Hypertension

Introduction
Hypertension: a level of blood pressure that damages the cardiovascular system

This is a dangerous condition as there often aren’t any noticeable symptoms. Due to the
lack of symptoms, this disease is not caught until the individual encounters a damaged
health.

Here are testing and interventions to manage and prevent hypertension.

Etiology & Pathophysiology

Primary (Essential) Hypertension: Secondary Hypertension:
Most common Cause: diseases,
Cause: unknown medications
Due to high blood pressure,
Left ventricle of heart hypertrophies to pump blood through aorta to the rest of the
tissues
High shearing force against arterial walls leads to:
Damaged endothelial layer of arterial blood vessels
Vasoconstriction and vasodilation does not occur as easily
Hypertrophied blood vessel walls
What is affected?
Oxygen flow, fluid volume, circulation
What does this mean?
The tissues and organs receiving the blood become damaged
BP Regulation Mechanisms
To increase low BP
Baroreceptors, renin-angiotensin-aldosterone system
To decrease high BP
Atrial and B type natriuretic peptides

Prevalence & Risk Factors

Risk factors:
121.5 million adults in the U. S. are affected Males
Age 60+
> Males from 20-64 years of age. African American ethnicity
> Females from 65+ years of age. Family history of hypertension
Medical History
Hypertension found more in African Americans Hypersensitivity to angiotensin II
High renin secretor
Obesity Lifestyle
Diabetes Sedentary
High sodium, diets
Chronic stress
Low SES
Alcohol and tobacco use

Signs & Symptoms

See Provider Immediately:
Symptoms
Mainly asymptomatic Target organ damage
Headaches
chest pain
Dizziness
dyspnea
Blurred vision
visual disturbances
Palpitations
extremity weakness

Diagnostic Tests & Procedures

Vital Signs: BP Measurement Ambulatory BP Monitoring
For accurate measurements: Measurement of blood pressure
Avoid exercise, caffeine, alcohol, over 24 hours
& smoking 30 minutes before
Seat for 5 minutes BP Staging in Hypertension Diagnosis
Results:
2 elevated blood pressure Normal:
readings Systolic blood pressure (SBP) < 120 mmHg,
Diastolic blood pressure (DBP) < 80 mmHg
Elevated
120-129 mmHg SBP; 80-89 mmHg DBP
Stage 1 hypertension
130-139 mmHg SBP; 80-89 mmHg DBP
Stage 2 hypertension
≥140 mmHg SBP or ≥90 mmHg DBP
Hypertensive crisis
≥180 mmHg SBP and/or ≥120 mmHg DBP

Blood Tests, Urinalysis, Imaging, & Hormonal Testing

Blood Tests
Urinalysis
Elevated blood glucose -
Proteinuria - renal damage
diabetes
Hematuria - kidney
Abnormal potassium or
pathology
calcium levels -
Elevated catecholamines -
aldosteronism or PTH
pheochromocytoma
disorders
Elevated glucose - diabetes
Increased BUN &
creatinine levels - renal
impariment
 Blood Tests, Urinalysis, Imaging, & Hormonal Testing (Cont)
Imaging Hormonal Testing
Chest radiography - Thyroid function test -
cardiomegaly hyperthyroidism
Renal ultrasound or CT scans - Elevated catecholamines -
kidney abnormalities pheochromocytoma
ECG - left ventricular Increased serum corticoids -
hypertrophy (LVH) Cushing’s disease
Abdominal CT or MRI - adrenal Renin & aldosterone levels -
tumors or vascular abnormalities primary aldosteronism
Echocardiography - LVH,
diastolic dysfunction

Pharmacologic & Non-Pharmacologic Therapeutic

Approaches
Non-Pharmacologic Approaches Stepwise Approach to
DASH diet Hypertension Treatment
Fruits, vegetables, whole grains, low-fat
dairy products Step 1
Sodium reduction Lifestyle modification
Other lifestyle modifications implementation
Weight loss Step 2
Stress management Drug therapy
Smoking cessation Step 3
Moderate alcohol intake Drug therapy adjustment
Increase physical activity Step 4
Additional medication

Pharmacologic Approaches
Diuretics Antiotensin II Receptor Blockers (ARBs)
Reduce blood volume Reduce vasoconstriction & aldosterone
Thiazide diuretics release
Hydrochlorothiazide Losartan, valsartan
Loop diuretics Side effects: hyperkalemia, dizziness,
Potassium-sparing diuretics angioedema
Spironolactone Alternative to ACE inhibitors
Often first-line treatments CONTRAINDICATION: pregnancy
For mild hypertension

Calcium Channel Blockers (CCBs)

ACE Inhibitors
Vasodilation & lower vascular resistance
To reduce vasoconstriction & fluid Amlodipine, verapamil
retention Side effects: peripheral edema,
Lisinopril, enalapril, ramipril constipation, bradycardia, dizziness
Side effects: dry cough, For hypertension, isolated systolic
hyperkalemia, angioedema hypertension, and dizziness
For CKD, diabetes, heart failure, MI
recovery
CONTRAINDICATION: pregnancy Beta-Adrenergic Blockers (Beta-Blockers)
Reduce heart rate, cardiac output, renin release
Metoprolol, propranolol
Side effects: bradycardia, fatigue,
bronchoconstriction, depression
For hypertension w/ heart failure, post-
myocardial infarction

Interventions & Rationales for Nursing

Treatment Interventions
1. Lifestyle Modifications 2. Pharmacological Management
Emphasize lifestyle changes as the first-line Add tailored medication treatment if needed
hypertension management First-line meds:
Encourage the DASH diet Thiazide Diuretics: hydrochlorothiazide (Microzide)
Advise reduced sodium intake up to 1500 Calcium Channel Blockers (CCBs): amlodipine (Norvasc)
mg/day and limiting daily alcohol ACE Inhibitors: lisinopril (Prinivil, Zestril)
consumption to 1 drink for women, and 2 for Angiotensin II Receptor Blockers (ARBs): losartan
men
Promote regular physical activity: (Cozaar)
Aerobic activity, resistance training If inadequate, use adjunct meds
Guide on smoking cessation & stress Beta-blockers
management. Aldosterone Receptor Antagonists
Educate on weight management via reduced Emphasize medication adherence to prevent organ damage
caloric intake & increased physical activity
& manage side effects
for overweight/obese patients
Collaborate with pharmacists for medication review & patient
education.
Symptom Management Interventions
Symptom Intervention Rationale

Administer pain meds as prescribed & Relives discomfort and

Chronic Pain (Headaches) teach stress-reduction techniques (deep promotes relaxation.
breathing & meditation).

Dizziness (Risk for Impaired Encourage slow position changes,, assess Prevents sudden drops in
Cerebral Tissue Perfusion) balance,, ensure safe environment by removing BP that can lead to
fall hazards and discuss home fall prevention dizziness or fainting &
ensures safe environment
at home.

Decreased Activity Intolerance Encourage daily BP monitoring at rest and light Ensures activities are within
activities., recording consistent readings in a log,, safe tolerance levels. Helps
& reviewing trends with primary healthcare with tracking patterns,
provider. guides adjustment to
activity levels,.

Eunice Chang, Danielle Dufek, Jennifer Kim References