1. SCHOOL OF NURSING,DEPARTMENT OF CARDIOVASCULAR NURSING
SEMINAR PRESENTATION ON HTN
BY:JIREGNA ETICHA GSRC /4247/14
: HABTAMU MULU GSRC/4236/14
INSTRUCTOR: (TAKALEGN, MSC IN CVNGP)
April 27/2022

2. Out line

3. Objective

4.  Introduction
Hypertension
Systolic Blood
Pressure (SBP)
Diastolic Blood
Pressure (DBP)
> 140 mmHg > 90 mmHg

5. Determinant's BP
 BP=CO X SVR=HR X EDV - ESV X SVR
 CO=HR X SV
 CO=is defined as amount of blood pumped out of each ventricle per minute.
 HR=The number of times your heart beats per minute (BPM)
 SV=is the volume of blood pumped from one ventricle of the heart with each beat.
 SV = EDV – ESV
 SRV=Vascular function and structure.

6. INTRODUCTION
 Arterial hypertension, simply started is high blood pressure. It is
defined as a persistent evaluation of the systolic blood pressure at
a level of 140 mm Hg or higher and diastolic blood pressure at a
level of 90 mm Hg or higher.

7. CLASSIFICATION OF HTN
Classification Systolic blood pressure Diastolic pressure
Normal ≤120 ≤ 80
Pre HTN 120-139 80-89
High BP Stage 1 140-159 90-99
High BP Stage 2 Higher than 160 Higher than 100

8. Risk factors
 Family history
 Age
 Gender
 Ethnicity
 Diabetes
 Stress
 Obesity
 Nutrients
 Substance abuse

9. Clinical manifestation
 Silent killer
 Headache
 Nausea and vomiting
 Fatigue and confusion
 Chest pain
 Dizziness
 Epistaxis
 Angina
 Dyspnea
 Severe head ache
 Blurred vision
 Irregular heart beat
 papilledema

10. Complications
 CAD
 LVH
 Heart attack / stroke
 HF
 Retinal damage
 Atherosclerosis
 Peripheral vascular disease

11. Types
1.Primary HTN / essential 95%
 Is the most common form of hypertension.
 The cause of primary hypertension is unknown.
2.Secondary HTN 5%
3.Systolic Isolated Hypertension
 It’s a high value of systolic pressure, and a normal value of diastolic pressure

12. 4. Hypertensive crisis
Hypertensive Urgencies
 Hypertensive urgency is acute severe elevation in blood pressure (>180/120 mmHg)
without evidence of end organ damage
 Usually due to under-controlled HTN.
Hypertensive Emergencies
 A severe elevation in blood pressure (usually >180/120 mmHg) complicated by
impending or progressive target organ dysfunction involving neurological, cardiac or
renal systems”
 Require lowering of BP within 1 hour to decrease morbidity
 Not determined by a BP level, but rather the imminent compromise of vital organ
function

13. Risk Factors for Primary Hypertension
 Age (> 55 for men; > 65 for women)
 Alcohol
 Cigarette smoking
 Diabetes mellitus
 Elevated serum lipids
 Excess dietary sodium
 Gender Risk Factors for Primary Hypertension
 Family history
 Obesity (BMI > 30)
 Ethnicity (African Americans)
 Sedentary lifestyle
 Socioeconomic status
 Stress

14. 2. Secondary HTN
 Some people have high blood pressure caused by an underling condition.
 This type of high blood pressure called secondary hypertension. Various
condition and medications can lead to secondary hypertension.
 Renal artery stenosis
 Oral contraceptive pills
 Illegal drugs

15. Conti….
 Sleep apnea
 Drug-induced or drug-related
 Chronic kidney disease
 Primary aldosteronism
 Reno vascular disease
 Chronic steroid therapy and Cushing syndrome
 Phaeochromocytoma
 Acromegaly
 Thyroid or parathyroid disease
 Coarctation of the aorta

16. Other types of HTN
1. White coat hypertension
 White coat syndrome have normal reading at home and only have high readings
when their BP is taken by a doctor.
2.Isolated systolic hypertension
 It’s not uncommon to have either a systolic number that’s elevate while the
diastolic number remains normal.
 It’s less common for patients to have elevated diastolic number.
 This condition known as isolated systolic hypertension

17. 3.Persistent Hypertension
 Characterized by a diastolic blood pressure above 110 to 120 mm Hg.
 It results when hypertension is unresponsive to treatment and become a truly
severe emergency condition as the pressure continues to rise unchecked

18. Benign hypertension
 is a term used to describe uncomplicated hypertension,
usually of long duration and mild to moderate severity.
 Benign hypertension may be primary or secondary.

19. Malignant hypertension
 is a syndrome of markedly elevated BP (diastolic BP over 140
mm Hg) associated with papilledema.
 Accelerated hypertension is a syndrome of markedly elevated
BP with retinal hemorrhage and exudates.
 Accelerated hypertension presumably develops into malignant
hypertension if not well managed.

20. Borderline or labile hypertension
 is defined as intermittent elevation of blood pressure
interspersed with normal readings.
 Clients with borderline hypertension still carry an increased
risk of developing cardiovascular disease.

21. Resistant hypertension
 Resistant hypertension is defined as blood pressure that remains
above goal in spite of the concurrent use of 3 antihypertensive
agents of different classes. Ideally, one of the 3 agents should be a
diuretic and all agents should be prescribed at optimal dose
amounts

22. Diagnostic Evaluation
 History collection and physical examination
 Medical history of diabetes mellitus
 Complete blood count
 Chest x-ray
 ECG
 Ophthalmoscopy/Funduscopy

23. laboratory Tests
 Renal
 Microscopic urinalysis, proteinuria, BUN and/or creatinine
 Endocrine,
 Serum sodium, potassium, calcium, TSH
 Metabolic
 Fasting blood glucose, HDL, LDL, and total cholesterol, triglycerides

24. Management
1.Non pharmacological management
2. Pharmacological management

25. 1.Non pharmacological management
 Lifestyle modifications
 Sodium restriction
 Nutritional therapy
 Physical activity
 Alcohol restriction
 Relaxation technique
 Weight reduction
 DASH Diet : Dietary Approaches to Stop Hypertension

26. 2.Pharmacological management
1.ACEI
 Angiotensin is a hormone in the body that causes blood vessels to narrow.
 The angiotensin converting enzyme inhibitors decreases the production of angiotensin
and in turn that helps lower blood pressure.
 Inhibit ACE and formation of angiotensin II and block its effects
 Drugs of choice in co-existent diabetes mellitus, Heart failure
 Captopril (25-150 mg/day)
 Ramipril (1.25-20 mg/day)
 Lisinopril

27. 2. Alpha blockers
 These medicines reduces nerve impulses to blood vessels, reducing the
effects of natural chemicals that narrow blood vessels.
 Block α-1 receptors and cause vasodilation
 Reduce peripheral resistance and venous return
 Exert beneficial effects on lipids and insulin sensitivity
 Drugs of choice in patients with co-existing BPH
 Prazocin (2-30 mg/day)
 Terazocin (1-20 mg/day)

28. 3. Alpha- beta blockers
 In addition to reducing nerve impulses to blood vessels, alpha beta blockers
slow the heartbeat to reduce the amount of blood that must be pumped through
the vessels.
 Help relax your blood vessels, which lowers your blood pressure.
 Labetalol (2-30 mg/day)
 Carvedilol (12.5-20 mg/day)

29. 4. Angiotensin II receptor blockers
 These medications help relax blood vessels by blocking the action, not
the formation of a natural chemical that narrows blood vessels.
 Block the angiotensin II receptor and inhibit effects of
angiotensin II
 Drugs of choice in patients with co-existing diabetes mellitus
 Valsartan
 losartan

30. 5.Beta blockers
 These medications reduce the workload on heart and open blood vessels, causing
heart to beat slower and with less force.
 Example: Atenolol, Metoprolol, nebivolol,
 Block β1 receptors on the heart
 Block β2 receptors on kidney and inhibit release of renin
 Decrease rate and force of contraction and thus reduce cardiac output
 Drugs of choice in patients with co-existent coronary heart disease

31. 6. Calcium channel blockers
 These medicines will block the movement of extra cellular calcium into the cells and causing
vasodilation and decreased heart rate.
 These medications relax the muscles of blood vessels. Some slow the heart rate.
 Calcium channel blockers relax blood vessels by stopping calcium from entering cells
 Cause vasodilation and reduce peripheral resistance
 Drugs of choice in elderly hypertensive and those with co-existing asthma
 Neutral effect on glucose and lipid levels
Example: Amlodipine

32. 7. Diuretics
 Example: Hydrochlorothiazide :-Act by decreasing blood volume and cardiac
output •
 Decrease peripheral resistance during chronic therapy
 Drugs of choice in elderly hypertensive
 Diuretics help the kidneys get rid of sodium and water from body. This decreases the
volume of blood in the body and lowers blood pressure.
 Diuretics are also called water pills. They help your kidneys remove some salt (sodium)
from your body. As a result, your blood vessels don't have to hold as much fluid and your
blood pressure goes down
 E.g. chlorothiazide, furosemide
 Furosemide (40-240mg/day)
 Spironolactone (25-100 mg/day

33. 8.Vasodilators
 These medications acting directly on the muscles in the wall of arteries and
preventing the muscles from tightening and arteries from narrowing. These
medications work directly on the muscles in the walls of arteries.
 signal the muscles in the walls of blood vessels to relax
E.g. Nitroglycerin, Sodium nitro prusside
 Minoxidil (5-100 mg/day)
 Hydralazine (50-300 mg/day)
9.Centrally acting drugs
 signal your brain and nervous system to relax your blood vessels

34.  Step to Management
Lifestyle modifications
weight loss, diet, exercise, stop smoking, limit alcohol
Medication
Diuretics or Beta-Blocker
Add second drug or substitute another drug
Add third drug and/or substitute second drug
Continue adding agents from other classes
Referral to hypertensive specialist
Step 1
Step 2
Step 3
Step 4
Step 5

35. Algorithm of HTN Management

36. THANK YOU!!!!!