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•Hypertension is sustained elevation of BP

– Systolic blood pressure ³ 140 mm Hg

– Diastolic blood pressure  ³ 90 mm Hg

•Primary – 90-95% of cases – also termed “essential” of “idiopathic”

•Secondary – about 5% of cases

–Renal or renovascular disease

–Endocrine disease


•Cusings syndrome

•Conn’s syndrome

•Acromegaly and hypothyroidism

–Coarctation of the aorta


•Hormonal / oral contraceptive




A systolic blood pressure ( SBP) >139 mmHg and/or

nA diastolic (DBP) >89 mmHg.

nBased on the average of two or more properly          measured, seated BP readings.

On each of two or more office visits



SBP >120 mmHg and <139mmHg and/or


nDBP >80 mmHg and <89 mmHg.


Prehypertension is not a disease category rather a designation for individuals at high risk of developing HTN

Classification of Hypertension


•Primary Hypertension

  -  Contributing factors:

  •  ­ SNS activity

     •  Diabetes mellitus

  •  ­ Sodium intake

   •  Excessive alcohol intake


Secondary Hypertension

  -  Contributing factors:

     •  Coarctation of aorta

  •  Renal disease

  •  Endocrine disorders

  •  Neurologic disorders

  -   Rx: Treat underlying cause

Risk Factors for Primary Hypertension


•Age (> 55 for men; > 65 for women)


•Cigarette smoking

•Diabetes mellitus

•Elevated serum lipids

•Excess dietary sodium


•Family history

•Obesity (BMI > 30)

•Ethnicity (African Americans)

•Sedentary lifestyle

•Socioeconomic status


Clinical Manifestations


Frequently asymptomatic until severe and target organ disease has occurred

–Fatigue, reduced activity tolerance


–Palpitations, angina


Hypertension: Complications

§Cerebrovascular Disease

• Stroke

§ Peripheral Vascular Disease

§ Nephrosclerosis

§ Retinal Damage

Treatment Goals

•Goal is to reduce overall cardiovascular risk factors and control BP by the least intrusive means possible

–BP < 140/90

–In patients with diabetes or renal disease, goal is < 130/80

Benefits of Lowering BP

                                               Average Percent Reduction

  Stroke incidence   35–40% 

  Myocardial infarction   20–25%

  Heart failure  50%  

Collaborative Care


Lifestyle Modifications


  -  Weight reduction

  -  Dietary changes (DASH diet)

  -  Limitation of alcohol intake (< 2 drinks/day for men;   

       < 1/day for women)

  -  Regular physical activity

  -  Avoidance of tobacco use

  -  Stress management

•  Nutritional Therapy: DASH Diet =  Dietary Approahes to Stop HTN

  -  Sodium restriction

  -  Rich in vegetables, fruit, and nonfat 

       dairy products

  -  Calorie restriction if overweight


Drug Therapy

  -  Reduce SVR

  -  Decrease volume of circulating blood 


•Adrenergic inhibitors

•β - Adrenergic blockers

•ACE Inhibitors

Calcium channel blockers

Hypertension: Drug Therapy

•Thiazide-type Diuretics

–Inhibit NaCl reabsorption

–Side effects:

•Electrolyte imbalances: ↓ Na, ↓ Cl, ↓ K** (advise K rich foods)

•Fluid volume depletion (monitor for orthostatic hypotension)

•Impotence, decreased libido

•Adrenergic Inhibitors

–Reduce sympathetic effects that cause HTN by:

•Reducing sympathetic outflow

•Blocking effects of sympathetic activity on vessels

–Side effects


• Varied, depending on specific drug

•  Drug Therapy and Patient Teaching

  -  Identify, report, and minimize side effects

  •  Orthostatic hypotension

  •  Sexual dysfunction

  •  Dry mouth

  •  Frequent urination

Primary Hypertension

Nursing Management
 Nursing Diagnoses


Ineffective health maintenance

  -  Anxiety

  -  Sexual dysfunction

  -  Ineffective therapeutic regimen       management r/t

  -  lack of S/S of HTN, side effects of Rx, cost of Rx,           etc.

 Health Promotion

  •  Individual patient evaluation

  •  Screening programs

  •  Cardiovascular risk factor modification

Hypertensive Crisis


•  Severe, abrupt elevation in BP

•  The rate of ­ in BP is more important than the absolute value

•  Most common in patients with a history of HTN who have failed to comply with medications or who have been under-medicated

Hypertensive Crisis
 Clinical Manifestations


-  Hypertensive encephalopathy (H/A, N & V,    

        seizures, confusion, coma)

  -  Renal insufficiency

  -  Heart failure

  -  Pulmonary edema