HYPERTENSION

A systolic blood pressure greater than 140 mm Hg and a diastolic pressure greater than 90 mm Hg silent killer

TYPES:
Primary or essential hypertension (90-95%) unidentified cause Secondary hypertension: A small percentage of patients (2-10%) have a secondary cause. The following is a list of secondary causes of hypertension: o Renal (2.5-6%) Renal parenchymal disease Polycystic kidney disease Urinary tract obstruction Renin-producing tumor Liddle syndrome o Renovascular hypertension (0.2-4%) o Vascular Coarctation of aorta Vasculitis Collagen vascular disease o Endocrine (1-2%) - Oral contraceptives o Adrenal Primary hyperaldosteronism Cushing syndrome Pheochromocytoma Congenital adrenal hyperplasia o Hyperthyroidism and hypothyroidism o Hypercalcemia o Hyperparathyroidism o Acromegaly o Neurogenic Brain tumor Bulbar poliomyelitis Intracranial hypertension o Obstructive sleep apnea o Pregnancy-induced hypertension o Drugs and toxins Alcohol Cocaine Cyclosporin, tacrolimus Erythropoietin Adrenergic medications

Decongestants containing ephedrine Herbal remedies containing licorice or ephedrine

Classification of Blood Pressure for adults age 18 and older BP Classification Systolic BP Diastolic BP (mm Hg) (mm Hg) Normal <120 <80 Prehypertension 120-139 80-89 Stage 1 Hypertension 140-159 90-99 Stage 2 Hypertension 160 100

Risk factors:
Family history: If your parents or siblings have or have had high blood pressure, your risk increases. Race: African Americans are more likely to develop high blood pressure than Caucasians and other ethnic groups. Gender: Men have a greater overall risk. Women who are 75 and older have a higher risk. Age: Your risk of developing high blood pressure increases after age 55 for men and 65 for women. Sodium Sensitivity: Most Americans eat too much salt. This can increase blood pressure. Weight: Obesity can lead to high blood pressure and complicate control. Alcohol Consumption: Heavy Alcohol consumption can increase your risk. Smoking: Smoking constricts blood vessels. Diet: Eating salty or high-fat foods regularly can increase your risk Stress Level: Ongoing stress such as job stress can affect your likelihood of developing high blood pressure. High Cholesterol: High cholesterol is mostly caused by a fatty diet and lack of exercise, factors influencing the development of high blood pressure.

 Depression: People who are depressed may be less likely to eat right, may eat too much, or may smoke or abuse alcohol. Seasonal Factors: when cold weather hits, blood pressure can increase because cold narrows the blood vessels. Kidney and heart disease: Untreated acute renal failure can lead to congestive heart failure because fluid backs up behind the heart into the lungs.

Pathophysiology:

Clinical Manifestations:
A blood pressure of greater than 140 mm Hg and a diastolic pressure greater than 90 mm Hg retinal changes (as hemorrhages, exudates arteriolar narrowing, and cotton-wool spots) papilledema (swelling of the optic disc) alterations in vision or speech dizziness weakness a sudden fall, or temporary paralysis on one side (hemiplegia) confusion ear noise or buzzing irregular heartbeat nosebleed

Assessment and Diagnosis:

Health history Physical examination Routine laboratory tests (urinalysis, blood chemistry, potassium, creatinine, fasting glucose, and total and high density lipoprotein [HDL] cholesterol levels) a 12-lead electrocardiogram (ECG) evaluation for end organ damage in a patient with borderline high blood pressure

Medical Management:
Goal: To prevent complications and death by achieving and maintaining the arterial blood pressure at 140/90mmHg or lower.

Pharmacologic Therapy: DRUG

Diuretics

MODE OF ACTION
- Cause diuresis,which decreases plasma volume and edema, thereby decreasing cardiac output and blood pressure. - Selectively block postsynaptic alpha1adrenergic

EXAMPLES
Hydrochlorothiazide (Esidrix, HydroDIURIL, Microzide)

CONTRAINDICATIONS
Documented hypersensitivity; anuria; renal decompensation

Alpha1-adrenergic blockers

Prazosin (Minipress)

Documented hypersensitivity

Beta-adrenergic blocking agents

receptors. Dilate arterioles and veins, thus lowering blood pressure. - Used to treat hypertension as initial agents or in combination with other drugs (eg, thiazides)

Atenolol (Tenormin)

Alpha/betaadrenergic blocking agents

- Block alpha-, beta1-, and beta2-adrenergic receptor sites, thus decreasing blood pressure

Labetalol (Normodyne, Trandate)

Peripheral vasodilators

Calcium channel blockers

- Relax blood vessels to improve blood flow, thus decreasing blood pressure. - May be a more effective class of medication for black patients.

Hydralazine (Apresoline)

Documented hypersensitivity; congestive heart failure; pulmonary edema; cardiogenic shock; AV conduction abnormalities; heart block (without a pacemaker) Documented hypersensitivity; cardiogenic shock; pulmonary edema; bradycardia; AV block; uncompensated congestive heart failure; reactive airway disease; severe bradycardia Documented hypersensitivity; mitral valve, rheumatic heart disease

Diltiazem (Cardizem CD, Dilacor XR)

Angiotensinconverting enzyme (ACE) inhibitors

Angiotensin II receptor

- Competitive Captopril (Capoten) inhibitors of ACE. Reduces angiotensin II levels, thus decreasing aldosterone secretion. - For patients Losartan (Cozaar) unable to tolerate

Documented hypersensitivity; severe CHF; sick sinus syndrome; second- or third-degree AV block; hypotension (<90 mm Hg systolic) Documented hypersensitivity; history of angioedema

Documented hypersensitivity

antagonists

ACE inhibitors

Alpha-adrenergic agonists

- Stimulate presynaptic alpha2adrenergic receptors in the brain stem, which reduces sympathetic nervous activity.

Methyldopa (Aldomet)

Documented hypersensitivity; acute liver disease

Complications:

Central nervous system - Intracerebral hemorrhage, lacunar infarcts, encephalopathy, thrombotic stroke, transient ischemic attack Ophthalmologic - Fundal hemorrhages, exudates, papilledema Cardiac - LVH, congestive heart failure, angina pectoris, myocardial infarction Vascular - Aortic dissection, diffuse arthrosclerosis Renal - Nephrosclerosis, renal artery stenosis

Health Teaching:
Lose weight if overweight. This can be accomplished with the DASH (Dietary Approaches to Stop Hypertension) diet, which is rich in fruits and vegetables and encourages the use of fat-free or low-fat milk and milk products. Limit alcohol intake to no more than 1 oz (30 mL) of ethanol per day in men (ie, 24 oz [720 mL] of beer, 10 oz [300 mL] of wine, 2 oz [60 mL] of 100-proof whiskey) or 0.5 (15 mL) of ethanol per day for women and people of lighter weight. Increase aerobic activity (30-45 min most days of the week). Reduce sodium intake to no more than 100 mmol/d (2.4 g sodium or 6 g sodium chloride). Maintain adequate intake of dietary potassium (approximately 90 mmol/d). Maintain adequate intake of dietary calcium and magnesium for general health. Stop smoking and reduce intake of dietary saturated fat and cholesterol for overall cardiovascular health. Manage stress Monitor blood pressure at home Practice relaxation or slow, deep breathing

QUESTIONS: 1. A client has been diagnosed with hypertension. The nurse priority nursing diagnosis would be: A. Ineffective health maintenance

B. Impaired skin integrity C. Deficient fluid volume D. Pain Answer: A. Managing hypertension is the priority for the client with hypertension. Clients with hypertension frequently do not experience pain, deficient fluid volume or impaired skin integrity. It is the asymptomatic nature of hypertension that makes it difficult to treat.

2. Dietary modifications for the client with hypertension include: A. Apple, low-fat milk, cereals B. Crispy pata, macaroni salad, strawberry juice C. Junkfoods, softdrinks, biscuits D. Coffee, pandesal, salad Answer: A. Fruits, vegetables and milk products especially low fat products is the recommended diet for client with hypertension. 3. Which of the following is true about verapamil? A. It is used for wide-complex tachycardia. B. It may cause a drop in blood pressure C. It is a first line drug for Pulseless Electrical Activity D. It is used for treatment of severe hypotension. Answer: B. Verapamil usually decreases blood pressure, which is why it is sometimes used as an antihypertensive agent. Verapamil may be lethal if given to a patient with V-tach, therefore it should not be given to a tachycardic client with a wide complex QRS. Verapamil is a calcium channel blocker any actually cause PEA if given too fast IV or if given in excessive amounts. 4. A type of hypertension wherein the cause is unidentified and called essential hypertension. A. Secondary hypertension B. Rebound hypertension C. Tertiary hypertension D. Primary hypertension Answer: D. Primary Hypertension is often called essential hypertension and known to be idiopathic.

5. The doctor prescribed Calcium channel blocker for a 78 year old client. In teaching the client about the mode of action of the drug prescribed. The nurse would tell that Calcium channel blocker: A. Cause diuresis,which decreases plasma volume and edema, thereby decreasing cardiac output and blood pressure. B. Decreases intracellular calcium leading to a reduction in muscle contraction C. For patients unable to tolerate ACE inhibitors D. Dilate arterioles and veins, thus lowering blood pressure. 6. All of the following are risk factors of hypertension except: A. Smoking B. Aging C. Family history D. Sport of the client Answer: D. All of the following are considered risk factors of hypertension except for the sport of the client. 7. Hypertension is defined as:
A. A systolic blood pressure greater than 130 mm Hg and a diastolic pressure greater than 60 mm Hg B. A systolic blood pressure greater than 120 mm Hg and a diastolic pressure greater than 80 mm Hg C. A systolic blood pressure greater than 140 mm Hg and a diastolic pressure greater than 90 mm Hg D. A systolic blood pressure greater than 130 mm Hg and a diastolic pressure greater than 80 mm Hg Answer: C. Hypertension is defined as a systolic blood pressure greater than 140 mm Hg and a diastolic pressure greater than 90 mm Hg.

8. The following are signs and symptoms of hypertension except: A. Dizziness B. Nosebleed C. Insomnia D. Retinal changes Answer: C. All of the other choices is considered signs and symptoms of hypertension except for insomnia. 9. Hypertension is often called: A. Essential hypertension B. Silent killer

C. Heart failure D. Idiopathic Answer: B. Hypertension is known to be called the silent killer. 10. The best diet for a hypertensive patient is: A. High protein and low fat B. Low salt and low fat C. High vitamins and high salt D. None of the above Answer: B. Low salt and low fat is the recommended diet for hypertensive patient. 11. High blood pressure from an identified cause, such as renal disease. A. Secondary hypertension B. Rebound hypertension C. Primary hypertension D. None Answer: A. Secondary hypertension is a type of high blood pressure from an identified cause. 12. Hydralazine is an example of a peripheral vasodilator which act to: A. Dilate arterioles and veins, thus lowering blood pressure. B. Relax blood vessels to improve blood flow, thus decreasing blood pressure. C. decreases plasma volume and edema D. Stimulate presynaptic alpha2-adrenergic receptors in the brain stem Answer: B. Peripheral vasodilator relaxes blood vessels to improve blood flow, thus decreasing blood pressure. 13. In teaching client about the preventive measures of hypertension. Which statement shows that the client understand the teaching. A. I should limit smoking. B. I should increase my sodium intake. C. I should stop smoking because smoking constricts my vessels which furthermore increase the risk of having hypertension D. I should eat more than my usual diet Answer: C. In smoking, it constricts the vessels which impedes the blood flow. Stop smoking is better than limiting it. 14. All of the following are complications of hypertension except: A. Nephrosclerosis, renal artery stenosis B. Aortic dissection, diffuse arthrosclerosis

C. none D. Fundal hemorrhages, exudates, papilledema Answer: C. All the choices were complications of hypertension. 15. Which of the following are risk factors for a client with hypertension: A. Alcohol intake B. High cholesterol level C. Kidney and heart disease D. All of the above Answer: D. All of the choices were considered risk factors for client with hypertension.