1. Nursing 210 Advanced Cardiac UNIT 2 Laurie Brown RN, MSN, MPA-HA, CCRN

2. Hypertension “In adults, a condition in which the blood pressure (BP) is higher than 140 mm Hg systolic of 90 mm Hg diastolic on three (two) separate readings… recorded several weeks apart”. “In adults, a condition in which the blood pressure (BP) is higher than 140 mm Hg systolic of 90 mm Hg diastolic on three (two) separate readings… recorded several weeks apart”. Blood Pressure = Cardiac Output x Systemic Vascular Resistance

4. Relevance Why is hypertension clinically significant? Why is hypertension clinically significant?

5. Procedure Take the Pulse obliteration pressure OR Known Blood Pressure Add 20-30 mm Hg Add 20-30 mm Hg Inflate Bp cuff to this number Inflate Bp cuff to this number Use the BELL of stethoscope take the Blood Pressure Use the BELL of stethoscope take the Blood Pressure

6. Types of Hypertension “White Coat” Hypertension “White Coat” Hypertension Malignant Hypertension Malignant Hypertension Hypertensive Urgency Hypertensive Urgency Pregnancy Induced Hypertension Pregnancy Induced Hypertension

7. Symptoms Often, there are no symptoms until damage has been done… Often, there are no symptoms until damage has been done…

8. Complications Heart Heart Brain Brain Kidneys Kidneys Aorta Aorta Arterial vessels Arterial vessels Eyes Eyes

9. Lifestyle modifications weight loss, diet, exercise, stop smoking, limit alcohol Medication Diuretics or Beta-Blocker Add second drug or substitute another drug Add third drug and/or substitute second drug Continue adding agents from other classes Referral to hypertensive specialist Step 1 Step 2 Step 3 Step 4 Step 5 Medication Management

10. Causes of Resistant Hypertension Improper BP measurement Improper BP measurement Excessive sodium intake Excessive sodium intake Inadequate diuretic therapy Inadequate diuretic therapy Medication Medication Inadequate dose Inadequate dose Drug actions and interactions Drug actions and interactions Smoking Smoking

11. Lifestyle modifications Weight reduction Weight reduction DASH eating plan DASH eating plan Dietary sodium restriction Dietary sodium restriction Aerobic physical activity Aerobic physical activity Moderation of alcohol consumption Moderation of alcohol consumption Cessation of smoking Cessation of smoking

12. Medications Classifications and Action Diuretics Diuretics Alpha Adrenergic Blockers Alpha Adrenergic Blockers Beta Adrenergic Blockers (olol) Beta Adrenergic Blockers (olol) Calcium Antagonist (ipine) Calcium Antagonist (ipine) ACE Inhibitor (pril) ACE Inhibitor (pril) Angiotensin II Antagonist (Receptor blockers or ARB’s) (sartan) Angiotensin II Antagonist (Receptor blockers or ARB’s) (sartan) Vasodilator Vasodilator

13. BP = CO x SVR

14. Treatment Program Individualized Step-Care Therapy for Hypertension

15. Review Analyze this EKG What medical orders do you anticipate? EKG