HYPERTENSION

Blood pressure is determined by the amount of blood your heart

pumps and the
amount of resistance to blood flow in your arteries. The more blood your
heart pumps
and the narrower your arteries, the higher your blood pressure. Hypertension
(HTN) or high blood pressure is a chronic medical condition in which the
systemic arterial blood pressure is elevated.

Risk factors
High blood pressure has many risk factors. High blood pressure risk factors
include:

• Age. The risk of high blood pressure increases as you age. Through
early middle age, high blood pressure is more common in men. Women
are more likely to develop high blood pressure after menopause.

• Race. High blood pressure is particularly common among blacks, often

developing at an earlier age than it does in whites. Serious
complications, such as stroke and heart attack, also are more common
in blacks.

• Family history. High blood pressure tends to run in families.

• Being overweight or obese. The more you weigh, the more blood you
need to supply oxygen and nutrients to your tissues. As the volume of
blood circulated
through your blood vessels increases, so does the pressure on your
artery
walls.

• Not being physically active. People who are inactive tend to have
higher heart rates. The higher your heart rate, the harder your heart
must work with
each contraction — and the stronger the force on your arteries. Lack of
physical activity also increases the risk of being overweight.

• Using tobacco. Not only does smoking tobacco immediately raise your
blood pressure temporarily, but the chemicals in tobacco can damage
the lining of
your artery walls. This can cause your arteries to narrow, increasing
your
blood pressure.
 • Too much salt (sodium) in your diet. Too much sodium in your diet can
cause your body to retain fluid, which increases blood pressure.

• Too little potassium in your diet. Potassium helps balance the amount
of sodium in your cells. If you don't consume or retain enough
potassium, you may accumulate too much sodium in your blood.

• Too little vitamin D in your diet. It's uncertain if having too little vitamin
D in your diet can lead to high blood pressure. Researchers think
vitamin D may
affect an enzyme produced by your kidneys that affects your blood
pressure.
More studies are necessary to determine vitamin D's role in blood
pressure.

• Drinking too much alcohol. Over time, heavy drinking can damage your
heart. Having more than two or three drinks in a sitting can also
temporarily raise your blood pressure, as it may cause your body to
release hormones that increase your blood flow and heart rate.

• Stress. High levels of stress can lead to a temporary, but dramatic,

increase in blood pressure. If you try to relax by eating more, using
tobacco or drinking alcohol, you may only increase problems with high
blood pressure.

• Certain chronic conditions. Certain chronic conditions also may

increase your risk of high blood pressure, including high cholesterol,
diabetes, kidney disease and sleep apnea.

• Sometimes pregnancy contributes to high blood pressure, as well.

Causes
There are two types of high blood pressure.
Primary (essential) hypertension
In 90 to 95 percent of high blood pressure cases in adults,
there's no identifiable cause. This type of high blood pressure, called
essential hypertension or primary hypertension, tends to develop
gradually over many years.
Secondary hypertension
The other 5 to 10 percent of high blood pressure cases are
caused by an underlying condition. This type of high blood pressure,
called secondary hypertension, tends to appear suddenly and cause
higher blood pressure than does primary hypertension. Various
conditions and medications can lead to secondary hypertension,
including:
• Kidney abnormalities
 • Tumors of the adrenal gland
• Certain congenital heart defects
• Certain medications, such as birth control pills, cold remedies,
decongestant over-the-counter pain relievers and some
prescription drugs
• Illegal drugs, such as cocaine and amphetamines

Symptoms
Uncomplicated high blood pressure usually occurs without any
symptoms (silently) and so hypertension has been labeled "the silent killer."
It is called this because the disease can progress to finally develop any one
or more of the several potentially fatal complications of hypertension such as
heart attacks or strokes. Uncomplicated hypertension may be present and
remain unnoticed for many years, or even decades. This happens when there
are no symptoms, and those affected fail to undergo periodic blood pressure
screening.
Some people with uncomplicated hypertension, however, may experience
symptoms such as headache, dizziness, shortness of breath, and blurred
vision. The presence of symptoms can be a good thing in that they can
prompt people to consult a doctor for treatment and make them more
compliant in taking their medications. Often, however, a person's first
contact with a physician may be after significant damage to the end-organs
has occurred. In many cases, a person visits or is brought to the doctor or an
emergency room with a heart attack, stroke, kidney failure, or impaired
vision (due to damage to the back part of the retina). Greater public
awareness and frequent blood pressure screening may help to identify
patients with undiagnosed high blood pressure before significant
complications have developed.

Treatment
The goal of treatment is to reduce blood pressure so that you have a lower
risk of complications. You and your health care provider should set a blood
pressure goal for you.

There are many different medicines that can be used to treat high blood
pressure, including:

• Alpha blockers
• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin receptor blockers (ARBs)
 • Beta blockers
• Calcium channel blockers
• Central alpha agonists
• Diuretics
• Renin inhibitors, including aliskiren (Tekturna)
• Vasodilators

Your health care provider may also tell you to exercise, lose weight, and
follow a healthier diet. If you have pre-hypertension, your health care
provider will recommend the same lifestyle changes to bring your blood
pressure down to a normal range.

Often, a single blood pressure drug may not be enough to control your blood
pressure, and you may need to take two or more drugs. It is very important
that you take the medications prescribed to you. If you have side effects,
your health care provider can substitute a different medication.

In addition to taking medicine, you can do many things to help control your
blood pressure, including:

• Eat a heart-healthy diet, including potassium and fiber, and drink

plenty of water.
• Exercise regularly -- at least 30 minutes a day.
• If you smoke, quit -- find a program that will help you stop.
• Limit how much alcohol you drink -- 1 drink a day for women, 2 a day
for men.
• Limit the amount of sodium (salt) you eat -- aim for less than 1,500 mg
per day.
• Reduce stress -- try to avoid things that cause stress for you. You can
also try meditation or yoga.
• Stay at a healthy body weight -- find a weight-loss program to help
you, if you need it.

Your health care provider can help you find programs for losing weight,
stopping smoking, and exercising. You can also get a referral from your
doctor to a dietitian, who can help you plan a diet that is healthy for you.

Your health care provider may ask you to keep track of your blood pressure
at home. Make sure you get a good quality, well-fitting home device. It will
probably have a cuff with a stethoscope or a digital readout. Practice with
your health care provider or nurse to make sure you are taking your blood
pressure correctly.

Nursing Management
Nursing Assessment
Nursing History
• Family history of high Blood Pressure
• Previous episodes of high Blood Pressure
• Dietary habits and salt intake
• Target organ disease or other disease processes that may place the
patient in a high-risk group diabetes, CAD, kidney disease
• Cigarette smoking
• Episodes of headache, weakness, muscle cramp, tingling, palpitations,
sweating, vision disturbances
• Medication that could elevate Blood Pressure:
o Hormonal contraceptives, steroids
o NSAIDs
o Nasal decongestants, appetite suppressants, tricyclic
antidepressants
• Other disease processes, such as gout, migraines, asthma, heart
failure, and benign prostatic hyperplasia, which may be helped or worsened
by particular hypertension drugs.
Physical Examination
• Auscultate heart rate and palpate peripheral pulses; determine
respirations.
• If skilled in doing so, perform funduscopic examination of the eyes for
the purpose of noting vascular changes. Look for edema, spasm, and
hemorrhage of the eye vessels. Refer to ophthalmologist for definitive
diagnosis.
• Examine the heart for a shift of the point of maximal impulse to the
left, which occurs in heart enlargement.
• Auscultate for bruits over peripheral arteries to determine the
presence of atherosclerosis, which may be manifested as obstructed blood
flow.
• Determine mentation status by asking patient about memory, ability to
concentrate, and ability to perform simple mathematical calculations.
• Blood Pressure Determination, Auscultate and record precisely the
systolic and diastolic.

Nursing Diagnoses
Common nursing diagnosis found in patient with hypertension
• Deficient Knowledge regarding the relationship between the treatment
regimen and control of the disease process
• Ineffective Therapeutic Regimen Management related to
medication adverse effects and difficult lifestyle adjustments
• Deficient knowledge (lifestyle modifications)
• Fatigue
• Ineffective coping
• Ineffective tissue perfusion: Cardiopulmonary
• Noncompliance: Therapeutic regimen
• Risk for injury