1. Hypertension “ the silent killer ”

2. On completion of this chapter, the learner will be able to:  Define blood pressure and identify risk factors for hypertension.  Explain the difference between normal blood pressure and hypertension and discuss the significance of hypertension.  Describe the treatment approach for hypertension, including lifestyle changes and medication therapy.  Use the nursing process as a framework for care of the patient with hypertension.  Describe the necessity for immediate treatment of hypertensive crisis.

3. Introduction: BP: The force of blood against the wall of the arteries. BP: The force of blood against the wall of the arteries. 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. 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.

4. Blood Pressure = Cardiac Output XPeripheral Vascular Resistance. BP = CO X TPR BP = CO X TPR HR X SV HR X SV

5. Definition of Hypertension: HT : is a systolic blood pressure greater than 140 mmHg and a diastolic pressure greater than 90 mm Hg. HT : is a systolic blood pressure greater than 140 mmHg and a diastolic pressure greater than 90 mm Hg.

7. Types of Hypertension: primary hypertension. primary hypertension. Secondary hypertension. Secondary hypertension.

8.  primary hypertension: which refers to high blood pressure for which no medical cause can be found. (About 90 – 95%). which refers to high blood pressure for which no medical cause can be found. (About 90 – 95%).  Secondary hypertension: related to specific causes, such as narrowing of the renal arteries, kidney abnormalities, rare tumors, certain medications, pregnancy, and stenosis of the aorta, (5 – 10%). related to specific causes, such as narrowing of the renal arteries, kidney abnormalities, rare tumors, certain medications, pregnancy, and stenosis of the aorta, (5 – 10%).

9. High blood pressure can be viewed in three ways: as a sign, a risk factor for atherosclerotic cardiovascular disease, or a disease. High blood pressure can be viewed in three ways: as a sign, a risk factor for atherosclerotic cardiovascular disease, or a disease.

10. As a sign, nurses and other health care professionals use blood pressure to monitor a patient ’ s clinical status. Elevated pressure may indicate an excessive dose of vasoconstrictive medication or other problems. As a risk factor, hypertension contributes to the rate at which atherosclerotic plaque accumulates within arterial walls. As a disease, hypertension is a major contributor to death from cardiac, renal, and peripheral vascular disease. As a sign, nurses and other health care professionals use blood pressure to monitor a patient ’ s clinical status. Elevated pressure may indicate an excessive dose of vasoconstrictive medication or other problems. As a risk factor, hypertension contributes to the rate at which atherosclerotic plaque accumulates within arterial walls. As a disease, hypertension is a major contributor to death from cardiac, renal, and peripheral vascular disease.

11. Pathophysiology : Several hypotheses about the pathophysiologic bases of elevated blood pressure are associated with the concept of hypertension as a multifactorial condition. Given the overlap among these hypotheses, it is likely that aspects of all of them will eventually prove correct. Hypertension may be caused by one or more of the following: Several hypotheses about the pathophysiologic bases of elevated blood pressure are associated with the concept of hypertension as a multifactorial condition. Given the overlap among these hypotheses, it is likely that aspects of all of them will eventually prove correct. Hypertension may be caused by one or more of the following:

12.  Increased sympathetic nervous system activity related to dysfunction of the autonomic nervous system.  Increased renal reabsorption of sodium, chloride, and water related to a genetic variation in the pathways by which the kidneys handle sodium.  An overactive Renin-angiotensin system leads to vasoconstriction and retention of sodium and water. The increase in blood volume plus vasoconstriction leads to hypertension.  Decreased vasodilation of the arterioles related to dysfunction of the vascular endothelium.  Resistance to insulin action, which may be a common factor linking hypertension, type 2 diabetes mellitus, hypertriglyceridemia, obesity.

13. Risk Factors for HBP: Tobacco, alcohol, caffeine. Tobacco, alcohol, caffeine. Obesity/Overweight. Obesity/Overweight. Oral Contraceptives. Oral Contraceptives. Stress. Stress. Lack of exercise. Lack of exercise. Poor Diet, Such as increased salt intake. Poor Diet, Such as increased salt intake. Aging- vessels lose elasticity (> 60 yrs age). Aging- vessels lose elasticity (> 60 yrs age). Heredity. Heredity. Race. Race.

14. Clinical Manifestations : No symptoms - many people are unaware they have hypertension until it is accidentally found at a doctor visit or they develop complications of hypertension. No symptoms - many people are unaware they have hypertension until it is accidentally found at a doctor visit or they develop complications of hypertension. Non-specific symptoms - symptoms of hypertension may be mild and vague: Non-specific symptoms - symptoms of hypertension may be mild and vague: Headache, Morning headache, Dizziness, Confusion, Papilloedema, Fatigue, Shortness of breath, Convulsion Headache, Morning headache, Dizziness, Confusion, Papilloedema, Fatigue, Shortness of breath, Convulsion Changes in vision, Nausea, Vomiting, Anxiety, Increased sweating, Nose bleeds, dizziness, weakness, hemiplegia. Changes in vision, Nausea, Vomiting, Anxiety, Increased sweating, Nose bleeds, dizziness, weakness, hemiplegia.

15. Assessment and Diagnostic Evaluation : Routine laboratory tests include urinalysis, blood chemistry (ie, analysis of sodium, potassium, creatinine, BUN, fasting glucose, and total and high-density lipoprotein [HDL] cholesterol levels), and a 12-lead electrocardiogram. Left ventricular hypertrophy can be assessed by echocardiography. Routine laboratory tests include urinalysis, blood chemistry (ie, analysis of sodium, potassium, creatinine, BUN, fasting glucose, and total and high-density lipoprotein [HDL] cholesterol levels), and a 12-lead electrocardiogram. Left ventricular hypertrophy can be assessed by echocardiography. CBC used to identify potential renal failure. CBC used to identify potential renal failure. Chest x-ray, shows any enlargement of the heart Chest x-ray, shows any enlargement of the heart and pulmonary vein, presence of pulmonary edema or pleural effusion

16. Management : Lifestyle Modifications for Hypertension Prevention and Management. Lifestyle Modifications for Hypertension Prevention and Management. PHARMACOLOGIC THERAPY. PHARMACOLOGIC THERAPY.

17. 1)- Lifestyle Modifications: Lose weight if overweight. Lose weight if overweight. Limit alcohol intake. Limit alcohol intake. Increase aerobic physical activity (30 to 45 minutes most days of the week). Increase aerobic physical activity (30 to 45 minutes most days of the week). Reduce sodium intake Reduce sodium intake Maintain adequate intake of dietary potassium Maintain adequate intake of dietary potassium Maintain adequate intake of dietary calcium and magnesium for general health. Maintain adequate intake of dietary calcium and magnesium for general health. Stop smoking and reduce intake of dietary saturated fat and cholesterol for overall cardiovascular health. Stop smoking and reduce intake of dietary saturated fat and cholesterol for overall cardiovascular health.

18. 2)PHARMACOLOGIC THERAPY: Diuretics. Diuretics. Calcium channel blocker. Calcium channel blocker. Angiotensin converting enzyme inhibitirs (ACE-I). Angiotensin converting enzyme inhibitirs (ACE-I). Vasodilators. Vasodilators.

19. Diuretics: Diuretics: spironolactone (Aldactone). spironolactone (Aldactone). Thiazide. Thiazide. furosemide (Lasix). furosemide (Lasix). to promote diuresis and block reabsorption of sodium and water in the kidney. to promote diuresis and block reabsorption of sodium and water in the kidney.

20. Calcium channel blocker(CCB): Calcium channel blocker(CCB): Nifedipin Nifedipin Amlodipine Amlodipine Verapamil Verapamil to produce vasodilation on vascular to produce vasodilation on vascular smooth muscle

21. ACE – Inhibitors: ACE – Inhibitors: Enalapril Enalapril Captopril. Captopril. Block the enzyme that converts angiotensin I to angiotensin II ( a vasoconstrictor) Block the enzyme that converts angiotensin I to angiotensin II ( a vasoconstrictor) Promote vasodilatation Promote vasodilatation Lowers aldosterone secretion Lowers aldosterone secretion

22. Vasodilators: Vasodilators: Hydralazine Hydralazine Minoxidil Minoxidil Sodium nitroprusside Sodium nitroprusside to relax smooth muscle of arterioles and reduce peripheral vascular to relax smooth muscle of arterioles and reduce peripheral vascular resistance and thus, blood pressure. resistance and thus, blood pressure.

23. NURSING Diagnosis: Risk for decreased cardiac output. Risk for decreased cardiac output. Related to: vasoconstriction, increased preload, increased afterload, ventricular hypertrophy, ischemia

24. Risk for altered tissue perfusion. Risk for altered tissue perfusion. Related to: increased blood pressure, decreased cardiac output.

25. Anxiety. Anxiety. Deficient knowledge. Deficient knowledge. Noncompliance with therapeutic. Noncompliance with therapeutic.