The document discusses hypertension, defining it as elevated blood pressure with specific systolic and diastolic thresholds. It outlines the causes, risk factors, classifications, symptoms, and treatment options, including both first-line and second-line medications. The management strategies also emphasize lifestyle changes, dietary modifications, and nursing considerations for effective control of high blood pressure.

2. Blood pressure is the product of cardiac output
multiplied by peripheral resistance. Cardiac output is the
product of the heart rate multiplied by the stroke
volume. In normal circulation, pressure is exerted by the
flow of blood through the heart and blood vessels. High
blood pressure known as hypertension, can result from a
change in cardiac output, a change in peripheral
resistance or both. The medications used for treating
hypertension decrease peripheral resistance, blood
volume or the strength and rate of myocardial
contraction.
INRODUCTION

3. Hypertension is a systolic blood pressure
greater than 140mmHg and diastolic pressure
greater than 90mmHg over a sustained period,
based on the average of two or more blood
pressure measurements taken in two or more
contacts with the health care provider after an
initial screening.
-Joint National Committee 1997
DEFINITION

4. Maximum (systolic) pressure
pressure in the artery when the left
ventricle is contracting to force the blood
into the Aorta and other arteries.
Minimum (diastolic) pressure
pressure in the artery when the ventricles
are relaxing and the heart is filling up,
receiving blood from veins.
Force exerted by circulating
blood on the arterial walls

5.  Age
 Sedentary lifestyle
 Obesity
 Salt sensitivity
 Alcohol, smoking
 Family history
 Race (blacks)
 Too little potassium in diet
 Too little vitamin D in diet.
 Stress.
RISK FACORS

6. PRIMARY HYPERTENSION
For most adults, there’s no
identifiable cause of high blood
pressure. This type of high blood
pressure called essential hypertension or
primary hypertension, tends to develop
gradually over many years.
CAUSES

7. Adrenal cortical abnormalities:
 Cushing’s syndrome (Adrenal glands overproduce
the hormone cortisol)
 Primary aldosteronism (over production of
aldosterone by adrenal cortex)
 Aldosteronism causes sodium and water
retention, potassium excretion in the kidneys
Diseases of the kidney (polycystic kidney disease)
SECONDARY HYPERTENSION

8.  Disease of the renal arteries supplying the
kidney RENOVASCULAR
HYPERTENSION
 Neuroendocrine tumors
 Medication side effects (NSAID)
 Kidney problems
 Adrenal gland tumors
 Certain defects in blood vessels (congenital)
 Thyroid problems

9.  Certain medications, such as birth
control pills, cold remedies, over-the-
counter pain relievers and some
prescription drugs.
 Illegal drugs such as cocaine and
amphetamines
 Alcohol abuse or chronic alcohol use
 Obstructive sleep apnea.

10. CLASSIFICATION
Primary hypertension
Secondary hypertension
Isolated systolic hypertension
Pseudo hypertension

11. Normal blood pressure
Prehypertension
Stage 1 hypertension
Stage 2 hypertension
AS PER JOINT NATIONAL
COMMITTEE

12. Category
Optimal
Normal
High-normal
Hypertension
Stage 1
Stage 2
Stage 3
Systolic BP
<120
<130
130-139
140-159
160-179
180
Diastolic BP
<80
<85
85-89
90-99
100-109
110
AS PER WHO

13. PATHOPHYSIOLOGY

14. MILD SYMPTOMS
 Headache
 Morning headache
 Tinnitus – ringing in ears
 Dizziness
 Confusion
 Fatique
 Shortness of breath
 Changes in vision – blindness
 Nausea
CLINICAL MANIFESTATION

15. History collection
Family history of hypertension
Physical examination
Check the vital signs
Through the physical examination found that
how much blood pressure
Obesity
Assess the sweating
DIAGNOSTIC EVALUATION

16.  Laboratory studies
 Routine lab. Test includes urine analysis, blood
chemistry (Na, K, creatinine, FBS, Total and
high density lipoprotein, cholesterol level)
 Renal damage ( BUN and creatinine levels or
by micro or macroalbuminuria)
 Add. Studies creatinine clearance, renin level,
urine test, 24hours urine protein may be
perform.
 12 lead ECG
 Echocardiography

17. FIRST LINE DRUGS
1. Diuretics
2. Beta blockers
3. ACE inhibitors
4. Angiotensin II type 1 receptor blockers
(Losartan, Telmisartan)
5. Calcium channel blockers
MEDICAL MANAGEMENT

18. II LINE DRUGS
Alpha I sympatholytic
Alpha II sympathomimetics
Direct vasodilators
Kallium channel openers
Agonist of II receptors in CNS

19. DIURETICS AND RELATED DRUGS
Loop diuretics (Lasix)
Blocks Reabsorption of Na, Cl & water
Thiazide diuretics ( Chlorothiazide)
 Decrease of blood volume, renal blood flow and
cardiac output depletion of ECF.
 Negative Na balance, mild hypokalemia directly affect
vascular smooth muscle volume.
Potassium – Sparing diuretics (Spironolactone or
Aldactone)
Competitive inhibitor of aldosterone acts on distal
tubule independently of aldosterone.

20. Beta blockers (Propanolol, Metaprolol
Block the sympathetic nervous system, producing a
slower HR and lower HR
Alpha blockers (Prazosin Hydrochloride or Minipress)
Peripheral vasodilators acting directly on the blood
vessel.
Combined Alpha and Beta blockers (Labetalol)
Peripheral dilatation and decreases peripheral
vascular resistance.
 vasodilators (Nitropress)
Decreases peripheral resistance but concurrently
elevates cardiac output, acts directly on smooth muscle
of blood vessels.

21.  ACE inhibitors
Inhibit conversion of angiotensin I to angiotensin II
lower total peripheal resistance.
Example – Captopril, Enalapril, Ramipril.
 Calcium Antagonists
Inhibits calcium in influx reduces cardiac afterload
Example – Cardizem SR
Inhibits calcium ion influx slows velocity of
conduction of cardiac impulse.
Example – Verapamil.

22. Lose weight if overweight
Limit alcohol
Increase aerobic physical activity
Reduce sodium intake
Maintain adequate intake of dietary potassium,
calcium and magnesium for general health
Stop smoking and reduce intake of dietary
saturated fat and cholesterol.
NURSING MANAGEMENT

23. FOOD GROUP NO
Grains & grains
products
Vegetables
Fruits
Low fat or fat
free dairy food
Meat, fish and
poultry
Nuts, seeds and
dry beans.
SERVINGS PER DAY
7-8
4-5
4-5
2-3
2 or fewer
4-5 weekly
THE DASH (DIETARY APPROACHES
TO STOP HYPERTENSION) DIET

24. Take medication properly
• If side effects or cost problem, do not stop medication
• Ask doctor about other problem
Schedule regular doctor visit
• It takes a team effort to treat high BP successfully.
Mange stress
Release negative thoughts,
Maintain good relationship.
Adopt healthy habits
• Loss excess weight & get regular physical activity
• Limits alcohol & if you smoke, quit
LIFE STYLE MODIFICATION

25. Fiber, such as blond psyllium and wheat bran
Minerals such as calcium and potassium
Supplements that increase nitric oxide or widen blood
vessels such as cocoa, coenzyme Q10 or garlic
Omega-3 fatty acids found in fatty fish, fish oil
supplements or flaxseed
Probiotics found in fermented dairy products such as
cultured yogurt, buttermilk, acidophilus milk, cultured
sour cream and cheese.
Alternative medicine

26. NURSING DIAGNOSIS
1.Decreased cardiac output related to
o Increased vascular resistance, vasoconstriction
o Myocardial ischemia
o Ventricular hypertrophy/rigidity
2. Activity intolerance related
o Generalized weakness
o Sedentary life style
o Imbalance between oxygen supply and demand
NURSING PROCESS

27. 3. Ineffective coping related to
o Situational /maturational crisis; multiple life
changes
o Inadequate relaxation; little or no exercise,
work overload
o Inadequate support system
o Poor nutrition
o Unmet expectation; unrealistic perceptions
o Inadequate coping methods
o Gender differences in coping strategies

28. 4. Acute pain (Headache) related to increased
vascular pressure
5. Nutrition imbalanced more than body
requirements related to
o Excessive intake in relation to metabolic need
o Sedentary activity level
o Cultural preferences