Hypertension

Recommendations for Follow-up Based on Initial Blood Pressure Readings

Tuesday, January 17, 2012

10:44 AM

Definitions
In normal circulation, pressure exerted by flow of blood through the heart and blood
vessel
High blood pressure can result from the changes in the cardiac output or changes in
peripheral resistance
Medication can use to treat HTN and decrease peripheral resistance
Blood volume is the strength and rate of the myocardial contraction
Blood Pressure = Cardiac Output x Peripheral Resistance
Cardiac Output = Heart Rate x Stroke Volume
Hypertension: AKA High blood pressure
Defined by the Seventh Report of the Joint National Commission on the Prevention,
Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) as a systolic
pressure greater than 140 mm Hg and a diastolic pressure greater than 90 mm Hg,
based on the average of two or more accurate blood pressure measurements taken
during two or more contacts with a health care provider
Classification of Blood Pressure for Adults Age 18 and Older

Hypertension Treatment
1. Medication Treatment
a. Usually initial medication treatment is a thiazide diuretic.
b. Low doses are initiated and the medication dosage is increased gradually if blood
pressure does not reach target goal.
c. Additional medications are added if needed.
d. Multiple medications may be needed to control blood pressure.
e. Lifestyle changes initiated to control BP must be maintained.
Lifestyle Modifications

Incidence of Hypertension- The Silent Killer

1. About 31% of the adult population of the U.S. have hypertension.
2. 90-95% of this population with hypertension have primary hypertension
3. Remaining 5-10% have secondary hypertension related to unidentifiable cause
a. Such as narrowing of the arteries, hyperaldosteronism, certain medication can
cause HTN
4. Incidence is greater in southeastern U.S. and among African-Americans (37%)
Factors Involved in the Control of Blood Pressure
1. Increase sympathetic nervous system activity
2. Insulin resistance
3. Increase reabsorbtion of water, sodium, and chloride by the kidney
4. Increase activity in the renin-angiotensin system
5. Decrease vasodilatation
Manifestations of Hypertension
1. Usually NO symptoms other than elevated blood pressure
2. Symptoms seen related to organ damage are seen late and are serious:
a. Retinal and other eye changes
b. Renal damage
c. Myocardial infarction
d. Cardiac hypertrophy
e. Stroke
Assessment & Diagnostic Evaluation
1. Major Risk Factors
a. Smoking
b. Obesity: BMI > 130
c. Physical inactivity
d. Dyslipidemia
e. Diabetes mellitus
f. Microalbuminuria or GFR < 60
g. Older age: vessel gets narrow and lose elasticity
h. Family history
Patient Assessment
1. History and Physical
2. Laboratory tests
a. Urinalysis
b. Blood chemistry
c. Cholesterol levels
d. Liver Panel (BUN & Creatinine)
3. ECG (12 lead)
4. Echocardiogram

Cardiovascular II Page 1

Medication Therapy for Hypertension

1. Diuretic and related drugs
a. Thiazide diuretics
b. Loop diuretics
c. Potassium-sparing diuretics
d. Aldosterone receptor blockers
2. Central Alpha2-Agonists and other centrally acting drugs
3. Beta blockers
4. Beta blockers with intrinsic sympathomimetic activity
5. Alpha and beta blockers
a. Adverse effects: orthostatic hypotension, postural hypotension (get up slowly, use
supportive device to prevent from falling)
6. Vasodilators
7. Angiotensin-converting enzyme (ACE) inhibitors
8. Angiotensin II antagonists
9. Calcium channel blockers
a. Nondihydropyridines (cardizem)
b. Dihydropyridines (Norvac)

Nursing Process: Hypertension

Tuesday, January 17, 2012
11:24 PM

Nursing History and Assessment

1. History and risk factors
2. Assess potential symptoms of target organ damage
a. Angina, shortness of breath, altered speech, altered vision, nosebleeds,
headaches, dizziness, balance problems, nocturia
b. Cardiovascular assessment: apical and peripheral pulses
3. Personal, social, and financial factors that will influence the condition or its
treatment
Nursing Diagnoses
1. Knowledge deficit regarding the relation of the treatment regimen and control of
the disease process.
2. Noncompliance with therapeutic regimen related to side effects of prescribed
therapy.
Goals:
1. Patient understanding of disease process.
2. Patient understanding of treatment regimen.
3. Patient participation in self-care.
4. Absence of complications.

Interventions
1. Patient teaching
2. Support adherence to the treatment regimen
3. Consultation/collaboration
4. Follow-up care
5. Emphasize control rather than cure
6. Reinforce and support lifestyle changes
7. A lifelong process
8. Objective is to lower B/P without adverse effects
Gerontologic Considerations
1. Noncompliance
2. Include family
3. Understanding of therapeutic regimen
a. Reading instructions
b. Monotherapy: placed on one drugs instead of a bunch of drugs

Cardiovascular II Page 2

Hypertensive Crises
1. Hypertensive emergency
a. Blood pressure >180/120 and must be lowered immediately to prevent damage
to target organs.
i. Can cause angina because heart is pumping harder
ii. Left ventricle works harder, can cause enlarged heart
b. Conditions includes
i. Pregnancy
ii. Acute myocardial infarction
iii. Dissecting aortic aneurysm
iv. Intracranial hemorrhage
c. Reduce BP 25% in first hour
d. Reduce to 160/100 over 6 hours
e. Then gradual reduction to normal over a period of days
f. Exceptions are ischemic stroke and aortic dissection
g. Medications
i. IV vasodilators: sodium nitroprusside, nicardipine, fenoldopam mesylate,
enalaprilat, nitroglycerin
1) Short acting drugs: takes minutes to 4 hours
2) May be used for initial treatment
h. Need very frequent monitoring of BP and cardiovascular status
2. Hypertensive urgency
a. Blood pressure is very high but no evidence of immediate or progressive target
organ damage.
b. Condition includes:
i. Severe HA
ii. Nosebleed
iii. Anxious
c. Patient requires close monitoring of blood pressure and cardiovascular status.
d. Assess for potential evidence of target organ damage.
e. Medications - Fast-acting oral agents:
i. Beta-adrenergic blocker- labetalol
ii. Angiotensin-converting enzyme inhibitors: captopril
iii. Alpha2-agonists-clonidine
Therapeutic goals are reduction of the mean blood pressure by up to 25% within 1st
hour of treatment
Further reduction of blood pressure is about 160/100 over a period of up to 6
hours
Gradual reduction of blood pressure is over a period of days
Exception of these goals are the treatment of ischemic stroke (ex. Aortic dissection)
You dont want B/P to stay elevated for long because it could rupture or can
cause a stroke