Adult 1- Hypertension

Hypertensive Crises

- *Hypertensive emergency*: Blood pressure >180/120 mm Hg and must be lowered immediately to prevent damage to target organs. - *Hypertensive urgency*: Blood pressure is very high but no evidence of immediate or progressive target organ damage.

Medical Management

- *Lifestyle modifications*: — Weight reduction: <25 BMI. — DASH diet, decreased sodium intake (first- no added salt, may progress to limiting sodium). — Physical activity: 150 min/week of moderate exercise. — Moderate alcohol consumption. - *Medication therapy*: — Diuretics, beta-blockers, alpha 1-blockers, combined alpha- and beta-blockers, vasodilators, ACE inhibitors, ARBs, calcium channel blockers, dihydropyridines, and direct renin inhibitors.

Major risk factors

- *Smoking* - Obesity - Physical activity - Alcohol (>2/day for males, >1 for females) - Gender (<45 years old for male, >65 for females) - Dyslipidemia - Diabetes mellitus - Microalbuminuria or GFR < 60 mL/min - Older age - Family history

Primary Hypertension

- High blood pressure, the cause of which is unknown; also known as essential hypertension.

Hypertension

- High blood pressure. - Defined as a systolic pressure greater than 140 mmHg and a diastolic pressure greater than 90 mmHg. - Based on the average of two or more accurate blood pressure measurements taken during two or more contacts with a healthcare provider within a month. - Leading risk factor for premature death.

Patient Assessment

- History and physical examination: have you had any vision or urinary problems? - Laboratory tests- — Urinalysis: albumin. — Blood chemistry: brain natriuretic peptide (BNP), electrolytes, BUN, creatinine. — Cholesterol levels - ECG: d/t strain on the heart. - Echocardiogram: size of the ventricles.

Collaborative problems and Potential complications

- Left ventricular hypertrophy - Myocardial infarction - Heart failure - Transient ischemic attack (TIA) - Cerebrovascular accident (CVA, stroke, or brain attack) - Renal insufficiency and failure - Retinal hemorrhage

Medication treatment

- Low doses are initiated, and the medication dosage is increased gradually if blood pressure does not reach target goal. - Additional medications are added if needed. - Multiple medications may be needed to control blood pressure. - Lifestyle changes initiated to control BP must be maintained.

Secondary Hypertension

- Occurs when a cause for the high BP has been identified. - Causes include: chronic kidney disease, renal artery stenosis, pregnancy, diabetes, etc.

Interventions

- Patient education - Support adherence to the treatment regimen - Consultation and collaboration - Follow-up care - *Emphasize control rather than cure* - Reinforce and support lifestyle changes - A lifelong process

Management of Hypertensive Urgency

- Patient requires close monitoring of blood pressure and cardiovascular status. - Assess for potential evidence of target organ damage. - Medications: *Fast-acting oral agents*: beta adrenergic blocker- labetalol, angiotensin-converting enzyme inhibitor- captopril, or alpha2 agonist- clonidine. - Possible s/s: headache, nose bleed, anxiety.

Management of a Hypertensive Emergency

- Reduce blood pressure by 20-25% within the first hour of treatment. - Reduce to 160/100 over a period of up to 6 hours. - Then a more gradual reduction in pressure over a period of days. - Exceptions are the treatment of ischemic stroke and aortic dissection, in which they need to lower it faster. - Medications: *IV* vasodilators- Sodium nitroprusside, nicardipine, fenoldopam mesylate, enalaprilat, nitroglycerin. - Need very frequent monitoring of BP and cardiovascular status. - Possible s/s: shortness of breath, oliguria, vision problems.

Manifestations of Hypertension

- Usually no symptoms other than elevated blood pressure. - Symptoms (due to prolonged and uncontrolled HTN) seen related to organ damage are seen late and are serious: — Retinal and other eye changes — Renal damage — Myocardial infarction — Cardiac hypertrophy: leads to heart failure. — Stroke

Going up ___ points systolic or ___ points diastolic doubles your risk for having a cardiac event.

20 systolic 10 diastolic

The nurse is preparing an education plan for a patient newly diagnosed with hypertension. What should be included in the education plan? A. Engage in regular aerobic physical activity such as brisk walking (at least 30 min/day most days of the week). B. Eliminate alcoholic beverages from the diet. C. Reduce sodium intake to no more than 200 mmol/day. D. Maintain a normal body weight with BMI between 18 and 30 kg/m2.

A. Engage in regular aerobic physical activity such as brisk walking (at least 30 min/day most days of the week).

Which two ethnic groups have the highest prevalence of hypertension?

African Americans and Hispanics

What is a priority nursing assessment when caring for the patient in a hypertensive crisis receiving intravenous vasodilators? A. Pain B. I&O C. Vision D. Family history

B. I&O

For patients with uncomplicated hypertension and no specific indications for another medication, what is the initial medication? A. Thiazide diuretic B. Calcium channel blockers C. Vasodilators D. Angiotensin-converting enzyme inhibitors

D. Angiotensin-converting enzyme inhibitors

What is an ideal blood pressure for someone diagnosed with hypertension?

Lower than 140/90 mmHg

Algorithm of hypertension treatment (picture)

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