A condition in which the force of the blood against the artery walls is too high. Usually hypertension is defined as blood pressure above 140/90, and is considered severe if the pressure is above 180/120. Hypertension typically develops over the course of several years. Usually, you don’t notice any symptoms. But even without symptoms, high blood pressure can cause damage to your blood vessels and organs, especially the brain, heart, eyes, and kidneys. Early detection is important. Regular blood pressure readings can help you and your doctor notice any changes. If your blood pressure is elevated, your doctor may have you check your blood pressure over a few weeks to see if the number stays elevated or falls back to normal levels. Symptoms of severe hypertension can include: headache, shortness of breath, nosebleeds, flushing, dizziness, chest pain. visual changes, blood in the urine. These symptoms require immediate medical attention. They don’t occur in everyone with hypertension, but waiting for a symptom of this condition to appear could be fatal. Treatment for hypertension includes both prescription medication and healthy lifestyle changes. If the condition isn’t treated, it could lead to health issues, including heart attack and stroke.

1. HYPERTENSION
B KALYAN KUMAR Msc(N)
Dept Of MSN

2. DEFINITION
Hypertension is persistently high blood pressure that
results from abnormalities in regulatory mechanisms.
It is usually defined as a systolic pressure above 140
mmHg or Diastolic pressure above 90 mmHg on
multiple blood pressure measurements.

3. TYPES OF HYPERTENSION:
 Primary hypertension
 Secondary hypertension
Primary hypertension: It is also known as essential
hypertension.
Secondary hypertension: It may result from renal, endocrine,
central nervous system disorders or cause retention of
sodium and water.
 Primary hypertension can be controlled with appropriate
therapy, secondary hypertension can sometimes be cured by
surgical therapy.

4. RISK FACTORS
 Atherosclerotic heart disease, such as dyslipidemia, obesity,
diabetes mellitus, metabolic syndrome.
 Prolonged blood pressure elevation eventually damages blood
vessels throughout the body, particularly in a target organs such as
heart kidney Brain and eyes.
 The usual consequences of prolonged, and un controlled
hypertension are myocardial infarction, heart failure, renal failure,
strokes and impaired vision. Hypertrophy of the left ventricle of
the heart may occur as it works to pump the blood against the
elevated pressure

5. ETIOLOGY
PRIMARY CAUSES
 Increasing age
 Alcohol
 Cigarette smoking
 Diabetes mellitus
 Elevated serum lipids
 Excess dietary sodium
 Sedentary life style

6. SECONDARY CAUSES
 Renal disease such as renal artery stenosis
 Endocrine disorders such as Cushing syndrome
 Neurologic disorder such as brain tumor, head
injury.
 Pregnancy induced hypertension.

7. PATHOPHYSIOLOGY:
Excess sodium
intake
Retention of water
Increased intra
vascular volume
Hypertension

8.  Increase the activity of Renin-angiotensin-aldosterone
system, resulting in expansion of extracellular fluid
volume and increase systematic vascular resistance.
 Decreased vasodilation of the arterioles related to
dysfunction of the vascular endothelium.
 Resistance to insulin action,which may be common
factor linking hypertension, type 2 diabetes
mellitus,obesity, and glucose intolerance.

10. CLINICAL MANIFESTATIONS:
 Blood pressure exceeding 2oo/100 mm Hg
 Retinopathy
 Papilledema of the optic disk
 Vomiting
 Altered level of conciousness
 Signs and symptoms of heart failure
 Increased MAP
Central nervous system
 Headache
 Confusion
 Visual change
 Focal weakness
 Disorientation
 Focal neurologic deficits
 Seizures
 Coma

11. Renal system
 Nocturia
 Heamaturia
 Oliguria
 Urinary frequency
 Flank tenderness
 Peripheral edema
Retinal
 Blurred vision
 Diplopia
 Retinal arteriolar constriction
 Papilledema
 hemorrhages

12. Cardiovascular system
 Chest pain
 Palpitations
 Nausea and vomiting
 Breathing diffculty
 Orthopnea
 Shortness of breath
 Wheezes
 Rales
 Murmurs
 S3 gallop
 Arrhythmias
 Abnormal peripheral pulses

13. DIAGNOSTIC EVALUATION
 Blood pressure monitoring
 Serum BUN elevated
 Serum creatinine elevated
 Urinalysis: Positive for blood cells and albumin
 24 hours blood pressure monitor
 Electrocardiography :Detect enlargement of heart
 CT Scan
 X-ray

14. MANAGEMENT
Hypertension drugs
Classification
 Diuretics
 Beta adrenergic blockers
 Calcium channel blockers
 Angiotensin converting enzyme inhibitors
 Angiotensin receptor blockers
 Direct arterial vasodilators

15. Diuretics
Types
 Loop diuretics
 Potassium sparing diuretics
Loop diuretics :
 Frusemide [lasix]
 Bumetanadine [bumex]
 Torsemide [demadex]
Potassium –sparing diuretics
 Amiloride [midamor]
 Triameterene [dyrenium]
 Aldosteron receptor blockers

16. Beta blockers:
 Atenolol [tenormin]
 Betaxolol [kerlone]
 Bisoprolol [zebeta]
 Propranolol [inderal]
 Propranolol long acting
 Metoprolol [lopressor]
 Metoprolol extended release
 Nadolol [corgard]
 Timolol [blocadren ]

17. Calcium channel blockers: Types
 Dihydropyridine: Nifedipine, amlodipine, nicardipine
 Non dihydropyridine: verapamil, diltiazem
Angiotensin converting enzyme inhibitors
 Captopril
 Ramipril
 Perindopril
 Lisinopril
Dilated arterial vasodilators: Hydralazine, minoxidil

18. SURGICAL MANAGEMENT
 Pheochromocytoma
-Laproscopic adrenelectomy
 Dissecting aortic aneurysm
 Pheochromocytoma: Non cancerous(benign) tumor
that develops in an adrenal gland,usually this type of
tumor affects one of your two adrenal glands.
 The tumor releases hormones that cause either
episodic or persistent high blood pressure

19. NUTRITIONAL MANAGEMENT
 Restriction of sodium , restricted cholesterol.
 DASH(Dietary approach for stop hypertension)
Other management: Reduce weight, Regular moderate
exercise
 Cessation of smoking
 Moderate of alcohol consumption
 Stress management.

20. NURSING MANAGEMENT
 Nursing assessment must involve careful monitoring
of the blood pressure at frequent and routinely
scheduled intervals.
 If patient is on antihypertensive medications, blood
pressure is assessed to determine the
effectiveness and detect changes in the blood pressure.
 Complete history should be obtained to assess for
signs and symptoms that indicate target organ damage.
 Pay attention to the rate , rhythm and character of the
apical and peripheral pulses.
 Assist in performing self-care activities as needed.
 Provide a quite environment.

21. NURSING DIAGNOSIS
1. Decreased cardiac output related to increased peripheral
vascular resistance secondary to hypertension as evidence by
BP 200/110.
Outcome: Maintaining blood pressure within an acceptable range.
Nursing interventions:
 Monitor and measure blood pressure
 Note the presence , quality of the central and peripheral pulses
 Provide quiet environment and therapeutic and reduce activity
 Monitor response to medication to control blood pressure , give
fluid and dietary sodium restriction as indicated.

22. 2. Ineffective tissue perfusion related to hypertension and
decreased cardiac output as manifested by blurred vision and
increased blood pressure.
Interventions:
 Monitor ECG for changes in rate and rhythm and conduction
defects
 Observe extremities for swelling , tenderness , peripheral pulses
and cyanosis
 Instruct the client to inform if headache , chest pain, increased
heart rate.