CARDIOVASCULAR MODULE: HYPERTENSION Adult Medical-Surgical Nursing

Hypertension: Description Blood pressure elevated above recognised normal value for age on several separate occasions

Hypertension: Classification Primary hypertension (90 – 95% of cases) Secondary hypertension (5 -10%)

Primary Hypertension: Aetiology Unknown cause but may relate to: Stress Atherosclerosis Hyperlipidaemia Family history Smoking Obesity Diabetes Mellitus (macrovascular)

Secondary Hypertension: Aetiology Chronic renal disease

Primary Hypertension: Pathophysiology Interaction of hyperlipidaemia and atherosclerosis Hypertension contributes to rate at which plaque develops, therefore: Prolonged hypertension damages blood vessels supplying target organs: heart, kidneys (renal arteries), brain, eyes, peripheral vessels

Secondary Hypertension: Pathophysiology Chronic renal disease → Increased fluid volume Sodium retention Imbalance of renin - angiotensin system: → Increased vasoconstriction and blood volume

Hypertension: Clinical Manifestations May be asymptomatic Headache often frontal Symptoms related to associated medical conditions: Cardiac disease Renal disease Stroke Impaired vision

Hypertension: Diagnosis BP: serial measurement ECG Kidney function tests Liver function tests Lipid profile Blood glucose Serum electrolytes

Hypertension: Management Calcium channel blockers β blockers Alpha blockers Central action anti-hypertensives ACE inhibitors Diuretics

Hypertension: Management Calcium channel blockers: Vasodilation (oppose vasospasm) Reduce peripheral constriction, opening up peripheral circulation to allow redistribution of blood ↓ afterload

Hypertension: Management β blockers: Slow heart rate ( ↓ sympathetic action) Vasodilation Alpha blockers: Peripheral vasodilation ( ↓ sympathetic action)

Hypertension: Management Central acting hypotensives: Reduce sympathetic activity from the level of the medulla (cardiac centre) in the brain

Hypertension: Management ACE inhibitors: Block the conversion of Angiotensin I → II Vasodilation ↓ Na - retaining effect of Aldosterone

Hypertension: Management Diuretics: Diuresis relieves pressure of fluid overload Frusemide also acts as a vasodilator Aldactone: inhibits Na re-absorption (competes with Aldosterone)

Hypertension: Nursing Considerations Health education related to a healthy lifestyle: Diet (low salt, low fat, high fruit and fibre) Anti-stress relaxation therapy Exercise Avoid smoking Regular BP check/ adherence to medication