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HYPERTENSION

Hypertension is having a blood pressure higher than 140 over 90 mmHg, a


definition shared by all the medical guidelines.
This means the systolic reading (the pressure as the heart pumps blood
around the body) is over 140 mmHg (millimeters of mercury) or the diastolic
reading (as the heart relaxes and refills with blood) is over 90 mmHg.
Blood Pressure Classification

Normal blood pressure is below 120 systolic and below 80 diastolic

Prehypertension is 120-139 systolic or 80-89 diastolic

Stage 1 high blood pressure (hypertension) is 140-159 systolic or 90-99


diastolic

Stage 2 high blood pressure (hypertension) is 160 or higher systolic or 100


or higher diastolic

Hypertensive crisis (a medical emergency) is when blood pressure is


above 180 systolic or above 110 diastolic.

Symptoms and Signs


Blood in the Urine.
Blurred Vision.
Chest Pain.
Decreased Urine Output.
Dizziness.
Headache.
Leg Swelling.
Nosebleeds.
Classification of Hypertension

Primary (Essential) Hypertension


-

Elevated BP with unknown cause


90% to 95% of all cases

Secondary Hypertension
-

Elevated BP with a specific cause


5% to 10% in adults

Risk Factors for Primary Hypertension


Age (> 55 for men; > 65 for women)
Alcohol
Cigarette smoking
Diabetes mellitus
Elevated serum lipids
Excess dietary sodium
Gender
Family history
Obesity (BMI > 30)
Ethnicity (African Americans)
Sedentary lifestyle
Socioeconomic status
Stress
Clinical Manifestations
Frequently asymptomatic until severe and target organ disease has
occurred
- Fatigue, reduced activity tolerance
- Dizziness
- Palpitations, angina
- Dyspnea
Hypertension: Complications

Complications are primarily related to development of atherosclerosis


(hardening of arteries), or fatty deposits that harden with age. The
common complications are target organ diseases occurring in the
-

Heart
Brain
Kidney
Eyes

Hypertension Collaborative Care


Lifestyle Modifications
- Weight reduction
- Dietary changes (DASH diet)
- Limitation of alcohol intake (< 2 drinks/day for men < 1/day for
women)
- Regular physical activity
- Avoidance of tobacco use

- Stress management
Drug Therapy
- Diuretics
- Adrenergic inhibitors
- - Adrenergic blockers
- ACE Inhibitors
- Calcium channel blockers
Drug Therapy and Patient Teaching
- Identify, report, and minimize side effects
- Orthostatic hypotension
- Sexual dysfunction
- Dry mouth
- Frequent urination

Treatment Goals
Goal is to reduce overall cardiovascular risk factors and control BP by the
least intrusive means possible
- BP < 140/90
- In patients with diabetes or renal disease, goal is < 130/80
Nursing Management
- Health Promotion
- Individual patient evaluation
- Screening programs
- Cardiovascular risk factor modification