Hypertension: 1. Systolic and Diastolic Hypertension

HYPERTENSION PHINMA-UPANG
Prof: Leonardo R. Sanchez IV, RN CHS Batch 2024

Adapted from: PowerPoint/Lecture NUR 155 (MS LEC)
Transcribed by: Julia Rae Delos Santos (3BSN-12) August 30, 2022
HYPERTENSION Risk Factors:
- Sustained, elevated, systemic, arterial blood Non-modifiable

pressure; diastolic elevation more serious,
• Family History
reflecting pressure on arterial wall during
resting phase of cardiac cycle • Age
- Persistent elevation of blood pressure for 2 or • Sex
more consecutive readings • Ethnic group
Classifications (according to type and degree of severity) Modifiable
1. Systolic and Diastolic Hypertension • Stress

a. Systolic HPN is systolic BP of 140 mmHg or • Obesity
higher • Diet
b. Diastolic HPN is diastolic BP of 90 mmHg or • Sedentary lifestyle
higher • Substance/Drug Use:
2. Primary and Secondary HPN Cigarette Smoking
a. Primary/Essential/Idiopathic HPN – occurs Alcohol
in 90-95% of patients; etiology unknown; Birth Control Pills
diastolic pressure is ≥90 mmHg, and other Caffeine
causes of hypertension are absent
Pathophysiology
b. Secondary HPN – occurs in remaining 5-10%
usually of renal, endocrine, neurogenic or
cardiac in origin
3. “White-Coat” Hypertension – HPN in a person
who is actually normotensive except when
his/her BP is measured by a healthcare
professional
4. Malignant Hypertension – Uncontrollable and
may arise from both types and certain drugs
(e.g., anesthesia)
5. Labile (prehypertension) – a fluctuating blood
pressure increases during stress, otherwise
normal or near normal
Systolic Diastolic
(mmHg) (mmHg)
Normal <120 <80
PreHPN 120-139 80-89
Stage I 140-159 90-99
Stage II ≥160 ≥100
ANTIHYPERTENSIVE DRUGS
1. Alpha-adrenergic Blockers
- Action: decreases peripheral vascular
resistance; relaxes smooth muscle of
bladder/prostate
- Drugs: Medications that end in SIN (e.g.
Alfuzosin, Doxazosin, Prazosin, Tamsulosin,
Terazosin, Silodosin)
2. Central Alpha Agonists
- Action: decrease the release of adrenergic
hormones from the brain (medulla oblongata)
which decreases peripheral vascular resistance
and reduces cardiac contractility
- Drugs: Clonidine (Catapress); Guanabenz
(Wytesin); Methyldopa (Aldomet)
Consideration: Take last dose of the day at
bedtime to minimize drowsiness during the day
Clinical Manifestations
3. Beta-Adrenergic Blockers
Subjective: - Action: these drugs exert antihypertensive
effects by:
• Headache ▪ Reducing contractility
• Lightheadedness ▪ Reducing release of renin
• Tinnitus ▪ Reducing the cardiac output
• Easy fatigability - Drugs: medications that end in OLOL (e.g.,
• Visual disturbances Metropolol, Propanolol, Nadolol)
• Palpitations 4. Vasodilators
• Brief lapses in memory - Action: Direct relaxation of vascular smooth
muscle
Objective:
- Drugs: Hydralazine (Apresoline); Nitrprusside
• BP greater than 140/90 Considerations:
• Retinal changes ▪ Assess for peripheral edema of the
• Possible hematuria hands and feet
• Cardiac hypertrophy ▪ Take with food
▪ Review of BP
Medical Management: 5. Calcium-Channel Blockers (Calcium
➢ Lifestyle modification Antagonists)
➢ Weight reduction - Action: Inhibit the entry of calcium into the
➢ Sodium restriction heart and vascular smooth muscle
➢ Dietary fat modification ▪ Decreases cardiac output
➢ Exercise ▪ Dilate blood vessels
➢ Relaxation techniques ▪ Lowers blood pressure
➢ Smoking cessation - Drugs: Verapamil, Nifedipine, Diltiazem
6. ACE Inhibitors GENERAL CONSIDERATIONS ON

- Action: Suppress RAAS by blocking conversion ANTIHYPERTENSIVE MEDICATIONS:
of Angiotensin I to Angiotensin II
Pressure monitoring (blood)
- Drugs: PRIL (e.g. Enalapril, Captopril, Lisinopril,
Benazepril, etc.) Rise slowly
Consideration: First dose – watch for
hypotension and loss of taste Eating must be considered
7. Angiotensin II Receptor Blockers (ARBs) Stay on medications
- Block the vasoconstrictive effect of RAAS by
blocking receptor sites of Angiotensin II Skipping or stopping is a “No-no”
- Drugs: SARTAN (e.g. Azilsartan, Candesartan, Undesirable responses assessment
Losartan, Olmesartan, etc.)
Remind to exercise
Eliminate smoking

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HYPERTENSION PHINMA-UPANG

Prof: Leonardo R. Sanchez IV, RN CHS Batch 2024

HYPERTENSION Risk Factors:

- Sustained, elevated, systemic, arterial blood Non-modifiable

Classifications (according to type and degree of severity) Modifiable

1. Systolic and Diastolic Hypertension • Stress

6. ACE Inhibitors GENERAL CONSIDERATIONS ON

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