HYPERTENSION NOTES FOR NURSING AND ALLIED HEALTH SCIENCES HELPS TO MANAGE THE PATIENTS WITH HYPERTENSION.

1. HYPERTENSION
YOGESH
STAPE
BSN

2. INTRODUCTION
Hypertension or HIGH BLOOD PRESSURE is an important
medical and public health problem. There is a direct
relationship between hypertension and cardio vascular
disease{CVA}. As blood pressure increase, so does the
risk of myocardial infarction, renal disease, stroke and
heart failure.

3. BLOOD PRESSURE
Blood pressure is the force exerted by
the blood against the wall of blood
vessels.
It must be adequate to maintain the
tissue perfusion during activity and
rest.
3

4. FACTORS INFLUENCING -BP
Cardiac Sympathetic nervous system
* Heart rate * Vasoconstriction
* Conductivity *Vasodilation
Blood Pressure = Cardiac output × Systemic vascular resistance
Renal fluid volume control Neurohormonal
*Renin-angiotensin-aldosterone system Vasoconstrictors
* Natriuretic peptides * Angiotensin
… * Norepinephrine

5. DEFINITION
Hypertension is defined as a persistent elevation
systolic BP [SBP] of 140 mm Hg or more , diastolic
BP [DBP] of 90 mmHg or more.
 SBP = Systolic Blood Pressure.
 DBP = Diastolic Blood Pressure.
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6. ISOLATED SYSTOLIC
HYPERTENSION
As an average SBP of 140 mm Hg or more,
coupled with an average DBP of less than 90 mm
Hg.
SBP increase with aging, DBP raises until approx
age of 55 and then declines.
[Control of ISH decrease the risk of stroke, heart
failure, and death’]
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7. RISK FACTORS
AGE
GENDER
FAMILY HISTORY
ALCOHOL
EXCESS DIATERY SODIUM
OBESITY
SEDENTARY LIFESTYLE
STRESS
DIABETES MELLITUS
ELEVATED SERUM LIPIDS
ETHNICITY
[INCREASE HYPERTENSION
2 HIGHER IN AFRICAN
AMERICAN THAN IN
WHITE]

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CLASSIFICATION OF HYPERTENSION
CATEGORY
SYSTOLIC BLOOD
PRESSURE
[mm Hg]
DIASTOLIC BLOOD
PRESSURE
[mm Hg]
NORMAL < 120 < 80
PRE-HYPERTENSION 120-139 80-89
HYPERTENSION
,STAGE 1
140-159 90-99
HYPERTENSION
,STAGE 2
≥ 160 ≥ 100

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CLASSIFICATON OF HYPERTENSION
PRIMARY HYPERTENSION
 Idiopathic
 Elevated BP without an identified cause
 90% to 95% of all the causes
 Several contributing factors are:
• Increased SNS
• Over production of sodium retaining hormone
• Increase sodium intake,
• Greater than ideal body weight
• Diabetes meters,
• Tobacco uses and excessive alcohol consumption.

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CLASSIFICATION OF HYPERTENSION
SECONDARY HYPERTENSION
 Elevated BP with a specific cause that often can be
identified and corrected.
 Causes of :
• Cirrhosis
• Coarctation or congenital narrowing of the aorta
• Drug related : oral contraceptives, corticosteroid,
NSAIDs etc.,
• Endocrine disorders[ Cushing syndrome, thyroid
diseases.,]
• Neurological disorders[brain tumors, traumatic brain
injuries.,]
• Renal disease[glomerulonephritis]
• Pregnancy induced hypertension.

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PATHOPHYSIOLOGY
• Increased sympathetic nervous system activity related to
dysfunction of their autonomic nervous system.
• Hyperinsulinemia or high insulin levels stimuli SNS
activities and impair nitric oxide-medicated vasodilation.
Additionally, pressor effect of insulin include vascular
hypertrophy and increased renal sodium resorption.
• Decreased vasodilation of the arterioles related to
dysfunction of the vascular endothelium.
• Altered Renin – Angiotensin – Aldosterone Mechanism.

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CLINICAL FEATURES
• Hypertension is often called the silent killer because it is
frequently asymptomatic until it becomes severe and target
organ disease occur.
• Symptoms
• Headache [may be severe]
• Fatigue
• Dizziness
• Palpitations
• Angina
• Dyspnea
• Nose bleeds [Epistaxis]

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COMPLICATIONS
• Hypertensive Heart Disease
• Coronary Artery Disease
• Left ventricular hypertrophy
• Heart failure
• Cerebrovascular Disease
• Atherosclerosis
• Hypertensive encephalopathy
• Increases ICP
• Cerebral oedema

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COMPLICATONS
• Peripheral Vascular Disease
Atherosclerosis =Intermittent claudication[Ischemic
leg pain precipitated by activity and relieved with rest] It is
the classic symptom of peripheral vascular Disease.
• Nephrosclerosis [Renal disease]
• Retinal damage [blurring vision, retinal haemorrhage ,
loss of vision]

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DIAGNOSTIC STUDIES
• History collection and physical examination
[including an ophthalmic examination]
• Routine urinalysis
• Basic metabolic panel [serum glucose , sodium,
potassium, chloride, carbon dioxide , BUN and
creatinine]
• Complete blood count.
• Serum lipid profile [total lipid, triglyceride, HDL and
LDL cholesterol, total to HDL cholesterol ratio]

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DIAGNOSTIC STUDIES
•Serum uric acid.
•12 lead electrocardiogram[ ECG]
•Others
• 24 hours urinary creatinine clearance
• Echocardiogram
• liver function studies.
• Serum thyroid stimulation hormone[ TSH]

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MANAGEMENT
Life style modifications
• Weight reduction
• DASH dietary plan [food lowering the low density
lipoprotein]
• Dietary sodium reduction
• Moderation alcohol consumption
• Physical exercise
• Avoidance of tobacco products
• Management of psychosocial risk factor.

18. DRUG MANAGEMENT
DIURETICS
o HYDROCHLOROTHIAZI
DE
o CHLORTHALIDONE
o FUROSEMIDE
o SPIRONOLACTONE
RENIN ANGIOTENSIN SYSTEM
INHIBITOR
• ACE INHIBITORS
 CAPTOPRIL
 ENALAPRIL
 LISINOPRIL
 RAMIPRIL
 FOSINOPRIL etc.,
• ANGIOTENSIN
RECEPTOR BLOCKERS
 LOSARTAN
 CANDESARTAN
 TELMISARTAN etc.,
• DIRECT RENIN
INHIBITORS
 ALISKIREN
SYMPATHETIC INHIBITORS
• BETA ADRENERGIC BLOCKERS
 PROPRANOLOL
 METOPROLOL
 ATENOLOL
OTHERS
• ALPHA AND BETA
ADRENERGIC
BLOCKERS
 LABETALOL
 CARVEDILOL
• CENTRAL SYMPATHOLYTICS
 CLONIDINE
 METHLDOPA
• ALPHA ADRENEGIC
BLOCKERS
 PRAZOSIN
 TERAZOSIN
 DOXAZOSIN
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19. CALCIUM CHANNEL BLOCKERS
• PHENYLALKYLAMI
NE
VERAPAMIL
• BENZOTHIAZEPINE
DILTIAZEM
• DIHYDROPYRIDINE
S
 NIFEDIPINE
 AMLODIPINE
 FELODIPINE
 NICARDIPINE
 CILNIDIPINE etc.,
VASODILATORS
• ARTERIOLAR DILATOR
 HYDRALAZINE
 MINOXIDIL
ARTERIOLAR +
VENODILATOR
NITROPRUSSIDE SOD.
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DRUG MANAGEMENT

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HYPERTENSION CRISIS
• This is a situation in which a patient’s BP is severely elevated,
usually about 180 /110 mm Hg.
• It occurred more often in patients with history of hypertension,
who have not adhered to their medication regimen or related to
cocaine or crack use in a frequent problem. And other drugs
such as amphetamines,PCP,LSD etc,. That may be complicated
by drug induce seizure, Stoke ,MI or encephalopathy ect,.
• Sodium nitroprusside is the most effective ib drug to treat
hypertensive emergency.

21. thank you