Hypertension

Karen Ruffin RN, MSN Ed.

Blood PressureArterial BP = Cardiac Output (CO) x

Systemic vascular resistance (SVR)

Cardiac Output = stroke volume x beats per min

Systemic vascular resistance = force opposing the movement of blood within the blood vessels

What is the effect on BP if SVR increased and CO remains

constant?

Blood Pressure

Definition: the force exerted by the blood against the walls of the blood vessels

Adequate to maintain tissue perfusion during activity and rest

Arterial blood pressure: primary function of cardiac output and systemic vascular resistance

Mechanisms that Regulate Blood Pressure

Sympathetic Nervous System

Vascular Endothelium

Renal System

Endocrine System

HypertensionAldosterone Mechanism

• Increased Aldosterone =

• Increases sodium reabsorption =

• Increases water reabsorption =

• Increases blood volume =

• Increases cardiac output

Hypertension

Regulatory mechanisms in the health person function in response to the demands on the body

When Hypertension develops, one or more of these mechanisms are defective

Sympathetic Nervous SystemVascular EndotheliumRenal SystemEndocrine System

HypertensionPathophysiologyPrimary (Essential) Hypertension:

Elevated BP without an identified causeAccounts for 95% of all cases of

hypertensionCause – unknown

Contributing Factors: Increased SNS activity, overproduction of Na+ retaining hormones & vasoconstrictors, increased Na+ intake

Risk Factors: Modifiable & Non-modifiable

Primary HypertensionPathophysiology

Heredity – interaction of genetic, environmental, and demographic factors

Water & Sodium Retention – 20% of pts with high Na+ diet develop HTN

Altered Renin-Angiotensin Mechanism – found in 20% of patients

Stress & Increased SNS Activity Insulin Resistance & Hyperinsulinemia Endothelial Cell Dysfunction

Diagnosis of HypertensionDx is made after multiple readings over several

weeks

NIH/Joint Committee Definition:

Category Systolic DiastolicOptimal <110 and < 80Normal <120 and <85High Normal 130-139 or 85-89

Stage 1 140-159 or 90-99Stage 2 160-179 or 100-109Stage 3 =>180 or => 110

Secondary HypertensionPathophysiology

Specific cause of hypertension can be identified

Affects >5% of adults with hypertension

What conditions can lead to or cause hypertension?

Primary HypertensionRisk Factors Age Alcohol Cigarette Smoking Diabetes Mellitus Elevated serum

lipids Excess Na+ in diet Gender

Family History Obesity Ethnicity Sedentary

Lifestyle Socioeconomic Stress

Which risk factors are modifiable

ornon modifiable?

Primary HypertensionClinical Manifestations

Organs that are affected by Hypertension:

Myocardium – angina / left ventricular hypertrophy

Brain – TIA / CVA Peripheral vascular – Peripheral pulse changeKidney – renal failure Creatinine / ProteinuriaEyes – Hemorrhages with or without papilledema

Primary HypertensionClinical Manifestations

“Silent Killer” – asymptomatic and insidious

Severe HTN – fatigue, reduced activity tolerance, dyspnea, dizziness, palpitations, angina

HypertensionMedical Diagnosis

History and Physical ExaminationRenal Function

Serum Creatinine & Urine Creatinine Clearance

Electrolytes – especially K+Blood Glucose Serum Lipids/EKGAmbulatory BP Monitoring

Primary HypertensionMedical Management

Risk Stratification

Level of BP

Presence of Target Organ Disease

Other Risk Factors

Primary HypertensionMedical Management

Lifestyle modification

Nutritional therapyAlcohol consumptionPhysical activityTobacco avoidanceStress management

Drug Therapy

Stepped Approach to Manage Hypertension

Lifestyle modificationNot at Goal BP

Drug TherapyNot at Goal BP

Substitute med / add a 2nd med/ increase dose

Not at Goal BP

Continue adding / changing meds until control

Medical Management – Drug Therapy Diuretics

ThiazideLoopK+ Sparing

Adrenergic Blockers/ InhibitorsB-Adrenergic BlockersCentral Acting Adrenergic AntagonistsPeripheral Acting Adrenergic AntagonistsA-Adrenergic Blockers

Vasodilators Angiotensin Inhibitors Calcium Channel Blockers

Antihypertensive Drug Therapy

Lack of Responsiveness to Therapy

Nonadherence to Therapy

Drug-Related Causes

Associated conditions

Secondary Hypertension

Volume overload

Nursing Care for the Patient with Hypertension

• What will you assess????

• What are some potential nursing diagnosis?????

• What are your goals for those diagnosis????

• What are your interventions?????

• How will you evaluate your goals?????

Basic Human Needs

• What Basic Human Need is being affected?

• What other Basic Human Needs are effected by hypertension?

Nursing Care for the Patient with Hypertension

Concept Map

• The patient with essential hypertension is prescribes the beta blocker metoprolol (Lopressor). Which assessment data would make the nurse question administering the medication?

• A. The patients blood pressure is 112/90.

• B. The patients apical pulse is 56.

• C. The patients ha an occipital headache.

• D. The patient is complaining of a yellow haze.

• The nurse is preparing to administer the following medications. Which medications would the nurse question administering?

• A. Vasodilator hydralazine(Apresoline) to the patient with blood pressure of 168/94.

• B. Beta Blocker Lopressor(metoprolol) to a patient with a serum sodium level of 137.

• C. Calcium Channel blocker diltiazem(Cardizem) to a patient with a glucose level of 280.

• D. Loop Diuretic(Lasix) to a patient with a K+ of 3.1.

Primary HypertensionCase Study