
• Diet
• Smoking
• Alcohol (more than one drink per day for women
and more than two drinks per day for men)
• Birth control pills

16. Blood Pressure >140/90 mm Hg
Damages Target Organs
HBP
Hemorrhage, LVH, CHD, HF
stroke, dementia
Peripheral
vascular
disease Renal failure
Chobanian AV. JAMA. 2003;289:2560-2572. CHD, coronary heart disease.

17. Organ Damage
• Vascular Effects
– Artery damage and narrowing
– Aneurysm
• Cardiac Effects
– Coronary artery disease
– Enlarged left ventricle
– Heart failure

18. High Blood Pressure Increases Risk of
Ischemic Heart Disease Death
80-89 yrs
• Risk of IHD death increases
256
with increasing age
128 70-79 yrs
60-69 yrs • Risk of IHD death increases
64
with increasing BP in each
(floating absolute risks & 95% CI)
50-59 yrs
32 decade of life
16 40-49 yrs
• Increased risk begins at systolic
8 BP >120 mmHg
IHD mortality
4
• Trend begins at 40 years old
2
1
120 140 160 180
Usual SBP (mmHg)
CI, confidence interval; SBP, systolic blood pressure.
Prospective Studies Collaboration. Lancet. 2002;360(9349):1903-1913.

19. Organ Damage
• Cerebral Effects
– Transient ischemic attack (TIA)
– Stroke
– Mild cognitive impairment
– Dementia
• retinopathy
– Vision impairment
– blindness

20. High Blood Pressure Increases
Risk of Stroke Death
256 80-89 yrs • Risk of stroke death increases
128 70-79 yrs
with increasing
BP in each decade of life
64 60-69 yrs
(floating absolute risks & 95% CI)
32 50-59 yrs
• Risk of stroke death increases
16
with increasing age
8
Stroke mortality
4
• Increased risk begins at systolic
2 BP >120 mmHg
1
120 140 160 180
Usual SBP (mmHg)
CI, confidence interval; SBP, systolic blood pressure.
Prospective Studies Collaboration. Lancet. 2002;360(9349):1903-1913.

21. Organ Damage
• Renal Effects
– Kidney failure
– Kidney scarring (glomerulosclerosis).
– Kidney artery aneurysm
healthtap.com

22. Treatment
• Lifestyle changes
– Weight
– Exercise
– Diet
– Smoking
– Alcohol use
– Stress
• Medication

23. JNC 7

24. Recommended by JNC 7

25. Recommended by JNC 7

26. Medications
• See additional information on
medication video in
hypertension module
• Refer to Drug and Medication
Textbook
• Review Medication Online
Module

27. Nurses Help Patients Significantly Reduce
Systolic BP
Baseline BP
165 P=0.02 After treatment
P=0.28
160
Systolic blood pressure (mmHg)
160.7
155 157.6
150
151.1
145
140
141.1
135
130
Nurse-led program Standard care
Denver E. Diabetes Care. 2003;26:2256-2260

28. Learning Activities
• Review module materials and videos
• Form a group of 2-4
• Create a nursing care plan for a hypertensive
patient using the nursing process and
following the provided rubric as a guide
• Review the nursing process and nursing care
plans as needed

29. plu.edu

30. Discussion forum
• Review hypertension Case scenario
• Using critical thinking answer questions in
discussion forum
• Respond and reply to fellow students
concerning case scenario and nursing care

31. Hypertensive Crisis
This is discussed in the next module
digplanet.com