Hypertension

ByDr. Manal Moussa

Ibrahim

Define hypertension. Identify etiology and risk factors of hypertension . Mention types of hypertension. Describe Pathophysiology of hypertension. Enumerate Clinical Manifestations of hypertension. Identify diagnostic Studies of hypertension. Explain management of hypertension. Identify nursing responsibilities for hypertensive

client.

Hypertension is defined as a consistent constant elevation of systolic or diastolic pressure above 140/95 mm Hg.

The etiology of hypertension can be classified as either primary (essential) or Secondary

.

Primary (essential) hypertensionIt is accounts more than 90 % of all cases and has no cause.

Contributing factors Overproduction of sodium retaining hormones and

vasoconstriction Increased sodium intake More than ideal body weight (central abdominal obesity) Diabetes mellitus and excessive alcohol intake.

Risk Factors1- Age and Sex The risk of high blood pressure increases, as you get

older. Through early middle age, high blood pressure is more common in men. Women are more likely to develop high blood pressure after menopause.

2- Race High blood pressure is particularly common among

blacks.

3- Family HistoryLevel of BP is strongly familial

4- SmokingNicotine constricts blood vessels

5- Elevated Serum LipidsIt leads to atherosclerosis. Narrowing of arteries

increases blood pressure

Aetiology cont.Aetiology cont.Primary hypertensionPrimary hypertension

6- AlcoholAlcohol increases plasma catecholamine.

(epinephrine and non epinephrine)

7- life stylesRegular physical activity can help control

weight and reduce cardiovascular risk.

Aetiology cont.Aetiology cont.Primary hypertensionPrimary hypertension

8- Socioeconomic statusIt is more prevalent in low socioeconomic

groups and among the less educated.

9- Emotional stressStress stimulate sympathetic nervous

systems.

Secondary Hypertension It develops as a consequence of a particular

underlying disease or condition.

Causes Congenital narrowing of the aorta.

Renal diseases such as renal artery stenosis ,renal failure, glomerulonephritis.

Endocrine disorders.

Secondary Hypertension Cont.Causes

Neurological disorders such as brain tumour , head injury

Medication such as sympathetic stimulation (cocaine), nonsteroidal anti-inflammatory

Pregnancy- induced hypertension, generalized vasospasm may be a contributing factor.

Pathophysiology Cont.

Inability of the kidneys to excrete sodium, resulting in factors being secreted to promote salt excretion with the side-effect of raising total peripheral resistance (Is the force opposing the movement of blood within the blood vessels ).

Pathophysiology Cont.

An overactive rennin / Angiotensin leads to vasoconstriction and retention of sodium and water. The increase in blood volume leads to hypertension.

An overactive sympathetic nervous system, leading to increased stress responses.

Clinical Manifestations Hypertension is called the (SILENT KILLER)

because it is a disease that usually occurs without any symptoms until it become more severe and target organ disease has occurred

It includeFatigue, reduced activity tolerance, dizziness,

palpitation, angina, and dyspnea, early morning headache, blurred vision,

spontaneous nose- bleed ,and depression.

Diagnostic Studies The initial diagnosis of hypertension is

made on the basis of two or more elevated blood pressure reading , supine and sitting obtained on at least two separate occasions

The diagnostic test include: Electrolytes (sodium, potassium) Glucose - to identify diabetes mellitus Cholesterol

Diagnostic Studies cont.

Creatinine (renal function), Testing of urine samples for proteinuria

Also a baseline for later monitoring the possible side-effects of certain antihypertensive drugs.

Diagnostic Studies cont.

Electrocardiogram (EKG/ECG)

May show (left ventricular hypertrophy) or the previous silent cardiac disease even a myocardial infarction).

Chest X-ray - again for signs of cardiac enlargement or evidence of cardiac failure.

Management Lifestyle modification. Weight reduction and regular mild exercise reduce

resting heart rate and blood pressure.

Reducing sodium (salt) diet is proven very effective:

it decreases blood pressure in about 60% of people

diet should be rich in fruits and vegetables and low fat .

Management Lifestyle modification cont.

Discontinuing tobacco use and alcohol consumption.

Relaxation therapy, such as meditation, that reduces environmental stress, reducing high sound levels

Management Drug Therapy

A- Diuretics

1- Thiazide/Thiazide- Like diureticIt blocks or inhibits sodium reabsorbtion.

(bebzythiazide)

Management Drug Therapy cont.

The nurse must monitor Check vital signs before administering drug. Monitor client weight. Monitor lab value of electrolytes (potassium) Teach client to:

Take drug early, take drug with food if GIT upset occur, eat K –rich diet (fruits, cereal and potato)

Report muscle weakness, cramping, fatigue.

Management Drug Therapy cont.

2- Beta-adrenergic blockers:

It block beta-adrenergic receptors of sympath.N.S.

Decreasing heart rate and blood pressure (atenolol)

Nursing intervention Be alert to the signs of hypoglycaemia.

Drug Therapy cont.

Nursing intervention Cont. Change position slowly. Teach client to: Avoid hot baths, steam room, saunas. Use gum or hard candies to counteract dry mouth. Be cautious in driving Report any decline in sexual responsiveness

Management Drug Therapy cont.

D- Angiotens in inhibitors

1- Angiotensin converting enzyme

It blocking the release of aldosterone, thereby reducing sodium and water retention(captopril)

Side Effects

Hypotension, loss of taste, cough, Hyprekalaemia, acute renal failure, skin rash.

Management Drug Therapy cont.

Nursing Management Monitor for first dose syncope in client with CHF.

Monitor renal function and potassium levels.

Check BP before administration.

Teach the client to change position slowly, report any incidence of fatigue, skin rash, impaired taste, and chronic cough

Management Drug Therapy cont.

E-Calcium channel blockersIt inhibit influx of calcium into muscle cells; acts on vascular

smooth muscle to reduce spasms and promote vasodilatation. Verapamol (Isoptin)

Side EffectsNausea, headache, dizziness, reflex tachycardia, oedema.

Nursing InterventionI. Check vital signs before administering

II. Monitor renal and liver function tests.

Nursing Responsibilities of Hypertension

Provide the numerical value of the client's BP and

explain that it exceeds normal limits.

Inform the client that hypertension usually asymptomatic.

Explain that long- term follow- up and therapy are necessary.

Explain that therapy will not cure but should control case

Be specific about the names, actions, dosages and side effects of prescribed medication.

Nursing Responsibilities of Hypertension Tell the client not to discontinue drugs abruptly because

withdrawal may cause a sever hypertensive reaction.

Tell the client not to double upon doses when a dose is missed

Tell the client to consult the health care provider about drugs or dosage if problems develop.

Tell the client to supplement diet with foods high in potassium. Tell the client to avoid hot baths, excessive amounts of

alcohol and strenuous exercises within 3 hours of taking drugs