For medical students

1. Hypertension
THE MUCHES

2. Definition
 It is a condition in which there is sustained
elevation of anterior blood pressure i.e.
systolic of over 140 and diastolic above
90mmHg.
 A condition where there is consistent
elevation of the systolic blood pressure
above 140mmHg and a diastolic blood
pressure above 90mmHg

3. Classification
 It is classified into two i.e.
 Primary or essential hypertension
 Secondary hypertension
• Two forms of high blood pressure have been
described: essential (or primary) hypertension and
secondary hypertension.
• Essential hypertension is a far more common
condition and accounts for (90-95% of hypertension.

4. Classification cont
 Primary or essential hypertension
 This type affects 90-95% of cases therefore
the commonest
 The cause is idiopathic or unknown
 It has a tendency to run in families.

5. Classification cont
 Primary hypertension is further subdivided
into:
 Benign HTN which can be present for a long
time without causing serious problems
 Malignant HTN It is of sudden onset and
produces severe symptoms making survival
to a few months or up to 2 years if not
properly managed

6. Classification cont
 Secondary hypertension: It accounts for 5-
10% of people with hypertension.
 This means that the hypertension in these
individuals is secondary to (caused by) a
specific disorder of a particular organ or
blood vessel, such as the kidney, adrenal
gland, or aortic artery

7. Classification of secondary
hypertension cont
 Adrenal gland tumor
 Anxiety and stress
 Arteriosclerosis
 Birth control pills
 Coarctation of the aorta
 Endocrine disorders e.g.Cushing syndrome
 Diabetes mellitus

8. Classification of secondary
hypertension cont
 Kidney disease, including:
– Glomerulonephritis (inflammation of kidneys)
– Kidney failure
– Renal artery stenosis
– Renal vascular obstruction or narrowing

9. Classification of secondary
hypertension cont
 Obesity
 Pregnancy (called gestational hypertension)
 Renal artery stenosis

10. Kidney disease
 Kidney disorders lead to renal ischaemia which in
turn leads to activation of the renin angiotensin
system.
 Renin leads to the conversion of angiotensinogen to
angiotensin 1
 Angiotensin I will be converted with the help
angiotensin converting enzyme to angiotensin II
 This will lead to constriction of blood vessels leading
to hypertension

11. Kidney disease cont
 Aldestorone will also be released causing
retention of sodium and water retention
 This increases the circulatory volume which
in turn causes hypertension

12. Coarctation of the aorta
 This is the stenosis of the aorta which leads
to elevation of the blood pressure due to
narrowing of the aorta at the point of
stenosis.

13. Endocrine disorder
 Endocrine disorders e.g.Cushing syndrome
 This is causes retention of water hence
elevating the BP

14. Adrenal gland tumor
 The tumours of the adrenal medulla which
secretes excessive adrenaline
 Adrenaline causes constriction of blood
vessels causing hypertension
 Birth control pills: These will lead to release
of renin causing elevation of blood pressure.

15. Risk Factors
 Age over 60 years
 Male gender
 Black africans
 History of diabetes
 Family of HTN
 Obesity
 Sedentary life stile
 Excessive intake of salt
 Emotional stress

16. Clinical features
 Uncomplicated high blood pressure usually occurs
without any symptoms (silently) and so hypertension
has been labeled "the silent killer.“
 It is called this because the disease can progress to
finally develop any one or more of the several
potentially fatal complications of hypertension such
as heart attacks or strokes.
 Uncomplicated hypertension may be present and
remain unnoticed for many years, or even decades.
This happens when there are no symptoms, and
those affected fail to undergo periodic blood
pressure screening

17. Clinical features cont
 Some people with uncomplicated hypertension,
however, may experience symptoms such as
 headache, cerebral hypoxia,
 dizziness cerebral hypoxia,
 shortness of breath due to impaired gaseous
exchange,
 blurred vision due to rupture of blood vessel
supplying the retina.

18. Clinical features cont
 Confusion due to damage to the brain
 Chest pain due to anginal pain as aresult
myocardial ischaemia
 Ear noise or buzzing due to ear involvement
 Palpitation due to over work of the heart
 Nosebleed due to rapture of blood vessel in
the nose
 Tiredness due to impaired tissue perfusio

19. Investigation
 History will reveal HTN in the family
 Blood pressure will be high e.g. 150/100
 Renal function to r/o renal disease
 Aortography to r/o Coarctation
 Renal angiography to r/o stenosis
 Urinalysis can be do to r/o renal disorder

20. Treatment
 Alpha blockers e.g. Methydopa 250-500mg
tds for 5/7
 Angiotensin-converting enzyme (ACE)
inhibitors eg enalapril
 Beta-blockers eg propranolol 20-40mg tds for
5/7
 Calcium channel blockers Nifedipine 20mg
bd for 5/7

21. Treatment cont
 Diuretics Lasix 30-60mg tds 5/7
 Vasodilators eg. Hydralazin 20mg bd for 3/7
 Analgesics for pain e.g. panadol 1g tds 3/7
 Enough rest
 Restrict salt intake

22. Complications
 Aortic dissection
 Blood vessel damage (arteriosclerosis)
 Hypertensive encephaloparthy
 Congestive heart failure
 Kidney damage
 Hypertensive heart disease
 Stroke
 Vision loss

23. Nursing care
 Reduce the BP
 Educate the patient about his condition
 Prevent complications like stroke
 Promote quick recovery

24. Environment
 The patient will be nursed in a stress free
environment to promote rest and prevent
further elevation of the BP
 Patient will be nursed at the acute bay for
close observation.
 Room should have BP checking apparatus
for close monitoring of patients BP

25. Rest and activity cont
 I will nurse the patient in a quiet room to promote
rest
 I will play the radio at low volume to promote rest
 I will answer all phone calls promptly to prevent
disturbing the patient there by promote rest
 I will do related procedures in blocks to promote rest
 I will administer prescribed analgesics to relieve
headache there by promote rest
 I will ensure that squeaking trolleys a oiled to prevent
noise and there by promote rest

26. Observations
 I will do vital sign and BP to act as the base
line data in order to know if the condition is
improving or deteriorating
 I will observe dyspnea if present will prop up
the patient to promote lung expansion and
there by relieve dyspnea
 I will do regular BP checks to monitor
patient’s response to treatment

27. Psychological care
 I will explain the disease process in order to
raise the knowledge levels and thereby alley
anxiety
 I will encourage the patient to ask question
and I will answer accordingly those I cant
answer I will refer to the physician
 I will explain all procedures to my patient in
order to allay anxiety

28. Elimination
 I will offer a bed pan if he is confined to bed
to ensure bowel movement

29. Exercises
 In the acute phase I will restrict patient’s
activity to promote recovery
 As condition improves mild exercises will be
encouraged

30. Nutrition
 I will offer a salt free diet to prevent further
elevation of the BP
 I will advise my patient to eat more fruits,
vegetables, and fiber to boost the immunity
and prevent constipation

31. Medication
 I will administer prescribed analgesic like
panadol to relieve headache
 I will give prescribed antihypatensive in order
to promote recovery
 I will ensure that the drugs are swallowed in
my presence to promote recovery.

32. Hygiene
 I will encourage the patient to take plunge
baths in order to remove dead epithelium
and promote comfort
 I will do hair care to promote self esteem and
also prevent pediculosis
 I will do nail care to prevent auto infection
and bruising self which can lead to bleeding

33. Health education
 I will advise my patient to lose weight if he/she is
overweight. Excess weight adds to strain on the
heart. In some cases, weight loss may be the only
treatment needed.
 Exercise regularly.
 Eat a healthy diet. Eat less fat and sodium. Salt,
MSG, and baking soda all contain sodium. Eat more
fruits, vegetables, and fiber.
 I will encourage my patient to avoid smoking.
 If my patient has diabetes, I will advise him to keep
his blood sugar under control