Hypertension, or high blood pressure, affects over 1 billion people worldwide and 65 million Americans. It increases the risk of heart attack, stroke, heart disease, and kidney disease. The document defines hypertension as a systolic blood pressure of 140 mmHg or higher or a diastolic blood pressure of 90 mmHg or higher. Risk factors include age, family history, obesity, smoking, excessive alcohol, stress, and a diet high in salt. Preventing hypertension involves maintaining a healthy weight, exercising regularly, reducing salt intake, moderating alcohol, and regular blood pressure screenings.

1. HYPERTENSION
ARE YOU AT RISK
FOR A HEART
ATTACK? STROKE?
OR HEART
DISEASE?
THESE ARE
COMLPLICATIONS OF
HYPERTENSION
LEARN WHAT
HYPERTENSION IS
AND HOW TO PREVENT
IT.

2. Teaching Objectives
 Explain the prevalence and affects of hypertension in
the U.S.
 Define hypertension.
 Describe the mechanisms involved in the regulation of
blood pressure.
 Name the risks of Hypertension.
 Describe the signs & symptoms and complications of
hypertension.
 Define the classifications of hypertension.
 Describe preventative measures for hypertension.
 Explain how to monitor blood pressure at home using
manual and/or electronic devices.

3. Considerations
 Hypertension is an important medical and public health issue.
 It is estimated that 1 billion people Worldwide are affected
by hypertension.
 At least 65 million American adults, or 1 in 3, have high Blood
pressure.
 There is a direct relationship between hypertension and
Cardiovascular disease (CVD).
 There is a proportional risk for heart attack, heart failure,
stroke, and renal disease with higher Blood pressure.

4. WHAT IS HYPERTENSION?
 Blood pressure is expressed as two numbers, for example 120/80 mmHg
 These numbers represent the pressure against the walls of your blood
vessels as the blood moves through them.
 The top number (or first number) represents the systolic pressure, which
occurs when the heart contracts.
 The bottom number (or second number) represents the diastolic pressure,
which occurs when the heart relaxes.
 Normal blood pressure is less than 120 (systolic) over 80 (diastolic),
typically written as 120/80 mm Hg (read 120 over 80 millimeters of
mercury).
 Hypertension, or High blood pressure is persistent
Systolic blood pressure SBP ≥140 mmHg, and
Diastolic blood pressure DBP ≥ 90 mmHg.

5. Lets take a step back and learn a
little about what happens in our
bodies……..
The organs and tissue in your
body need oxygen to survive.
Oxygen is bound to your
blood and is delivered( after
an exchange of carbon
dioxide for oxygen in your
lungs) to your body by blood
vessels.
When your heart beats, it
creates pressure that
pushes blood through your
arteries and veins, also
known as blood vessels and
capillaries.
Blood pressure is the force
of blood pushing against your
blood vessel walls.
Your blood pressure must be
within a normal range to
properly deliver this oxygen
rich blood to your organs and
tissues in order to survive.

6. Okay……so what does this mean?
 When someone has high blood pressure , this increased force makes the heart work
harder to pump blood to the body.
 The increased force puts a strain on both the heart and the blood vessels.
 If the force of the blood flow is high for some time, eventually the tissue that
makes up the walls of the arteries gets stretched beyond its healthy limit.
 This overstretching of the blood vessels makes them more prone to rupture.
 Damages to the vessels results in the development of Atherosclerosis
( hardening of the arteries).
 Uncontrolled high blood pressure increases your risk of serious health
problems, including heart attack and stroke.

7. Who is at risk for Hypertension?
 Age- Blood pressure rises with increasing age.
 Alcohol- Excessive alcohol intake is associated with Hypertension
 Cigarette smoking- Smoking increases your risk for Cardiovascular disease. If you have hypertension &
smoke and/or take Oral contraceptives you have a greater risk for Cardiovascular disease and blood
clots.
 Diabetes Mellitus- Hypertension is more common in Diabetics
 Elevated Cholesterol & Triglycerides- High levels of cholesterol & triglycerides are primary risk
factors for atherosclerosis (plaque build up in your blood vessels).
 Too much salt in your diet- High sodium intake contributes to high blood pressure and causes water
retention.
 Gender- Hypertension is more common in young adulthood men & middle aged men (<55 yr of age). After
the age off 55 Hypertension is more common in women.
 Family history- Having a close blood relative ( parents or sibling) with hypertension increases your risk
of developing hypertension.
 Obesity- Weight gain is highly associated with increased frequency of hypertension, especially with
central abdominal obesity.
 Ethnicity- The incidence of hypertension is twice as high in African Americans as they are in whites.
 Sedentary lifestyle- Inactivity and weight gain are associated with high blood pressure & increases
the risk for heart disease.
 Stress- People exposed to repeated stress may develop hypertension more
 frequently than others.

8. Signs & Symptoms Of Hypertension
 Hypertension is often called the “Silent killer” because it is frequently asymptomatic- meaning “without
symptoms” until it has become severe and damage to organs have occurred.
 A person with severe hypertension may have symptoms caused by the effects on the blood vessels
which my be:
 Fatigue
 Reduced activity tolerance
 Dizziness
 Palpitations
 Angina (chest pain)
 And difficulty breathing
• According to the American Heart Association There's a common misconception that people with high
blood pressure will experience symptoms such as nervousness, sweating, difficulty sleeping or facial
flushing. The truth is that HBP (high blood pressure) is largely a symptomless condition. If you ignore
your blood pressure because you think symptoms will alert you to the problem, you are taking a
dangerous chance with your life. Everybody needs to know their blood pressure numbers, and everyone
needs to prevent high blood pressure from developing.
 There are also myths of headaches/nosebleeds believed to be related to HBP. According to the AHA
studies have shown that people with higher systolic (top number) blood pressure were up to 40% less
likely to have headaches ( except in the cases of Hypertensive crisis SBP ≥180mmHg and DSP
≥110mmHg)
 It is important to know that nosebleeds can be associated with other factors,. Most common reasons
for nosebleeds are dry air especially in hot climates like the desert Southwest (Arizona). Other causes
may be allergies, sinusitis or anticoagulants such as Warfarin or aspirin.

9.  Cardiovascular disease
 Atherosclerosis – “ Hardening of the
arteries”
 Coronary Artery Disease- damage to the
heart & coronary arteries
 Cerebrovascular Disease
 Peripheral Vascular Disease
 Stroke or Heart Attack
 Angina- Chest pain
 Kidney damage
 Vision loss
 Heart failure- Over time as
the heart works harder to push
the blood throughout the body,
the heart (which is a muscle)
enlarges.
 Just like any other muscle in
your body enlarges when you
work it out.
 This enlargement causes
stretching of the heart muscle
and eventually not enough blood
is pumped out of the heart to
the body to meet the body’s
requirements of oxygen as
discussed earlier.
Complications of Hypertension

10. Classifications of Blood Pressure
Normal BP ‘
SBP <120 mmHg & DBP < 80 mmHg
Prehypertension
SBP 120-139 mmHg or DBP 80-89
Stage 1 Hypertension
SBP 140-159 mmHg or DBP 90-99
Stage 2 Hypertension
SBP ≥ 160 mmHg or DBP ≥ 100 mmHg

11. Prevention Of Hypertension
 Maintain a healthy weight- A weight loss of
even 10 pounds can decrease your SBP ( top
number of your blood pressure)by 5-20mmHg .
 Exercise- at least 30 minutes of aerobic
physical activity (brisk walking, jogging, swimming)
most days of the week.
 Reduce salt and sodium intake- Foods that have
a lot of salt are processed foods ( frozen
dinners, canned foods) and Lunch meats.
 Increase level of physical activity.
 Limit alcohol consumption to moderate levels-
Men should limit their alcohol intake to no more
than 2 drinks per day and women to no more than
one drink per day.
1 drink = 1.5 oz. alcohol or 12 0z. Beer, 5 oz. of
wine, 1.5 oz 80 proof whiskey.
 Monitor Blood pressure and know if it is high,
low, normal, or borderline for hypertension.
 Regular check ups with your Primary care
Physician.
How can I prevent Hypertension ?

12. Prevention: Numbers to Remember
Lifestyle
Maintain a healthy
weight
BMI < 25%
Waist circumference
Men: 40 in. or less
Women: 35 in. or l less
Diet
5 or more servings of
fruits & veggies a day
1 tsp or less of salt per
day
Exercise
Jogging, walking,
swimming
30 minutes a day most
days of the week
Quit smoking
Limit Alcohol
consumption to 1 0z per
day
Regular Health Check
ups
LDL Cholesterol < 130
mg/dl
HDL Cholesterol 50
mg/dl or higher

13. Monitoring your Blood pressure
 Your blood pressure should be taken during your regular health
check ups.
 Your doctor may recommend checking your blood pressure at home
if you have risk factors of hypertension or if you have been
diagnosed with pre-hypertension (systolic -top number between 120
and 139 mm Hg OR diastolic -bottom number between 80 and 89
mm Hg).
 A record of readings taken over time can provide you and your
healthcare provider a clearer picture of your blood pressure.
AHA Recommendation:
 The American Heart Association recommends an automatic, cuff-
style, bicep (upper-arm) monitor. Wrist and finger monitors are not
recommended because they yield less reliable readings.

14. Monitoring your blood pressure cont.
How to monitor your blood pressure
 Use a bicep (upper-arm) monitor for more accurate readings as recommended
by the AHA.
 electronic or automatic versions at work or in your local pharmacy/shopping
center may be used but can give inaccurate readings.
 A manual blood pressure cuff can also be used if you have someone that knows
how to accurately use it.
 Make sure the cuff fits
 Be still
 Sit correctly with your back straight & supported (using a dining chair instead
of a sofa is recommended), feet flat (don’t cross your legs), and upper arm
supported at heart level.
 Make sure the middle of the cuff is directly over the brachial artery.
 Record all your readings & understand the readings (optimal BP is < 120/80
mmHg).
 The average of three readings, at least one minute apart, should be used as the
BP reading.
 Consult your health care provider if you get several high recordings.

15. Blood pressure monitoring devices

16. Prevention is Key
According to the U.S. Health and Human Services a combination
of increased physical activity, moderation in alcohol intake, and
consumption of an eating plan that is lower in sodium content and
higher in fruits, vegetables and low-fat dairy products than the
average American diet represents the best approach for
preventing high blood pressure in the general population and in high
risk groups.

17. References
Lewis, S.L., & Heitkemper, M.M., & Dirksen, S. R., &
O’Brien, P. G., & Bucher, L. (2007). Medical Surgical
Nursing. Philadelphia, PA: Mosby Elsevier.
Primary prevention of hypertension. (2002). National
Institutes of Health , 14.
What is high blood pressure. (2010).
Retrieved October 20th, 2010, from
http://www.heart.org.