This document provides information about hypertension (high blood pressure) for nurses caring for patients with the long-term condition. It defines hypertension and normal blood pressure levels. Hypertension has no obvious cause for most people and is a growing problem worldwide. Regular exercise and lifestyle factors can both impact and help control blood pressure. The nurse's role is to understand the condition, its effects on the body, and provide education to patients on self-care strategies to sustain their health.

1. LIVING WITH
HYPERTENSION
Sustaining Health

2. The aim of this session
◦Analyse the role of the nurse caring for patients
with the long term condition hypertenion

3. The objectives
◦ To study the condition further in order to gain a deeper level of knowledge of the condition
required to care for patients with hypertension LO2
◦ Describe who is effected by this disorder LO1
◦ List why individuals are affected by this condition LO1
◦ Explain using evidence how an individual with the condition can be effected LO2
◦ Reflect upon the role of the nurse and determine the health needs of the patient. LO4
◦ List self care strategies that can be used by the nurse in order to sustain the health of patients
with this long term condition LO3

4. Need to know: Need to Study
◦ Knowledge of the cardio vascular system
◦ Regulation of Blood Pressure
◦ Normal Blood Pressure Measurements
What is blood pressure?
1. The pressure exerted by the flow of blood through the major arteries of the body.
2. This pressure is greatest during the contraction of the ventricles of the heart (systolic
pressure) which forces blood into the arterial system.
3. Pressure falls to its lowest level when the heart is filling with blood (diastolic pressure).

5. hypertension 2016, , 7th edn, Oxford University Press.
◦ Normal blood pressure for a young average adult human is in the region of 120/80 mmHg
◦ NOTE that the higher number is the systolic blood pressure; the lower number the diastolic
blood pressure, but individual variations are common.
◦ So explain what a systolic170/ diastolic 90 mmHg means
◦ Note that The phase of the heart beat during which the ventricles of the heart contract to force
blood into the arteries is the systolic
◦ The phase of a heart beat that occurs between two contractions of the heart, during which the
heart muscles relax and the ventricles fill with blood is the diastolic

6. Blood Pressure
◦ Mean arterial pressure (MAP)—the mean of systolic and diastolic pressures—is determined by
Cardiac Output (CO) and Total Peripheral Resistance (TPR) according to the equation MAP = CO
× TPR.
◦ It is regulated by various neural and hormonal mechanisms, both local and systemic. CO
depends on stroke Volume and heart rate, which are governed chiefly by the autonomic
nervous system, and hormones such as adrenalin.
◦ TPR is determined by the resistance of the arteries and arterioles feeding the capillary beds.
◦ Contraction and relaxation of smooth muscle in the walls of these vessels alters their internal
diameter, and hence resistance to blood flow.

7. Blood Pressure
◦ These changes may occur in response to local requirements for oxygen or delivery/removal of
metabolites, or more general changes.
◦ For instance, in the stress response noradrenaline binds to receptors in vessels in the gut and
other ‘non-essential’ tissues, causing vessels to constrict.
◦ Another hormone, angiotension, also causes constriction of arterioles in peripheral tissues and is
important in raising blood pressure.

8. What is hypertension?
◦ https://www.youtube.com/watch?v=tTKnNp7bw8Y
◦ So what is hypertension?
◦ How is hypertension diagnosed?
◦ Explain the effect on the body……
◦ So can you identify the potential health risks for people who have hypertension?

9. Definitions of Hypertension
◦ Elevation of the arterial blood pressure above the normal range expected in a particular age
group hypertension 2014, , 6th edn, Oxford University Press.
◦ In the NICE guideline (2016) the following definitions are used.
• Stage 1 hypertension Clinic blood pressure is 140/90 mmHg or higher and subsequent
ambulatory blood pressure monitoring (ABPM) daytime average or home blood pressure
monitoring (HBPM) average blood pressure is 135/85 mmHg or higher.
• Stage 2 hypertension Clinic blood pressure is 160/100 mmHg or higher and subsequent
ABPM daytime average or HBPM average blood pressure is 150/95 mmHg or higher.
• Severe hypertension Clinic systolic blood pressure is 180 mmHg or higher or clinic diastolic
blood pressure is 110 mmHg or higher.

10. Catergories
◦ Essential (primary)
◦ Accounts for 95% of hypertension cases in the UK. Genetic pre-disposition in addition to lifestyle factors eg salt
intake, physical inactivity
◦ Secondary
◦ Accounts for up to 5% of cases. Caused by an underlying disease, most commonly chronic kidney disease, or as a
result of medication
◦ Malignant (accelerated)
◦ A very high or rapidly rising blood pressure which threatens end organ damage and requires urgent or emergency
treatment. Around 1% of those with essential hypertension develops malignant hypertension
◦ Gestational
◦ Occurs during pregnancy and usually returns to normal after the birth
◦ ‘White Coat’
◦ Occurs when BP is high in the presence of a health care professional but returns to ‘normal’ at other times
Mancia, G. 2015;2014;, White coat hypertension: an unresolved diagnostic and therapeutic problem, 2015th edn, Springer,
New York.

11. 10-minute consultation : hypertension, edited by Morris Brown, et al., Cedilla Publishing,
2013. ProQuest Ebook Central,
http://ebookcentral.proquest.com/lib/edgehill/detail.action?docID=1696049.
Created from edgehill on 2018-01-17 16:28:53
Arbitrary definitions of hypertension Category
◦ Optimal SBP (mmHg) <120 and DBP (mmHg) <80
◦ Normal SBP (mmHg) 120 – 129 and/or DBP (mmHg) 80 – 84
◦ High-normal SBP (mmHg) 130– 139 and/or DBP (mmHg) 85– 89
◦ Hypertension, Grade 1 (mild) SBP (mmHg) 140– 159 and/or DBP (mmHg) 90– 99
◦ Hypertension, Grade 2 (moderate) SBP (mmHg) 160– 179 and/or DBP (mmHg) 100– 109
◦ Hypertension, Grade 3 (severe) SBP (mmHg) ≥180 and/or DBP (mmHg) ≥110
◦ Isolated Systolic Hypertension SBP (mmHg) ≥140 and DBP (mmHg) <90
DBP, diastolic blood pressure; SBP, systolic blood pressure.

12. 10-minute consultation : hypertension, edited by Morris Brown, et al., Cedilla Publishing,
2013. ProQuest Ebook Central,
http://ebookcentral.proquest.com/lib/edgehill/detail.action?docID=1696049.
Created from edgehill on 2018-01-17 16:46:07.
◦ “Acute severe hypertension i.e.
◦ SBP >180 mmHg or a DBP >120 mmHg
◦ is known as a ‘hypertensive crisis’, for which treatment to
safely reduce BP should be considered as an emergency or
urgency, depending on the degree of BP elevation and
presence or absence, respectively, of target-organ damage
(CV, neurological, retinal and renal symptoms)”

13. Diagnosis
◦ One high reading does not mean you have high blood pressure.
◦ It is necessary to measure your blood pressure at different times, while you are resting comfortably
for at least five minutes. To make the diagnosis of hypertension, at least three readings that are
elevated are usually required. 2017
◦ medical history and physical examination.
◦ routine tests, such as a urine test (urinalysis), blood tests, a cholesterol test and an electrocardiogram
— a test that measures your heart's electrical activity.
◦ What is the rationale for these tests?
◦ What is the role of the nurse
◦ https://www.nice.org.uk/guidance/cg127/chapter/1-guidance

14. Who is effected by hypertension?
◦ NOTE That Abnormally high blood pressure (hypertension) may be associated with disease or it
may occur without an apparent cause.
◦ 16 million people in the UK have high blood pressure.
◦ 31.5% men and 29% women (>16yrs) have hypertension
◦ 15% adults are currently being treated for hypertension
◦ Up to the age of 64 there are higher rates of men with high blood pressure than women
◦ Approximately 62,000 unnecessary deaths from stroke and heart attacks occur due to poor
blood pressure control
◦ Taken from DH 2011

15. What are to health determinants?
Main risk factors for developing hypertension (WHO 2013)
◦ Although prevalence varies in different countries, in the UK up to 40% of the general population
have hypertension, the disease becoming more prevalent with age (it is estimated that 75% of
75 year olds have hypertension).(2013)
◦ Can you list other determinants that can increase risk of hypertension ?
◦ What about Poor BP recording!!!
◦ Brown, M. 2013, The 10-minute consultation: hypertension, 1st edn, Cedilla Publishing Limited,
London, [England].

16. Global Picture (2008)
◦ About
◦ one billion people are suffering from hypertension globally and the prevalence rate will increase
up to1.56 billion by 2025.2
◦ It is reported that consistent high blood pressure is damaging the health of almost 25% of
youngsters of both sexes.3
◦ The alarming point is that more than 50% hypertensive patients do not even know that they are
suffering from it.
◦ Chockalingam A. World hypertension day and global awareness. Canadian J Cardiol. 2008;24(6):441-444.doi:10.1016/S0828-
282X(08)70617-2

17. Effects of Exercise on Hypertension : From Cells to Physiological Systems, edited by
Linda S. Pescatello, Humana Press, 2015. ProQuest Ebook Central,
http://ebookcentral.proquest.com/lib/edgehill/detail.action?docID=3567578.
Created from edgehill on 2018-01-17 16:13:16.
◦ “During bouts of acute exercise, blood pressure rises. Paradoxically, high levels of chronic
physical activity and aerobic exercise training can prevent some of the age associated rise in
blood pressure seen in many normal humans, and exercise training can also lower blood
pressure in those with hypertension. The rise in blood pressure with acute exercise is driven via
neural signals known as central command acting in concert with baroreceptor resetting and
feedback from skeletal muscle afferents. Together, these signals reduce the activity of the
parasympathetic nervous system and increase the activity of the sympathetic nervous system.
These adjustments cause the increase in heart rate and ultimately cardiac output, and also
vasoconstriction in many vascular beds. The targets of these neural adjustments also offer clues
about the long-protective effects of physical activity and exercise training on blood pressure.
Likewise the vasodilation in active skeletal muscles and increases in blood flow might offer clues
about long-term adaptations that favor vascular health and reductions in peripheral resistance.”

18. High blood pressure is the UK's biggest
silent killer
◦ Professor Graham MacGregor, Chairman at Blood Pressure UK, (2015) said:
◦ 'Over half of the estimated 16 million people in the UK living with high blood pressure are
unaware they have the condition, as it is symptomless. The only way to ‘Know Your Numbers' is
to have a blood pressure test at one of our free Pressure Stations in your area, your GP, local
pharmacy, or by using a home blood pressure monitor.'
◦ High blood pressure is the UK's biggest silent killer, responsible for 60% of strokes and 40% of
heart attacks. High blood pressure is also a risk factor for kidney disease and dementia.
Volunteers hosting the ‘Pressure Stations' provide information and advice on simple steps to
keep blood pressure under control.

19. The Role of the Nurse
Detection Control
Opportunistic halves risk of death from stroke
Systematic and CHD
Targeted
Decisions about treating hypertension must focus upon not just Blood Pressure but overall
cardiovascular risk
http://www.nursinginpractice.com/article/managing-hypertension-primary-care-settings-
application-nice-guidelines
https://pathways.nice.org.uk/pathways/hypertension/hypertension-overview

20. Role of the nurse
◦ There are clear indications for incidence and prevalence and the role of the nurse is to
determine the data, analyse or interpret the findings and follow guidelines that link directly to
their practice population.
◦ By supporting individuals and communities make lifestyle changes, can help lower blood
pressure and reduce your risk of heart disease. (DH 2013)
◦ Evidence Based Practice (is it proved to work or is it theory trial and error)
◦ Information Prescription ( at all opportunities)

21. Strategies to promote self care
◦Reflecting on the risk factors list 4 strategies that
are available to support patients with
hypertension mange their conditions
◦List 4 strategies that are adopted by nursing in
order to reduce the risk of people developing
hypertension. Think of lifestyle changes

22. Strategies Available
◦ https://www.nice.org.uk/guidance/cg127/chapter/1-guidance
◦ Medication anti hypertensive
◦ Secondary Health Promotion approaches Monitoring BP
◦ Management of Kidney Disease
◦ Lip, G.Y.H. & Nadar, S. 2015, Hypertension, Second edn, Oxford University Press, Oxford.
◦ Primary Health Promotion Lifestyle Changes Campaigns
◦ Quit Smoking (Smoking Cessation)
◦ Undertake Exercise (Exercise Prescription)
◦ Control weight through a healthy diet (Salt intake)

23. References
http://www.nursinginpractice.com/article/managing-hypertension-
primary-care-settings-application-nice-guidelines
https://pathways.nice.org.uk/pathways/hypertension/hypertension-
overview
◦ Department of Health (2010) Healthy Lives Healthy People. London. HMSO
◦ Department of Health (2011) Health Survey for England. London DH
◦ Department of Health (2014) Health Survey for England. London. DH
Faculty of Public Health (2005) Hypertension – the silent killer. London. FPH
◦ National Institution for Health and Care Excellence (2011) Hypertension in
adults: diagnosis and management. http://www.nice.org.uk/guidance/CG127
◦ World Health Organisation (2013) Global Brief on Hypertension. Genever.
WHO
◦ Mancia, G. 2015;2014;, White coat hypertension: an unresolved diagnostic and
therapeutic problem, 2015th edn, Springer, New York.
◦ Brown, M. 2013, The 10-minute consultation: hypertension, 1st edn, Cedilla
Publishing Limited, London, [England].
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