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Hypertension Definition: the force exerted by the blood  against the walls of the bleed vessels  Adequate to maintain ti...
HypertensionArterial BP = Cardiac Output (CO) x Systemic              vascular resistance (SVR)Cardiac Output = stroke vol...
HypertensionMechanisms that Regulate BP    Sympathetic Nervous System    Vascular Endothelium    Renal System    Endoc...
Hypertension      Mechanisms that Regulate BP Sympathetic Nervous System (SNS) –  norepinephrine released from sympatheti...
HypertensionSNS Receptors Influencing B/P
Hypertension   Mechanisms that Regulate BP Sympathetic Nervous System (SNS)–  Sympathetic Vasomotor Center – located in ...
Hypertension   Mechanisms that Regulate BP Sympathetic Nervous System (SNS) –  Baroreceptors: specialized nerve cells th...
Hypertension    Mechanisms that Regulate BP Vascular Endothelium  Single cell layer that lines the blood vessels  Produ...
Hypertension    Mechanisms that Regulate BP Renal System  Control Na+ excretion & extracellular fluid   volume  Renal -...
HypertensionRenin-Angiotensin
HypertensionRenin-Angiotensin System
Hypertension      Mechanisms that Regulate BP Endocrine System  Stimulates the SNS with    Epinephrine – increases HR a...
HypertensionAldosterone Mechanism•   Increased Aldosterone =•   Increases sodium reabsorption =•   Increases water reabsor...
Hypertension        Mechanisms that Regulate BP Regulatory mechanisms in the health person function in response  to the d...
Secondary Hypertension            Pathophysiology Specific cause of hypertension can be identified 5+% of adult hyperten...
Hypertension              Pathophysiology Primary (Essential) Hypertension:  Elevated BP without an identified cause  A...
Primary Hypertension           Pathophysiology Heredity – interaction of genetic,  environmental, and demographic factors...
Hypertension              Clinical ManifestationDx is made after multiple readings over several weeksNIH/Joint Committee D...
Primary Hypertension    Risk Factors       Age       Alcohol       Cigarette Smoking       Diabetes Mellitus       El...
Primary Hypertension         Clinical Manifestations Target Organ Complications:   Myocardium – angina / left ventricula...
Primary Hypertension          Clinical Manifestations “Silent Killer” – asymptomatic and insidious Severe HTN – fatigue,...
Hypertension          Medical Diagnosis History and Physical Examination Renal Function  Serum Creatinine & Urine Creat...
Primary HypertensionMedical Management Risk Stratification  Level of BP  Presence of Target Organ Disease  Other Risk ...
HypertensionMedical Management Risk Stratification
Primary HypertensionMedical Management Lifestyle modification    Nutritional therapy    Alcohol consumption    Physica...
Hypertension Nutrition
HypertensionRisk Factor Modification
Primary Hypertension        Medical Management         Stepped Approach            Lifestyle modification                 ...
Primary Hypertension Medical Management – Drug Therapy Diuretics   Thiazide   Loop   K+ Sparing Adrenergic Blockers/ ...
HypertensionMedication - Diuretics
HypertensionMedication – Beta-blocking Agents
Hypertension      MedicationCalcium Channel Blockers
Hypertension        MedicationAlpha Agonists & Vasodilators
HypertensionAntihypertensive Drug Therapy
Primary HypertensionLack of Responsiveness to Therapy        Nonadherence to Therapy        Drug-Related Causes        ...
Primary Hypertension          Hypertensive Crisis Definition: Severe & abrupt elevation of BP with  diastolic > 120-130mm...
Primary Hypertension              Nursing DiagnosesAssess: Cardiovascular status; adherence to therapy; family  interactio...
HypertensionDynamics of Treatment
Primary Hypertension     Case Study
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Hypertension

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Hypertension
Hypertension. Definition: the force exerted by the blood against the walls of the bleed vessels. Adequate to maintain tissue perfusion during activity and rest ...
File link: http://www.mccc.edu/~martinl/documents/HTN.ppt

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Hypertension

  1. 1. Hypertension Definition: the force exerted by the blood against the walls of the bleed vessels Adequate to maintain tissue perfusion during activity and rest Arterial blood pressure: primary function of cardiac output and systemic vascular resistance
  2. 2. HypertensionArterial BP = Cardiac Output (CO) x Systemic vascular resistance (SVR)Cardiac Output = stroke volume x beats per minSystemic vascular resistance = force opposing the movement of blood within the blood vesselsWhat is the effect on BP if SVR increased and CO remains constant?
  3. 3. HypertensionMechanisms that Regulate BP  Sympathetic Nervous System  Vascular Endothelium  Renal System  Endocrine System
  4. 4. Hypertension Mechanisms that Regulate BP Sympathetic Nervous System (SNS) – norepinephrine released from sympathetic nerve endings - to receptors alpha1, alpha2, beta 1 & beta2 Reacts within seconds Increases Heart Rate - chronotropic Increased cardiac contractility - inotropic Produces widespread vasoconstriction in peripheral arterioles Promotes release of renin from the kidney
  5. 5. HypertensionSNS Receptors Influencing B/P
  6. 6. Hypertension Mechanisms that Regulate BP Sympathetic Nervous System (SNS)– Sympathetic Vasomotor Center – located in the medulla – interacts with many areas of the brain to maintain BP within normal range under various conditions Exercise – changes to meet oxygen demand Postural Changes – peripheral vasoconstriction
  7. 7. Hypertension Mechanisms that Regulate BP Sympathetic Nervous System (SNS) – Baroreceptors: specialized nerve cells the carotid arteries and the aortic arch Sensitive to BP changes: Increase: Inhibits SNS – peripheral vessel dilation. Decreased heart rate, and decreased contractility of the heart + increased parasympathetic activity (vagus nerve) decreased heart rate Decrease: Activates SNS – peripheral vessel constriction, increased heart rate, and increased contractility of the heart
  8. 8. Hypertension Mechanisms that Regulate BP Vascular Endothelium Single cell layer that lines the blood vessels Produce vasoactive substances: EDRF Endothelium-derive relaxing factor –  Helps maintain low arterial tone at rest  Inhibits growth of the smooth muscle layer  Inhibits platelet aggregation Vasodilation – prostacyclin Endothelin (ET) potent vasoconstrictor Endothelial dysfunction may contribute to atherosclerosis & primary hypertension
  9. 9. Hypertension Mechanisms that Regulate BP Renal System Control Na+ excretion & extracellular fluid volume Renal - Renin-angiotensin-aldosterone Renin converts angiotensinogen to angiotensin I Angiotensin-converting enzyme (ACE) converts I into angiotsensin II Immediate: Vasoconstrictor – increased systemic vascular resistance Prolonged: Stimulates the adrenal cortex to secret Aldosterone – Na+ and Water retention Renal Medulla - Prostaglandins - vasodilator effect
  10. 10. HypertensionRenin-Angiotensin
  11. 11. HypertensionRenin-Angiotensin System
  12. 12. Hypertension Mechanisms that Regulate BP Endocrine System Stimulates the SNS with Epinephrine – increases HR and contractility Activates B2-adrenergic receptors in peripheral arterioles of skeletal muscle = vasodilation Activates A1-adrenergic receptors in peripheral arterioles of skin and kidneys = vasoconstiction Adrenal Cortex – Aldosterone – stimulates kidneys to retain Na+ Increased Na+ stimulates posterior pituitary – ADH – reabsorbs ECF/water
  13. 13. HypertensionAldosterone Mechanism• Increased Aldosterone =• Increases sodium reabsorption =• Increases water reabsorption =• Increases blood volume =• Increases cardiac output
  14. 14. Hypertension Mechanisms that Regulate BP Regulatory mechanisms in the health person function in response to the demands on the body When Hypertension develops, one or more of these mechanisms are defective  Sympathetic Nervous System  Vascular Endothelium  Renal System  Endocrine System
  15. 15. Secondary Hypertension Pathophysiology Specific cause of hypertension can be identified 5+% of adult hypertension Causes:  Coarctation or congenital narrowing of the aorta  Renal disease – renal artery disease / parenchymal  Endocrine disorders: Pheochromocytoma, Cushing Syndrome, Hyperaldosteronism  Neurology disorders – brain tumors / head injury  Sleep apnea  Medications – sympathetic stimulants  Pregnancy-induced hypertension
  16. 16. Hypertension Pathophysiology Primary (Essential) Hypertension: Elevated BP without an identified cause Accounts for 95% of all cases of hypertension Cause – unknown Contributing Factors: Increased SNS activity, overproduction of Na+ retaining hormones & vasoconstrictors, increased Na+ intake Risk Factors: Modifiable
  17. 17. Primary Hypertension Pathophysiology Heredity – interaction of genetic, environmental, and demographic factors Water & Sodium Retention – 20% of pts with high Na+ diet develop HTN Altered Renin-Angiotensin Mechanism – found in 20% of patients Stress & Increased SNS Activity Insulin Resistance & Hyperinsulinemia Endothelial Cell Dysfunction
  18. 18. Hypertension Clinical ManifestationDx is made after multiple readings over several weeksNIH/Joint Committee Definition:Category Systolic DiastolicOptimal <110 and < 80Normal <120 and <85High Normal 130-139 or 85-89Stage 1 140-159 or 90-99Stage 2 160-179 or 100-109Stage 3 =>180 or => 110
  19. 19. Primary Hypertension Risk Factors  Age  Alcohol  Cigarette Smoking  Diabetes Mellitus  Elevated serum lipids  Excess Na+ in diet  Gender  Family History  Obesity  Ethnicity  Sedentary Lifestyle  Socioeconomic  Stress
  20. 20. Primary Hypertension Clinical Manifestations Target Organ Complications:  Myocardium – angina / left ventricular hypertrophy  Brain – TIA / CVA  Peripheral vascular – Peripheral pulse change  Kidney – renal failure Creatinine / Proteinuria  Eyes – Hemorrhages with or without papilledema
  21. 21. Primary Hypertension Clinical Manifestations “Silent Killer” – asymptomatic and insidious Severe HTN – fatigue, reduced activity tolerance, dyspnea, dizziness, palpitations, angina
  22. 22. Hypertension Medical Diagnosis History and Physical Examination Renal Function Serum Creatinine & Urine Creatinine Clearance Electrolytes – especially K+ Blood Glucose Serum Lipids/EKG Ambulatory BP Monitoring
  23. 23. Primary HypertensionMedical Management Risk Stratification Level of BP Presence of Target Organ Disease Other Risk Factors
  24. 24. HypertensionMedical Management Risk Stratification
  25. 25. Primary HypertensionMedical Management Lifestyle modification  Nutritional therapy  Alcohol consumption  Physical activity  Tobacco avoidance  Stress management Drug Therapy
  26. 26. Hypertension Nutrition
  27. 27. HypertensionRisk Factor Modification
  28. 28. Primary Hypertension Medical Management Stepped Approach Lifestyle modification Not at Goal BP Drug Therapy Not at Goal BPSubstitute med / add a 2nd med/ increase dose Not at Goal BPContinue adding / changing meds until control
  29. 29. Primary Hypertension Medical Management – Drug Therapy Diuretics  Thiazide  Loop  K+ Sparing Adrenergic Blockers/ Inhibitors  B-Adrenergic Blockers  Central Acting Adrenergic Antagonists  Peripheral Acting Adrenergic Antagonists  A-Adrenergic Blockers Vasodilators Angiotensin Inhibitors Calcium Channel Blockers
  30. 30. HypertensionMedication - Diuretics
  31. 31. HypertensionMedication – Beta-blocking Agents
  32. 32. Hypertension MedicationCalcium Channel Blockers
  33. 33. Hypertension MedicationAlpha Agonists & Vasodilators
  34. 34. HypertensionAntihypertensive Drug Therapy
  35. 35. Primary HypertensionLack of Responsiveness to Therapy  Nonadherence to Therapy  Drug-Related Causes  Associated conditions  Secondary Hypertension  Volume overload
  36. 36. Primary Hypertension Hypertensive Crisis Definition: Severe & abrupt elevation of BP with diastolic > 120-130mm Hg. Causes: Nonadherence, renovascular changes, pre- eclampsia, eclampsia, Pheochromocytoma, Rebound from abruptly stopping beta blockers, head injury, necrotizing vasculitis, acute aortic dissection Hypertensive Encephalopathy: headache, N/V, confusion, obtunded, stuporous, seizures, blurred vision, transient blindness
  37. 37. Primary Hypertension Nursing DiagnosesAssess: Cardiovascular status; adherence to therapy; family interaction; risk factor modification?Nsg Action: Supportive & reality-based; Administer meds; referrals; diagnostic preps; ask questions; supportive care during hospitalization for acute crisisPt/Family Education: Medications; risk factor modification; Community support
  38. 38. HypertensionDynamics of Treatment
  39. 39. Primary Hypertension Case Study

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