Health Promotion for Hypertension
Introduction
a. Definition and prevalence of hypertension
i.
Elevated blood pressure above 120 SBP or above 80 DBP; depending on the
blood pressure, it’s classified as different elevated stages
ii.
About half of the United States population in 2017-2018 had hypertension at
49.64% (Chobufo et al., 2020)
b. Impact of hypertension on health
i.
Lead to an increased risk of morbidity and mortality
ii.
Can lead to stroke, heart attack, heart failure, renal failure, and atherosclerosis
c. Importance of health promotion in managing hypertension
i.
Various modifiable risk factors can lead to hypertension:
1.
ii.
diet, exercise, occupation, stress, smoking
A research study (Carey et al., 2021) stated that the best nonpharmacological
interventions for hypertension are diet modification (DASH diet and reduced
sodium intake), increased physical activity, and reduced alcohol consumption.
Understanding Hypertension
Groups at higher risk for hypertension: older adults, pregnant women
a. Pregnant Women
i.
Gestational hypertension
1. Causes
a. Pre-existing hypertension
b. Renal disease
c. Diabetes mellitus
d. Thrombophilia
e. Autoimmune disease
(Luger & Knight, 2022)
2. Risk factors
a. Placental abnormalities, such as insufficient blood flow
b. Genetic factors
c. Environmental exposures
d. Nutritional factors
e. Maternal immunology and autoimmune disorders
f. Cardiovascular and inflammatory changes
g. Hormonal imbalances (NICHD, 2017)
h. previous history of preeclampsia, HELLP syndrome, twin
or other multiple pregnancies
i. BMI >30,
j. autoimmune disease,
k. women who are more than 35 years of age, are first-time
mothers, or have a mother or sister who has had gestational
hypertension
(Luger & Knight, 2022)
3. Signs and symptoms
a. high blood pressure
b. Edema or rapid weight gain
c. headache
d. blurred vision, flashes of light, or dots in the eyes
e. Nausea
(Holman et al., 2022)
4. Progression
a. Preeclampsia
b. Eclampsia
c. HELLP syndrome
5. Complications associated with hypertension
a. Eclamptic seizures, Intracranial hemorrhage, Pulmonary
edema, Renal failure, Coagulopathy, Hemolysis, Liver
injury, Thrombocytopenia, Intra-uterine growth restriction,
Oligohydramnios, Placental abruption, Nonreassuring fetal
status (Luger & Knight, 2022)
6. Treatment
a. Pharmacological treatment
i.
Anti-hypertensives
ii.
Anti-seizure
b. Non-pharmacological treatment
i.
Delivery of the fetus
b. Older Adults
i.
Causes
1. Primary and secondary hypertension
a. Primary — not the result of a medical condition
b. Secondary — Obesity, sleep apnea, coarctation of the aorta,
renal insufficiency, diabetic nephropathy, obstructive
nephropathy, thyroid disease
c. Depends on lifelong diet and exercise habits as well as
occupation
ii.
Risk factors
1. Common risk factors of hypertension in the elderly are:
a.
smoking, lack of exercise, stress, and obesity (Potter et al.,
2020, page 187)
2. Increased risk of having more comorbidities
a. diabetes mellitus, hyperlipidemia, etc.
iii.
Treatment
a. Treatment of hypertension is used to decrease the incidence of heart attacks,
chronic kidney disease, stroke, and/or heart failure (Potter et al., 2020, page 187)
1. Non-pharmacological
a. Healthy diet (reduce sodium intake), exercise regularly,
stop smoking (vasoconstriction), limit alcohol intake, and
adequate sleep.
2. Pharmacological treatment
a. Anti-hypertensives: diuretics, vasodilators, ACE inhibitors,
ARBs, etc.
3. A research study found that incorporating nursing interventions
based on Sister Callista Roy’s Adaptation Model increased the
self-efficacy and management of their experimental group
significantly compared to that of a control group (Zhang et al.,
2021)
iv.
Signs & symptoms
1. Silent killer in older adults because they are usually unaware that
their blood pressure is elevated
a. However, some patients experience headaches, facial
flushing (redness), dizziness, or fainting as a result of the
elevated blood pressure.
2. Symptoms that may indicate vascular damage/target organ damage
as a consequence of hypertension may include exudate, retinal
hemorrhages, swelling of the optic disc, cotton wool spots, arterial
stenosis, or microaneurysms (Hinkle et al., 2021, page 868-869)
3. Chronic or acute ocular changes may be the first sign of
hypertension in asymptomatic patients (Hinkle et al., 2021, page
870)
4. Blood pressure measurement and classification
a. According to the American Heart Association:
Normal
120 or less
80 or less
Recheck in 1 year
Elevated
120-129
80 or less
Recheck in 3-6 months
HTN Stage 1
130-139
80-90
Evaluate therapy in 3-6 months
HTN Stage 2
140-159
90-99
Evaluate therapy in 1 month
HTN Crisis
160 or greater
100 or greater
Evaluate therapy and treat immediately or within one week,
depending on the clinical situation and complication.
v.
Complications associated with hypertension
1. May lead to stroke, end-stage renal disease, heart failure, blindness
Lifestyle Modifications
Importance of lifestyle modifications in managing hypertension (Fuchs, F. D. et al., 2020)
a. Stroke
b. Cardiovascular disease
c.
Heart disease
d. Iv. cardiovascular death
Promotion of a Healthy Diet
a. Reducing sodium and sugar intake
b. Increase foods to lower cholesterol (fatty fish, olive oil, nuts)
c. DASH (Dietary Approaches to Stop Hypertension) diet
i.
Clear guidelines regarding food groups and serving sizes for patients to
follow, making an easier adherence
ii.
Decreases systolic BP by 6-11 mmHg (Oliveros et al., 2020).
d. Promoting a balanced diet rich in fruits, vegetables, and whole grains (Oliveros, E
et al., 2020)
i.
Vegetables: 5 servings/day
ii.
Fruits: 5 servings/day
iii.
Carbohydrates: 7 servings/day
iv.
Low-fat dairy products: 2 servings/day
v.
Lean meats: < 2 servings/day
vi.
Nuts and seeds 2-3 servings/day
Importance of Regular Physical Activity
a. Types of exercises beneficial for blood pressure control
i.
Dynamic resistance
ii.
Isometric resistance
iii.
Aerobic exercise
b. Recommended duration and frequency of physical activity
i.
Dynamic: 60-150 mins/week for 65-75% heart reserve
ii.
Isometric: 8-12 repetitions for each exercise
iii.
Aerobic: maximum of 150 mins per session in non-consecutive days
c. Incorporating aerobic and resistance training
Relevance of Smoking Cessation in Hypertension Prevention
a.
The detrimental effects of smoking on hypertension
i.
Risk factors for hypertension
b. Supportive resources and strategies for quitting smoking
i.
American Cancer Society (Quit for Life) 866-QUIT-4-LIFE
(866-784-8454); 24 hours a day, 7 days a week
ii.
American Lung Association: Lung Help Line & Tobacco Quit Line
iii.
National Cancer Institute: Smokefree.gov
iv.
U.S. Department of Health and Human Services - Be Tobacco Free
Significance of Moderate Alcohol Consumption in Hypertension Prevention
a. Understanding the impact of excessive alcohol intake on blood pressure
i.
Alcohol increases blood pressure by causing blood vessels to constrict and
by stimulating the release of certain hormones that elevate blood pressure.
ii.
acute effects
1. depression of cardiac contractility, cardiac rhythm disturbances,
arterial hypertension, sudden death
iii.
chronic effects
1. ventricular dysfunction, atrial dysfunction, arrhythmia, alcoholic
cardiomyopathy, and heart failure
iv.
Chronic high doses of alcohol
1. associated with the development of hypertension, coronary and
peripheral atherosclerosis, changes in lipid profile, and an
increased risk of all forms of stroke.
(Day et al., 2020)
b. Recommended limits for alcohol consumption
i.
an average maximum alcohol intake of one drink per day in women and
two drinks per day in men is a reasonable goal if drinking is not otherwise
contraindicated (American Heart Association, 2023)
Importance of Adequate Sleep
a. The Significance of Sufficient Rest and Recommended Sleep Duration
i.
During normal sleep, your blood pressure goes down. Having sleep problems
means your blood pressure stays higher for longer (Centers for Disease Control
and Prevention, 2021).
b. Tips to get better sleep
i.
Stick to a regular sleep schedule. Go to bed at the same time each night and get up
at the same time each morning, including on the weekends.
ii.
Get enough natural light, especially earlier in the day. Try going for a morning or
lunchtime walk.
iii.
Get enough physical activity during the day. Try not to exercise within a few
hours of bedtime.
iv.
Avoid artificial light, especially within a few hours of bedtime. Use a blue light
filter on your computer or smartphone.
v.
Don’t eat or drink within a few hours of bedtime; avoid alcohol and foods high in
fat or sugar in particular.
vi.
Keep your bedroom cool, dark, and quiet.
(Centers for Disease Control and Prevention, 2021).
Stress Management
a. Link between stress and hypertension
i.
Chronic stress releases cortisol and adrenaline. Stress hormones temporarily raise
blood pressure. However, prolonged stress responses can cause persistent high
blood pressure (Mayo Clinic, 2022).
b. Relaxation techniques:
i.
Deep breathing
ii.
Meditation
iii.
Yoga
c. Time management and prioritization
d. Seeking social support and engaging in enjoyable activities
e. Seeking professional help when necessary
Health Promotion Towards Pregnant Women
a. Promoting the Significance of Prenatal Checkups
i.
Physical examination and laboratory examination
b. Empowering Self-Care:
i.
Blood Pressure Monitoring at Home
ii.
Importance of adhering to Hypertension Medication Prescriptions
iii.
Healthy diet
iv.
Provide information on various exercises to prevent gestational hypertension
and/or pre-eclampsia.
1. Supervised exercise classes that meet at least three times weekly for 30 to
60 minutes of moderate-intensity aerobic activity.
2. Regular, moderate-intensity walking sessions where women (alone or in a
group) walk for 90 to 150 minutes a week, or 11,000 steps a day.
(Guide to Community Preventive Services, 2019).
Conclusion
a. Recap of key points
b. Importance of health promotion in managing hypertension
c. Encouragement to adopt healthy lifestyle habits
References
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