For 2nd year B.Sc Nursing students

1. HYPERTENSION
Presented By:
Mr. Nandish.S
Asso. Professor
Mandya Institute of Nursing Sciences

3. DEFINITION :
 It is a sustained elevation of blood pressure, when systolic blood
pressure is equal to or greater than 140 mm of hg and diastolic
pressure is equal to or greater than 90 mm of hg for extended period of
time.
 it is also known as high blood pressure, is a long term medical
condition in which blood pressure in the arteries is elevated.
 It is also called as “ Silent Killer” as patient will not display any
symptom.

4. STAGES :
Category Systolic BP Diastolic BP
Pre Hypertension 120 – 139 80 - 89
Hypertension Stage - I 140 - 159 90 - 99
Hypertension Stage - II 160 - 179 100 - 109
Hypertension Stage - III > 180 > 110
* The term stage is used to define levels of Hypertension.

5. Incidence & Prevalence:
- According to WHO, around 1.28 billion adults aged between 30 – 79
years have hypertension.
- 46% of adults with hypertension are unaware that they have this
condition.
- In India, 29.8% of overall population are suffering from this illness
(who are diagnosed).
- Incidence rate is increased along with the age. 33.2% of cases are
reported between 40 – 59 years and 63% of cases seen over the age of
60 years.

6. CLASSIFICATION :
The Etiology of hypertension can be classified as either primary or
secondary.
1. Primary or Essential Hypertension.
• In this type, BP is elevated without an identified cause and accounts
for 90 to 95% cases.
• Although exact cause is unknown, there are several contributing
factors like increased SNS activity, over production of sodium
retaining hormones & vasoconstrictors, increased sodium intake,
greater than ideal body weight, Diabetes Mellitus & excessive alcohol
intake.

7. 2. Secondary Hypertension :
• In this type, BP is elevated with specific cause that can be identified &
corrected.
• This type accounts for 5 – 10% of cases in adults.
• Causes of secondary hypertension include :
1) Coarctation or Congenital Narrowing of Aorta
2) Renal diseases such as Renal artery stenosis
3) Endocrine disorders such as Cushing syndrome, Hyperaldosteronism
4) Neurologic disorders like Brain tumors, Head Injury, Quadriplegia
5) Sleep Apnea
6) Medications NSAID’s, Oral Contraceptive pills, estrogen replacement
therapy, sympathetic stimulants (Cocaine), Monoamine Oxidase
Inhibitors,…
7) Pregnancy Induced Hypertension

8. Other Types of Hypertension :
1) Malignant Hypertension : it occurs suddenly & drastically. Patient
will experience numbness in body, vision problems, extreme fatigue,
confusion, anxiety.
2) Isolated Systolic Hypertension : it occurs as a result of old age and
poor diet.
3) White Coat Hypertension : it occurs only when a person’s blood
pressure is taken in clinical setting, outside of Doctor’s office blood
pressure is normal.

9. RISK FACTORS :
1) Age : Blood pressure progressively increases with age.
2) Alcohol : excessive alcohol intake is strongly associated with
hypertension.
3) Cigarette smoking : it greatly increases the risk of cardio vascular
disease.
4) Diabetes Mellitus : hypertension is more common in diabetes.
5) Elevated Serum Lipids : increased cholesterol & triglycerides are
major risk factors for atherosclerosis.
6) Excessive dietary sodium
7) Gender : it is more prevalent in men.
Continued…

10. 8) Family History
9) Obesity / weight gain
10) Sedentary lifestyle
11) Socioeconomic status : it is more prevalent in lower socioeconomic
groups.
12) Ethnicity : it is high in African & Americans.
13) Stress : people exposed to repeated stress will develop hypertension
more frequently.

13. CLINICAL MANIFESTATIONS :
• It remains asymptomatic until it becomes severe and target organs are
affected.
• Patients may experience variety of symptoms secondary to effects on
blood vessels. It include :
 Fatigue
 Reduced activity tolerance
 Dizziness
 Severe Headache
 Palpitation
 Angina / Chest pain
 Dyspnoea
Continued …

14.  Nose bleeding
 Blurred vision
 Nausea & Vomiting
 Irregular Heart beat
 Papilledema

15. COMPLICATIONS :
1) Hypertensive Heart Disease
- Coronary Artery Disease (CAD)
- Left Ventricular Hypertrophy
- Heart Failure
2) Cerebrovascular Disease
- Cerebrovascular Accident
- Hypertensive Encephalopathy
3) Peripheral Vascular Disease
4) Nephrosclerosis
5) Retinal damage

16. DIAGNOSTIC STUDIES :
 History collection & Physical Examination
 Blood Pressure Monitoring
 Routine urine analysis
 Serum Electrolytes (sodium, potassium)
 BUN, Serum creatinine, serum uric acid
 Blood Glucose level
 CBC
 Fasting Lipid Profile
 12 lead ECG
 Echocardiogram

17. MANAGEMENT :
Treatment / management of hypertension is possible in two ways, which
include
 Life style modification
 Pharmacological therapy

18. LIFE STYLE MODIFICATION :
The life style modification measures mainly include,
Weight reduction
DASH diet (Dietary Approaches to stop Hypertension)
Sodium restriction
Reduce alcohol
Regular Exercise
Stress management
Caffeine restriction

19. PHARMACOLOGICAL THERAPY :
Various group of drugs are used for the treatment of hypertension
and they are collectively called as Antihypertensive drugs.
They include :
1) Diuretics – it helps the kidneys to inhibit the sodium reabsorption in
the distal convoluted tubules and loop of Henle.
Ex : Furosemide, Chlorthiazide.
2) Beta Blockers – these medications reduces the workload of heart &
blood vessels, which causes heart to beat slowly and with less force.
Ex: Atenolol, Propanolol

20. 3) Alpha Blockers – these drugs causes peripheral vasodilation of blood
vessels.
Ex: Prazosin
4) Vasodilators – these medications act directly on the muscles in the
wall of arteries and preventing the muscles from tightening and arteries
from narrowing.
Ex : Nitroglycerin, Sodium Nitroprusside
5) ACE Inhibitors – these medications will reduce the conversion of
Angiotensin – I to Angiotensin – II and prevents vasoconstriction.
Ex : Captopril, Ramipril
Continued…

21. 6) Calcium channel blockers – these drugs will block the movement of
extra cellular calcium into the cells and causing vasodilation & they
decrease heart rate.
Ex: Amlodipine, Verapamil.
 Alternative therapies which are helpful to regulate blood pressure
include Acupuncture, Relaxation techniques & Diversional therapies

23. NURSING INTERVENTIONS :
 Monitoring dietary habits.
 Identify the medical history such as diabetes, CAD, Renal
diseases,…
 Instruct the patients to avoid smoking & alcoholism
 Check vital signs frequently
 Periodic check up for blood cholesterol level
 Encourage the patients to consume more green leafy vegetables &
fruits.

24. NURSING DIAGNOSIS .. ?