Know as the silent killer because most individuals don’t even know they have it
Hypertension power point for module
Learning OutcomeStudents will gain an understanding ofhypertension, its disease process andmanagement, and will apply thatunderstanding to planned patient care.
Learning ObjectivesBy the end of this module students will• Compare and Contrast prehypertension, stage I and stage II parameters according to JNC 7 Guidelines• Differential between essential and secondary hypertension• Describe effects of uncontrolled hypertension on body organs
Learning Objectives• Name a minimum of four causes of secondary hypertension• Define the term "silent killer“• Create a nursing care plan for a hypertensive patient using the nursing process and following the provided rubric
Outline• JNC guidelines for prehypertension and stage I & II Hypertension• Types of hypertension• Risk factors• Organ damage• Treatment
Introduction• Nearly 60 million Americans, or 1 in 4 adults, have high blood pressure• High blood pressure contributes to the deaths of almost 30 individuals every hour of every day• An additional 45 million adults, or 22% of the population, have prehypertension• Many individuals don’t even know they have hypertension the JNC 7 report. JAMA. 2003;289:2560-72.
Manifestations of Hypertension• Usually no symptoms other than elevated blood pressure• Symptoms are related to organ damage and are seen late and are very serious
Parameters According to JNC 7• Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) U . S . D E PA RT M E N T O F H E A LT H A N D H U M A N S E RV I C E S National Institutes of Health National Heart,Lung,andBlood Institute http://www.nhlbi.nih.gov/guidelines/hypertension/phycard.pdf
What is High Blood Pressure? JNC 7 Guidelines for Patients Age ≥18 Years Systolic BP Diastolic BP BP classification (mmHg) (mmHg) Normal <120 and <80 Prehypertension 120–139 or 80–89 Stage 1 hypertension 140–159 or 90–99 Stage 2 hypertension >160 or >100JNC, Joint National Committee; DBP, diastolic blood pressure; HTN,hypertension; SBP, systolic blood pressure.http://www.nhlbi.nih.gov/guidelines/hypertension/phycard.pdf
Types of Hypertension• Essential 90% - 95% – Cause is unknown• Secondary 5% - 10% – High blood pressure that is caused by another medical condition or medication
Secondary Hypertension Causes• Chronic kidney disease• Disorders of the adrenal gland (pheochromocytoma or Cushing syndrome)• Pregnancy (preeclampsia)• Medications such as birth control pills, diet pills, some cold medications, and migraine medications• Narrowed artery that supplies blood to the kidney (renal artery stenosis)• Hyperparathyroidism
Risk Factors• Factors that cannot be changed –Family history of high blood pressure –Family history of premature CVD –Diabetes –Race (African American)
Lifestyle Risk Factors• Weight (body mass index > 30 kg/m2)• Stress• Sedentary lifestyle• Diet• Smoking• Alcohol (more than one drink per day for women and more than two drinks per day for men)• Birth control pills
Organ Damage• Vascular Effects – Artery damage and narrowing – Aneurysm• Cardiac Effects – Coronary artery disease – Enlarged left ventricle – Heart failure
High Blood Pressure Increases Risk of Ischemic Heart Disease Death 80-89 yrs • Risk of IHD death increases 256 with increasing age 128 70-79 yrs 60-69 yrs • Risk of IHD death increases 64 with increasing BP in each(floating absolute risks & 95% CI) 50-59 yrs 32 decade of life 16 40-49 yrs • Increased risk begins at systolic 8 BP >120 mmHgIHD mortality 4 • Trend begins at 40 years old 2 1 120 140 160 180 Usual SBP (mmHg) CI, confidence interval; SBP, systolic blood pressure. Prospective Studies Collaboration. Lancet. 2002;360(9349):1903-1913.
High Blood Pressure Increases Risk of Stroke Death 256 80-89 yrs • Risk of stroke death increases 128 70-79 yrs with increasing BP in each decade of life 64 60-69 yrs(floating absolute risks & 95% CI) 32 50-59 yrs • Risk of stroke death increases 16 with increasing age 8Stroke mortality 4 • Increased risk begins at systolic 2 BP >120 mmHg 1 120 140 160 180 Usual SBP (mmHg)CI, confidence interval; SBP, systolic blood pressure.Prospective Studies Collaboration. Lancet. 2002;360(9349):1903-1913.
Medications• See additional information on medication video in hypertension module• Refer to Drug and Medication Textbook• Review Medication Online Module
Nurses Help Patients Significantly Reduce Systolic BP Baseline BP 165 P=0.02 After treatment P=0.28 160 Systolic blood pressure (mmHg) 160.7 155 157.6 150 151.1 145 140 141.1 135 130 Nurse-led program Standard careDenver E. Diabetes Care. 2003;26:2256-2260
Learning Activities• Review module materials and videos• Form a group of 2-4• Create a nursing care plan for a hypertensive patient using the nursing process and following the provided rubric as a guide• Review the nursing process and nursing care plans as needed