Table of Contents:

1. Pathophysiology & Risk Factors 4. Antihypertensive Medications

2. Assessment & Diagnostics 5. Hypertensive Crisis
3. Lifestyle Modifications

Hypertension

1. Pathophysiology & Risk Factors

Cardiovascular
Blood pressure (BP): Force of blood against vessel Risk factors
walls (FIGURE 1). y Modifiable:
y Adequate BP is essential for maintaining y High-sodium diet
tissue perfusion. y Alcohol consumption, smoking
y Obesity, sedentary lifestyle
FIGURE 1. BLOOD PRESSURE PHYSIOLOGY y Diabetes mellitus
y Non-modifiable:
y Age >60
y Black individuals
y Family history of HTN
Hypertension complications
BP is determined by CO and SVR:
y Cardiac output (CO): Volume of blood pumped by Chronic HTN pressure on the heart and vessel
the heart per minute, determined by HR and stroke walls  Vessel damage and narrowing (remodeling +
volume (volume per heartbeat) atherosclerosis) perfusion  Damage to
y Systemic vascular resistance (SVR): Blood vessel target organs (brain, heart, kidneys) (FIGURE 2)
resistance to blood flow, affected by vessel radius
Stroke: Blood vessel damage and thickening or
y Vasoconstriction:resistance and BP rupture cerebral perfusion
y Vasodilation:resistance and BP y Myocardial infarction (MI): Blood vessel damage
y Hypertension (HTN) isBP and classified by and thickening myocardial perfusion
severity (see TABLE 1). y Heart failure (HF): Chronicpressure strains the
heart  Left ventricular hypertrophy
TABLE 1. STAGES OF HYPERTENSION y Chronic kidney disease (CKD): Renal artery
damage  Impaired filtration
SBP <120 mmHg and
Normal BP FIGURE 1. BLOOD PRESSURE PHYSIOLOGY
DBP <80 mmHg

SBP 120-129 (even if DBP

Elevated BP
is normal)

Stage 1 SBP 130-139 or DBP 80-89

Stage 2 SBP >140 or DBP >90

Hypertensive crisis SBP >180 or DBP >120

HTN is further classified as primary or secondary:

y Primary (essential) HTN is caused by modifiable
risk factors (lifestyle).
y Most common type of HTN
y Secondary HTN is caused by underlying disease
(CKD, sleep apnea).
y Typically resolves once underlying disease
is treated
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2. Assessment & Diagnostics 3. Lifestyle Modifications
Assessment findings Healthy lifestyle modifications are used to prevent and
y BP (see TABLE 1) control HTN:
y Often asymptomatic initially
Dietary modifications: Implement DASH diet (Dietary

Known as the “silent killer” because it often has no Approach to Stop Hypertension) (see TABLE 3).
symptoms but causes stroke and heart attack
Limit sodium intake: <2,300 mg/day (ideally
Diagnostics <1,500 mg/day)
y BP monitoring:
Weight loss: Losing excess weight can
y Assess BP (see TABLE 2). significantlyBP.

Cardiovascular
y Monitor BP trends—one high reading does not
Exercise: Engage in 150 min/week of moderate
diagnose HTN. aerobic activity, like walking (e.g., 30 min/day,

Confirm elevated readings on 5 days/week).
≥2 separate occasions.
Smoking cessation and alcohol moderation: Stop
y Ambulatory BP monitoring (24-hr BP monitoring smoking and limit alcohol to ≤1 drink/day for women
outpatient): Used to rule out white coat and ≤2 drink/day for men.
syndrome (BP from anxiety in medical setting). y Stress management: Implement stress
y Orthostatic vital signs: Measure orthostatic BP management techniques (relaxation).
and HR with the client supine, sitting, and standing.
y Measure BP after 3 min in each position. TABLE 3. HTN DIETARY TEACHING
y SBP should not decrease >20 mmHg, and
HR should not increase by >20/min. Limit sodium to
Avoid deli meats and
y Instruct clients with HTN to monitor and record <2,300 mg/day canned foods.
BP at home. y Teach clients to read
y Laboratory testing assesses for causes of nutrition labels.
secondary HTN and presence of organ damage: y Avoid OTC medications
y BUN/creatinine and urinalysis for high in sodium (antacids,
kidney function NSAIDs, cold medications).
y Lipid profile for atherosclerosis risk
y Blood glucose and A1C for diabetes risk
DASH diet y intake of vegetables,
fruits, and whole grains.

TABLE 2. BP MONITORING
y intake of saturated fat,
cholesterol, and sugar:
y Instruct clients not to smoke or consume
y Use fat-free or low-fat
caffeine within 30 min of BP measurement.
dairy.
y Measure BP after client has sat and rested for 5 min.
y Choose lean meat and

Use a BP cuff that fits properly (bladder covers at
poultry.
least 80% of arm circumference).
y Limit sweets or desserts.
y Too small = falselyreading
y Too large = falselyreading

When measuring BP:
y Do not measure over clothing.
y Keep arm still and at heart level.
y Ensure client does not talk or move.
y Keep legs uncrossed.

 Measuring BP: Always use a properly fitted BP  DASH diet: Clients with HTN should follow a
cuff; too small causes false high readings, and low-sodium DASH diet. Avoid high-sodium
too large causes false low readings. Keep the foods, including canned foods and deli meats.
arm at heart level during measurement and ensure Clients should choose lean meats and low-fat
clients do not talk, move, or cross their legs. dairy products.

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4. Antihypertensive Medications 5. Hypertensive Crisis
HTN that cannot be controlled with lifestyle modifications requires A hypertensive crisis is a life-threatening
antihypertensive medications (TABLE 4). emergency that requires immediate
intervention to prevent stroke, kidney
TABLE 4. ANTIHYPERTENSIVES AT A GLANCE failure, or heart failure.
Assessment findings
All antihypertensives: y SeverelyBP (SBP >180 or DBP >120)

Check BP and HR before administering. y Headache, blurred vision

Monitor for symptoms of hypotension (dizziness, syncope).

Cardiovascular
y Confusion, seizures
y Teach clients to stand slowly to prevent orthostatic hypotension. y Dizziness

Instruct clients to never stop medication abruptly due to the risk y Chest pain
of rebound HTN.
Interventions
y Administer oxygen as needed to keep
Medications Nursing considerations
pulse oximetry reading >90%.

Implement continuous BP
ACE inhibitors
Monitor for angioedema, a rare life-
and ECG monitoring until BP
threatening complication.
lisinopril is lowered.
y Assess for cough, a common side effect.
enalapril y Monitor MAP; MAP guides medication
y Monitor for hyperkalemia.
titration.

Administer IV antihypertensives
Angiotensin II y Monitor for hyperkalemia.
(e.g., nitroprusside).
receptor blockers
y Goal = gradual BP reduction.
(ARBs)
y Lowering BP quickly causes
losartan hypoperfusion (risk for
valsartan stroke and kidney damage).

Closely monitor urine output to assess
Calcium channel y Monitor for edema and dizziness. for renal damage.
blockers y Avoid grapefruit juice due to risk for
Perform frequent neuro assessments
amlodipine toxicity. and report any signs of stroke (facial
nifedipine droop, arm weakness).
y Switch to oral antihypertensives once
BP is stabilized (see TABLE 4).
Thiazide diuretics y Monitor for hypokalemia.
y Measure daily weights to assess for fluid
hydrochlorothiazide
retention.

Beta-blockers y Monitor for bradycardia.

y Hold medication if HR <60/min.
metoprolol
atenolol

See DIURETICS CHEAT SHEET for more information.

 Lifestyle modifications: Clients with HTN can lower  Hypertensive crisis: A hypertensive crisis
BP with smoking cessation, limiting alcohol, losing is a life-threatening, severe elevation in BP of
weight, managing stress, and exercising at least SBP >180 or DBP >120. Treatment includes
150 minutes/week. continuous BP monitoring and administration of
IV antihypertensives.
 Antihypertensives: Before administering antihypertensives,
always check HR and BP. Teach clients to report signs of
hypotension like dizziness or syncope.

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  A BP cuff that is too small can cause a false  Before administering antihypertensive
______ reading, while a cuff that is too large can medications, always check ______ and ______.
cause a false ______ reading. When measuring Clients should report signs of hypotension,
BP, the arm should be kept at ______ level, and such as ______ and ______.
clients should avoid _____, moving, or ______
their legs.  A hypertensive crisis is a severe elevation in

Cardiovascular
BP with SBP > ______ mmHg or DBP > ______
 Teach clients to follow the DASH diet that is low mmHg. Treatment includes continuous BP
in ______. What are some high-sodium foods that monitoring and administration of ______.
should be avoided?

 Lifestyle modifications to lower BP include ______

cessation, limiting _____ intake, losing ______,
managing stress, and exercising at least ______
minutes per week.
5. 180, 120; IV antihypertensives
Answers: 1. high, low; heart, talking, crossing 2. sodium; Deli meats, canned foods 3. smoking, alcohol, weight, 150 4. heart rate, blood pressure; dizziness, syncope

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y Blood Pressure Pathophysiology: Created with
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