1. Michelle Gardner RN NUR-224

2. OBJECTIVES  Define normal blood pressure and categories of abnormal pressure  Identify risk factors for hypertension  Describe treatment approaches for hypertension, including lifestyle and medication therapy  Use the nursing process as a framework for care of the patient with hypertension

3.  A systolic pressure greater than 140 mm Hg and a diastolic pressure greater than 90 mm Hg, based on the average of two or more accurate blood pressure measurements taken during two or more contacts with a health care provider.

5.  28-31% of the adult population of the U.S. have hypertension.  90-95% of this population with hypertension have primary hypertension.  The remaining 5%-10% have secondary hypertension  Incidence is greater in southeastern U.S. and among African-Americans.  Silent Killer

6.  BP = CO x peripheral resistance  Normal circulation  pressure transfers from the heart muscle to blood each time the heart contracts, and then pressure is exerted by the blood as it flows through the vessels  Hypertension  increases CO, and increases peripheral resistance  No precise cause can be identified for hypertension  multifactorial condition

7.  Increased sympathetic nervous system activity  Increased reabsorption of sodium, chloride and water by the kidneys  Increased activity of the renin-angiotensin system  Decreased vasodilatation

8.  Smoking  Obesity  Physical inactivity  Dyslipidemia  Diabetes mellitus  Impaired renal function  Older adult  Family history

9.  Usually NO symptoms other than elevated blood pressure  Symptoms may be related to target organ damage  Retinal and other eye changes  Renal damage  Confusion  N/V

10.  History and Physical  Laboratory tests  Urinalysis  Blood chemistry  Cholesterol levels  ECG

11.  Lifestyle Modifications: Weight loss Reduced alcohol intake Smoking cessation Regular physical activity DASH Diet:

12.  Initial medication treatment  diuretic, a beta blocker, or both.  Low doses are initiated and the medication dosage is increased gradually if blood pressure does not reach target goal.  Additional medications may be added  Multiple medications may be needed to control blood pressure.  Lifestyle changes initiated to control BP must be maintained.

13.  Diuretic and related drugs  Beta blockers  Alpha blockers  Angiotensin-converting enzyme (ACE) inhibitors  Calcium channel blockers

14.  History and risk factors  Assess potential symptoms of target organ damage  Personal, social, and financial factors that will influence the condition or its treatment

15.  Patient understanding of disease process.  Patient understanding of treatment regimen.  Patient participation in self-care.  Absence of complications.

16.  Knowledge deficit regarding the relation of the treatment regimen and control of the disease process.  Noncompliance with therapeutic regimen related to side effects of prescribed therapy.

17.  Patient teaching- nutrition, excess fluid volume  Support groups  Follow-up care  Emphasize control rather than cure  Rebound hypertension

18.  Noncompliance  Understanding of therapeutic regimen  Reading instructions  Monotherapy

19.  Hypertensive emergency  Blood pressure >180/120 and must be lowered immediately to prevent damage to target organs.  Hypertensive urgency  Blood pressure is very high but no evidence of immediate or progressive target organ damage.  Oral agents – beta-adrenergic blocking agents - labetalol(Trandate), ACE inhibitors-captopril (Capoten)

20.  Reduce BP 25% in first hour  Reduce to 160/100 over 6 hours  Then gradual reduction to normal over a period of days  Exceptions are ischemic stroke and aortic dissection  Medications  IV vasodilators: sodium nitroprusside (Nitropress), nicardipine (Cardene), fenoldopam mesylate (Corlopam), enalaprilat, nitroglycerin  Need very frequent monitoring of BP and cardiovascular status

21.  Blood pressure is very elevated no evidence of target organ damage.  Associated with: severe headaches, nosebleeds, anxiety  Normalize B/P within 24-48 hours  Medications  Fast-acting oral agents: labetalol (Trandate), captopril (Capoten) or clonidine (Catapres)

22. THE END