Allan Lester V.

Medina

BSN IV-1 2060019

Medical Centrum Dagupan

Primary and Secondary Hypertension

I. Primary Hypertension
a. Definition: Is the form of hypertension that by definition has no identifiable
cause.
b. Epidemiology: 95% of HPN clients

c. Synonym: Essential Hypertension; Idiopathic Hypertension

d. Risk Factors: Idiopathic, Genetic/Hereditary, Race, Gender,

Environmental, Age, Lifestyle, Na+ sensitivity, Medicine

e. Signs and Symptoms:

none, headache, dizziness, blurred vision, nausea and vomiting, chest pain,
shortness of breath, fatigue, confusion, anxiety, perspiration, pale or red skin

f. Classification:

Classification Systolic Diastolic

Normal 90-119 60-79
Prehypertension 120-139 81-89
Hypertension
*Stage 1 140-159 90-99
*Stage 2 ≥160 ≥100
Isolated Systolic >140 <90
Hypertension

Note: Isolated Systolic Hypertension

Risk: Age

Result: L ventricular hypertrophy, coronary ischemia, heart failure

g. Diagnosis:

 Confirmation of hypertension is based on the initial visit, plus two

follow-up visits with at least two blood pressure measures at each
visit.
  Standardized blood pressure measurement techniques (including
out-of-office or home blood pressure measurements) should be
employed when confirming an initially elevated blood pressure and
for all subsequent measures during follow-up and treatment for
hypertension.
 Systolic blood pressure level should be the major factor for the
detection, evaluation and treatment of hypertension, especially in
adults 50 years and older.

f. Nursing Management:

 Identify appropriate food choices. (DASH DIET)

 Express that he has more energy.
 Demonstrate adaptive coping behaviors.
 Maintain adequate cardiac output and hemodynamic stability.
 Comply with his therapy regimen.
 Remain free from complications
 Teach how to use a blood pressure apparatus and to record results
and also medications used.
 To encourage compliance with antihypertensive therapy, suggest
establishing a daily routine for taking medication. Warn the patient
that uncontrolled hypertension may cause stroke and heart attack.
tell him to verbalize any adverse effects.
 Help the patient examine and modify his lifestyle behavior.
 Stress reduction
 Lifestyle changes can help bring your blood pressure down. This
includes regular exercise, including weight loss if you are
overweight. You should follow a low fat diet rich in fish, chicken,
whole grains, fruits and vegetables, and eat lower amounts of red
meat and salt.
 Do not smoke. If you have diabetes, make sure you keep your
blood sugars under control.
 Many different medicines are used to control blood pressure. Some
of them are listed below.
o Angiotensin converting enzyme (ACE) inhibitors
o Angiotensin receptor blockers (ARBs)
o Beta-blockers
o Calcium channel blockers
o Direct renin inhibitors, including aliskiren (Tekturna)
o Diuretics
 o Vasodilators

II. Secondary Hypertension

a. Definition: is a type of hypertension which by definition is caused by an

identifiable underlying secondary cause

b. Epidemiology: 5% of HPN clients

c. Synonym: Inessential Hypertension

d. Risk Factors: Endocrine diseases, Kidney diseases, tumors, drug side

effects

e. Signs and symptoms: none, headache, dizziness, blurred vision, nausea

and vomiting, chest pain, shortness of breath, fatigue, confusion, anxiety,
perspiration, pale or red skin
f. Types:
 Renovascular hypertension
o It has two main causes: fibromuscular dysplasia and
atheromatous stenosis.
 Hypertension secondary to other renal disorders
o Chronic renal failure
o Kidney disease / renal artery stenosis: the normal
physiological response to low blood pressure in the renal
arteries is to increase cardiac output (CO) to maintain the
pressure needed for glomerular filtration. Here, however,
increased CO cannot solve the structural problems causing
renal artery hypotension, with the result that CO remains
chronically elevated.
o Renal segmental hypoplasia (Ask-Upmark kidney)
o Hypertension secondary to endocrine disorders
o Pheochromocytoma - caused by an excessive secretion of
norepinephrine and epinephrine which promotes
vasoconstriction
o Hyperaldosteronism (Conn's syndrome) - idiopathic
hyperaldosteronism, liddle's syndrome (also called
pseudoaldosteronism), glucocorticoid remediable
aldosteronism
 o Cushing's syndrome - an excessive secretion of
glucocorticoids causes the hypertension
o Hyperparathyroidism
o Acromegaly
o Hyperthyroidism
o Hypothyroidism
 Other secondary hypertension
o Hormonal contraceptives
o Neurologic disorders
o Obstructive sleep apnea
o Pregnancy: unclear etiology.
o Cancers: tumors in the kidney can operate in the same way
as kidney disease. More commonly, however, tumors cause
inessential hypertension by ectopic secretion of hormones
involved in normal physiological control of blood pressure.
o Drugs: In particular, alcohol, nasal decongestants with
adrenergic effects, NSAIDs, MAOIs, adrenoceptor
stimulants, and combined methods of hormonal
contraception (those containing ethinyl-estradiol) can cause
hypertension while in use.
o Heavy alcohol use
o Steroid use
o Malformed aorta, slow pulse, ischemia: these cause reduced
blood flow to the renal arteries, with physiological responses
as already outlined.
o Aortic valve disease: unclear etiology.
o Coarcation of the aorta
o Atherosclerosis
o Anemia: unclear etiology.
o Fever: unclear etiology.
o White coat hypertension, that is, elevated blood pressure in
a clinical setting but not in other settings, probably due to the
anxiety some people experience during a clinic visit.
o Perioperative hypertension is development of hypertension
just before, during or after surgery. It may occur before
surgery during the induction of anesthesia; intraoperatively
e.g. by pain-induced sympathetic nervous system
stimulation; in the early postanesthesia period, e.g. by pain-
induced sympathetic stimulation, hypothermia, hypoxia, or
 hypervolemia from excessive intraoperative fluid therapy;
and in the 24 to 48 hours after the postoperativ period as
fluid is mobilized from the extravascular space. In addition,
hypertension may develop perioperatively because of
discontinuation of long-term antihypertensive medication.
g. Diagnosis:
 Hypertension is generally diagnosed on the basis of a persistently
high blood pressure. Usually this requires three separate
sphygmomanometer measurements at least one week apart.
 Initial assessment of the hypertensive patient should include a
complete history and physical examination. Exceptionally, if the
elevation is extreme, or if symptoms of organ damage are present
then the diagnosis may be given and treatment started
immediately.
 Once the diagnosis of hypertension has been made, physicians will
attempt to identify the underlying cause based on risk factors and
other symptoms, if present. Secondary hypertension is more
common in preadolescent children, with most cases caused by
renal disease. Primary or essential hypertension is more common
in adolescents and has multiple risk factors, including obesity and a
family history of hypertension
 Laboratory tests can also be performed to identify possible causes
of secondary hypertension, and determine if hypertension has
caused damage to the heart, eyes, and kidneys. Additional tests for
Diabetes and high cholesterol levels are also usually performed
because they are additional risk factors for the development of
heart disease require treatment.

h. Nursing Management:
 Identify appropriate food choices. (DASH DIET)
 Express that he has more energy.
 Demonstrate adaptive coping behaviors.
 Maintain adequate cardiac output and hemodynamic stability.
 Comply with his therapy regimen.
 Remain free from complications
 Teach how to use a blood pressure apparatus and to record results
and also medications used.
 To encourage compliance with antihypertensive therapy, suggest
establishing a daily routine for taking medication. Warn the patient
 that uncontrolled hypertension may cause stroke and heart attack.
tell him to verbalize any adverse effects.
 Help the patient examine and modify his lifestyle behavior.
 Stress reduction
 Lifestyle changes can help bring your blood pressure down. This
includes regular exercise, including weight loss if you are
overweight. You should follow a low fat diet rich in fish, chicken,
whole grains, fruits and vegetables, and eat lower amounts of red
meat and salt.
 Do not smoke. If you have diabetes, make sure you keep your
blood sugars under control.
 Many different medicines are used to control blood pressure. Some
of them are listed below.
o Angiotensin converting enzyme (ACE) inhibitors
o Angiotensin receptor blockers (ARBs)
o Beta-blockers
o Calcium channel blockers
o Direct renin inhibitors, including aliskiren (Tekturna)
o Diuretics
o Vasodilators

 Safety
 ROM
 Positioning
 Monitor V.S.
 Change modifiable risk factors
 Support vital function
 Emotional support
 Assistance ADL
 Drugs