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HYPERTENSION NOTES FOR NURSING AND ALLIED HEALTH SCIENCES HELPS TO MANAGE THE PATIENTS WITH HYPERTENSION.

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HYPERTENSION
YOGESH
STAPE
BSN
INTRODUCTION
Hypertension or HIGH BLOOD PRESSURE is an important
medical and public health problem. There is a direct
relationship between hypertension and cardio vascular
disease{CVA}. As blood pressure increase, so does the
risk of myocardial infarction, renal disease, stroke and
heart failure.
BLOOD PRESSURE
Blood pressure is the force exerted by
the blood against the wall of blood
vessels.
It must be adequate to maintain the
tissue perfusion during activity and
rest.
3
FACTORS INFLUENCING -BP
Cardiac Sympathetic nervous system
* Heart rate * Vasoconstriction
* Conductivity *Vasodilation
Blood Pressure = Cardiac output × Systemic vascular resistance
Renal fluid volume control Neurohormonal
*Renin-angiotensin-aldosterone system Vasoconstrictors
* Natriuretic peptides * Angiotensin
… * Norepinephrine
DEFINITION
Hypertension is defined as a persistent elevation
systolic BP [SBP] of 140 mm Hg or more , diastolic
BP [DBP] of 90 mmHg or more.
 SBP = Systolic Blood Pressure.
 DBP = Diastolic Blood Pressure.
20XX presentation title 5
ISOLATED SYSTOLIC
HYPERTENSION
As an average SBP of 140 mm Hg or more,
coupled with an average DBP of less than 90 mm
Hg.
SBP increase with aging, DBP raises until approx
age of 55 and then declines.
[Control of ISH decrease the risk of stroke, heart
failure, and death’]
20XX presentation title 6

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HYPERTENSION.pptx

  • 2. INTRODUCTION Hypertension or HIGH BLOOD PRESSURE is an important medical and public health problem. There is a direct relationship between hypertension and cardio vascular disease{CVA}. As blood pressure increase, so does the risk of myocardial infarction, renal disease, stroke and heart failure.
  • 3. BLOOD PRESSURE Blood pressure is the force exerted by the blood against the wall of blood vessels. It must be adequate to maintain the tissue perfusion during activity and rest. 3
  • 4. FACTORS INFLUENCING -BP Cardiac Sympathetic nervous system * Heart rate * Vasoconstriction * Conductivity *Vasodilation Blood Pressure = Cardiac output × Systemic vascular resistance Renal fluid volume control Neurohormonal *Renin-angiotensin-aldosterone system Vasoconstrictors * Natriuretic peptides * Angiotensin … * Norepinephrine
  • 5. DEFINITION Hypertension is defined as a persistent elevation systolic BP [SBP] of 140 mm Hg or more , diastolic BP [DBP] of 90 mmHg or more.  SBP = Systolic Blood Pressure.  DBP = Diastolic Blood Pressure. 20XX presentation title 5
  • 6. ISOLATED SYSTOLIC HYPERTENSION As an average SBP of 140 mm Hg or more, coupled with an average DBP of less than 90 mm Hg. SBP increase with aging, DBP raises until approx age of 55 and then declines. [Control of ISH decrease the risk of stroke, heart failure, and death’] 20XX presentation title 6
  • 7. RISK FACTORS AGE GENDER FAMILY HISTORY ALCOHOL EXCESS DIATERY SODIUM OBESITY SEDENTARY LIFESTYLE STRESS DIABETES MELLITUS ELEVATED SERUM LIPIDS ETHNICITY [INCREASE HYPERTENSION 2 HIGHER IN AFRICAN AMERICAN THAN IN WHITE]
  • 8. 20XX presentation title 8 CLASSIFICATION OF HYPERTENSION CATEGORY SYSTOLIC BLOOD PRESSURE [mm Hg] DIASTOLIC BLOOD PRESSURE [mm Hg] NORMAL < 120 < 80 PRE-HYPERTENSION 120-139 80-89 HYPERTENSION ,STAGE 1 140-159 90-99 HYPERTENSION ,STAGE 2 ≥ 160 ≥ 100
  • 9. 20XX presentation title CLASSIFICATON OF HYPERTENSION PRIMARY HYPERTENSION  Idiopathic  Elevated BP without an identified cause  90% to 95% of all the causes  Several contributing factors are: • Increased SNS • Over production of sodium retaining hormone • Increase sodium intake, • Greater than ideal body weight • Diabetes meters, • Tobacco uses and excessive alcohol consumption.
  • 10. 20XX presentation title 10 CLASSIFICATION OF HYPERTENSION SECONDARY HYPERTENSION  Elevated BP with a specific cause that often can be identified and corrected.  Causes of : • Cirrhosis • Coarctation or congenital narrowing of the aorta • Drug related : oral contraceptives, corticosteroid, NSAIDs etc., • Endocrine disorders[ Cushing syndrome, thyroid diseases.,] • Neurological disorders[brain tumors, traumatic brain injuries.,] • Renal disease[glomerulonephritis] • Pregnancy induced hypertension.
  • 11. 20XX presentation title 11 PATHOPHYSIOLOGY • Increased sympathetic nervous system activity related to dysfunction of their autonomic nervous system. • Hyperinsulinemia or high insulin levels stimuli SNS activities and impair nitric oxide-medicated vasodilation. Additionally, pressor effect of insulin include vascular hypertrophy and increased renal sodium resorption. • Decreased vasodilation of the arterioles related to dysfunction of the vascular endothelium. • Altered Renin – Angiotensin – Aldosterone Mechanism.
  • 12. 20XX presentation title 12 CLINICAL FEATURES • Hypertension is often called the silent killer because it is frequently asymptomatic until it becomes severe and target organ disease occur. • Symptoms • Headache [may be severe] • Fatigue • Dizziness • Palpitations • Angina • Dyspnea • Nose bleeds [Epistaxis]
  • 13. 20XX presentation title 13 COMPLICATIONS • Hypertensive Heart Disease • Coronary Artery Disease • Left ventricular hypertrophy • Heart failure • Cerebrovascular Disease • Atherosclerosis • Hypertensive encephalopathy • Increases ICP • Cerebral oedema
  • 14. 20XX presentation title 14 COMPLICATONS • Peripheral Vascular Disease Atherosclerosis =Intermittent claudication[Ischemic leg pain precipitated by activity and relieved with rest] It is the classic symptom of peripheral vascular Disease. • Nephrosclerosis [Renal disease] • Retinal damage [blurring vision, retinal haemorrhage , loss of vision]
  • 15. 20XX presentation title 15 DIAGNOSTIC STUDIES • History collection and physical examination [including an ophthalmic examination] • Routine urinalysis • Basic metabolic panel [serum glucose , sodium, potassium, chloride, carbon dioxide , BUN and creatinine] • Complete blood count. • Serum lipid profile [total lipid, triglyceride, HDL and LDL cholesterol, total to HDL cholesterol ratio]
  • 16. 20XX presentation title 16 DIAGNOSTIC STUDIES •Serum uric acid. •12 lead electrocardiogram[ ECG] •Others • 24 hours urinary creatinine clearance • Echocardiogram • liver function studies. • Serum thyroid stimulation hormone[ TSH]
  • 17. 20XX presentation title 17 MANAGEMENT Life style modifications • Weight reduction • DASH dietary plan [food lowering the low density lipoprotein] • Dietary sodium reduction • Moderation alcohol consumption • Physical exercise • Avoidance of tobacco products • Management of psychosocial risk factor.
  • 18. DRUG MANAGEMENT DIURETICS o HYDROCHLOROTHIAZI DE o CHLORTHALIDONE o FUROSEMIDE o SPIRONOLACTONE RENIN ANGIOTENSIN SYSTEM INHIBITOR • ACE INHIBITORS  CAPTOPRIL  ENALAPRIL  LISINOPRIL  RAMIPRIL  FOSINOPRIL etc., • ANGIOTENSIN RECEPTOR BLOCKERS  LOSARTAN  CANDESARTAN  TELMISARTAN etc., • DIRECT RENIN INHIBITORS  ALISKIREN SYMPATHETIC INHIBITORS • BETA ADRENERGIC BLOCKERS  PROPRANOLOL  METOPROLOL  ATENOLOL OTHERS • ALPHA AND BETA ADRENERGIC BLOCKERS  LABETALOL  CARVEDILOL • CENTRAL SYMPATHOLYTICS  CLONIDINE  METHLDOPA • ALPHA ADRENEGIC BLOCKERS  PRAZOSIN  TERAZOSIN  DOXAZOSIN 20XX presentation title 18
  • 19. CALCIUM CHANNEL BLOCKERS • PHENYLALKYLAMI NE VERAPAMIL • BENZOTHIAZEPINE DILTIAZEM • DIHYDROPYRIDINE S  NIFEDIPINE  AMLODIPINE  FELODIPINE  NICARDIPINE  CILNIDIPINE etc., VASODILATORS • ARTERIOLAR DILATOR  HYDRALAZINE  MINOXIDIL ARTERIOLAR + VENODILATOR NITROPRUSSIDE SOD. 20XX presentation title 19 DRUG MANAGEMENT
  • 20. 20XX presentation title 20 HYPERTENSION CRISIS • This is a situation in which a patient’s BP is severely elevated, usually about 180 /110 mm Hg. • It occurred more often in patients with history of hypertension, who have not adhered to their medication regimen or related to cocaine or crack use in a frequent problem. And other drugs such as amphetamines,PCP,LSD etc,. That may be complicated by drug induce seizure, Stoke ,MI or encephalopathy ect,. • Sodium nitroprusside is the most effective ib drug to treat hypertensive emergency.