Hypertension: Causes, Management, & Care

Hypertension: Causes, Management, & Care

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  HYPERTENSION – NURSINGNOTES 1. Definition According to WHO: “Hypertension (high blood pressure) is when the pressure in your blood vessels is too high (140/90 mmHg or higher).” Hypertension is diagnosed when the systolic blood pressure is ≥140 mmHg and/or the diastolic blood pressure is ≥90 mmHg, measured on two different days. 2. Types of Hypertension A. Based on Cause 1. Primary (Essential) Hypertension Primary hypertension is high blood pressure in which no single specific cause can be identified. It is the most common type. 2. Secondary Hypertension Secondary hypertension is high blood pressure caused by an identifiable disease, condition, or medication. B. WHO/ISH Classification – Traditional Classification 1. Optimal: <120/80 mmHg 2. Normal: <130/85 mmHg 3. High Normal: 130–139/85–89 mmHg 4. Grade 1 Hypertension (Mild): 140–159/90–99 mmHg 5. Grade 2 Hypertension (Moderate): 160–179/100–109 mmHg 6. Grade 3 Hypertension (Severe): ≥180/≥110 mmHg 7. Isolated Systolic Hypertension: Systolic BP ≥140 mmHg with diastolic BP <90 mmHg Note: Current ACC/AHA (American College of Cardiology / American Heart Association) guidelines use a different classification, with Stage 1 hypertension beginning at 130–139 mmHg systolic or 80–89 mmHg diastolic. © Dr. Sudhadevi Sadanandan | Rajkali Institute of Nursing & Paramedical Sciences | Page 1
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  3. Etiology A. PrimaryHypertension No single identifiable cause. Contributing factors include: • Family history and genetic factors • Increasing age • Overweight or obesity • High-salt or high-sodium diet • Lack of physical activity • Excessive alcohol intake • Smoking • Stress B. Secondary Hypertension Possible causes include: • Kidney disease • Renal artery disease • Endocrine disorders • Obstructive sleep apnea • Certain medications • Pregnancy-related hypertensive disorders 4. Pathophysiology Risk factors such as family history, obesity, high-salt intake, stress, smoking, and lack of physical activity affect the normal regulation of blood pressure. ↓ These factors may increase sympathetic nervous system activity. ↓ The heart beats faster and more forcefully, and the blood vessels become narrow. ↓ Sympathetic stimulation also causes the kidneys to release renin. ↓ © Dr. Sudhadevi Sadanandan | Rajkali Institute of Nursing & Paramedical Sciences | Page 2
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  Renin activates theRenin-Angiotensin-Aldosterone System (RAAS). ↓ This leads to the formation of angiotensin II. ↓ Angiotensin II causes vasoconstriction (narrowing of blood vessels). ↓ Resistance to blood flow increases. ↓ Angiotensin II also stimulates the adrenal glands to release aldosterone. ↓ Aldosterone causes sodium and water retention by the kidneys. ↓ Blood volume increases. ↓ Narrow blood vessels + Increased blood volume ↓ The heart pumps against greater resistance. ↓ Blood pressure increases. ↓ Long-term hypertension can damage the heart, brain, kidneys, eyes, and blood vessels. 5. Clinical Manifestations Hypertension is commonly called a “silent killer” because it may occur without noticeable symptoms. 8. Headache 9. Dizziness 10. Blurred vision 11. Palpitations 12. Fatigue © Dr. Sudhadevi Sadanandan | Rajkali Institute of Nursing & Paramedical Sciences | Page 3
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  13. Shortness ofbreath 14. Nosebleed 15. Chest pain Hypertension should be identified through proper blood pressure measurement. 6. Complications Heart • Coronary artery disease • Heart attack • Heart failure • Enlargement of the heart Brain • Stroke • Cerebrovascular disease Kidneys • Chronic kidney disease • Kidney failure Eyes • Hypertensive retinopathy • Visual problems Blood Vessels • Peripheral artery disease • Aortic aneurysm • Aortic dissection 7. Medical Management Antihypertensive drugs are given to control high blood pressure. 16. Diuretics: Hydrochlorothiazide, Furosemide 17. ACE Inhibitors: Enalapril, Ramipril © Dr. Sudhadevi Sadanandan | Rajkali Institute of Nursing & Paramedical Sciences | Page 4
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  18. Angiotensin IIReceptor Blockers (ARBs): Losartan, Telmisartan 19. Calcium Channel Blockers (CCBs): Amlodipine, Nifedipine 20. Beta Blockers: Atenolol, Metoprolol 21. Alpha-1 Blockers: Prazosin, Doxazosin 22. Central-Acting Drugs: Clonidine, Methyldopa 23. Direct Vasodilators: Hydralazine, Minoxidil 24. Direct Renin Inhibitor: Aliskiren 8. Blood Pressure Measurement 25. Allow the patient to rest for 5 minutes. 26. Keep the patient sitting comfortably with feet flat on the floor. 27. Support the arm at heart level. 28. Use the correct cuff size on the bare upper arm. 29. Ask the patient not to talk during measurement. 30. Measure and record BP accurately. 9. Nursing Management 31. Monitor BP regularly and record the readings. 32. Assess for headache, dizziness, chest pain, breathing difficulty, and visual or neurological changes. 33. Administer antihypertensive drugs as prescribed and observe for side effects. 34. Monitor kidney function, fluid balance, and electrolytes as ordered. 35. Provide a low-salt, healthy diet and support appropriate weight management. 36. Promote regular physical activity according to the patient's condition. 37. Advise smoking cessation and limitation of alcohol. 38. Teach regular medication use and advise not to stop medicines without medical advice. 39. Check for postural hypotension, particularly when dizziness occurs. 40. Promote regular follow-up and home BP monitoring when advised. © Dr. Sudhadevi Sadanandan | Rajkali Institute of Nursing & Paramedical Sciences | Page 5
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  41. Observe forcomplications involving the heart, brain, kidneys, eyes, and blood vessels. 10. DASH Diet DASH – Dietary Approaches to Stop Hypertension Include • Fruits and vegetables • Whole grains • Low-fat dairy products • Beans and nuts • Fish and lean meat Limit • Salt and sodium • Saturated fat • Sugary foods and drinks 11. Nursing Diagnosis Ineffective Health Self-Management Related to: Difficulty following treatment As evidenced by: Not taking medicines regularly and not checking blood pressure regularly. 12. Important Formula Blood Pressure = Cardiac Output × Peripheral Vascular Resistance Cardiac Output: Amount of blood pumped by the heart in one minute. Peripheral Vascular Resistance: Resistance offered by the blood vessels to the flow of blood. © Dr. Sudhadevi Sadanandan | Rajkali Institute of Nursing & Paramedical Sciences | Page 6