23% 19%
16%
42%
or or or
Hypertension
1. Primary - 90% of all cases - cause unknown - essential or idiopathic Benign gradual onset with prolonged course Malignant abrupt with short course can be fatal severely damages
Hypertension
2. Secondary cause identifiable
- C.V., renal, pregnancy, drugs, corticosteroids
Hypertension
Isolated hypertension: If the patient has increased systolic BP with normal diastolic BP
Complications
Heart - CAD - atherosclerotic changes
Angina, M.I., ( C.A. blood flow) CHF - afterload, O2 need Arrhythmias Brain - stroke microaneurysms hemorrhage
Complications
Kidneys renal failure
Eyes visual disturbances
blindness
Peripheral Vessels intermittent claudication dissecting aortic aneurysm
Mechanisms of 1 Hypertension
1. Overactive SNS stimulation
- excite with nonepinephrine
- contractions
- vasoconstriction with workload & B/P
Mechanisms of 1 Hypertension
2. Na & H2O retention by kidneys
- excessive secretion of renin
Hypertension
Causes are however numerous &
interrelated
- environment
- psychological - physiologic
Hypertension
No obvious changes at first
Changes widespread with time Large vessels sclerosed (narrowed)
Vasoconstriction heart contractions (afterload) to maintain C.O. chronic overwork L.V. hypertrophy coronary insufficiency M.I.
Cont
LVF eventually renal perfusion Na & H2O retention blood flow to kidneys, heart, eyes, brain Progressive Impairment
Secondary Hypertension
Causes are numerous
diabetes glomerulonephritis corticosteroid Rx Drugs - BCP - Amphetamines
Secondary Hypertension
Causes are numerous
ICP
anemia
aortic regurgitation
Secondary Hypertension
Mechanisms
1. secretion catecholamines 2. release renin 3. Na & blood volume Dx: B/P high over several readings averages >140 > 90
Assessment
1. Extent of organ involvement
2. Presence of C.V. risk factors 3. ID type
History
Family Hx
Diabetes
Previous B/P
results of hypertensives angina, dyspnea hx use of BCP, alcohol, steroids, diet pills
History cont
Weight gain
Na intake
Physical Exam
Retina
Neck Heart
edema, hemorrhage
distended veins, bruit HR, murmurs
Interventions
Nonpharmacological - weight reduction - exercise - Na - relaxation - monthly BP checks - Ethol, coffee - smoking cessation
Hypertensive patient
For age over 44, Restricted to a target range of 90-130 mmol/day. (Limitation of salt additives and foods with excessive added salt)
Fresh fruits, Vegetables, Low fat dairy products, Low fat diet, in accordance with Canada's Guide to Healthy Eating
Dietary Potassium
Daily dietary intake 60 mmol
Calcium supplementation
No conclusive studies for hypertension
Magnesium supplementation
No conclusive studies for hypertension
Hypertensive Crisis
Reduction in BP needed stat
Malignant hypertension
hypertensive encephalopathy - LOC heart failure toxemia dissecting aneurysm intracranial hemorrhage
Continuous EKG
Management Long-term
Assess Knowledge - disease process - consequences - administration drugs - diet - exercise - home monitoring Compliance Ineffective coping
Drugs
Never dose
Never miss dose
Take on time
Side effects Never discontinue
Hypotensive Alert
Lie down with legs elevated
No hot baths No excessive alcohol
Costs