Hypertension
Karen Ruffin RN, MSN Ed.
Blood Pressure
Arterial BP = Cardiac Output (CO) x
Systemic vascular resistance (SVR)
Cardiac Output = stroke volume x beats
per min
Systemic vascular resistance = force
opposing the movement of blood within
the blood vessels
What is the effect on BP if SVR
increased and CO remains
constant?
Blood Pressure
Definition: the force exerted by the
blood against the walls of the blood
vessels
Adequate to maintain tissue
perfusion during activity and rest
Arterial blood pressure: primary
function of cardiac output and
systemic vascular resistance
Mechanisms that Regulate
Blood Pressure
Sympathetic Nervous System
Vascular Endothelium
Renal System
Endocrine System
Hypertension
Aldosterone Mechanism
• Increased Aldosterone =
• Increases sodium reabsorption
=
• Increases water reabsorption =
• Increases blood volume =
• Increases cardiac output
Hypertension
 Regulatory mechanisms in the health person
function in response to the demands on the
body
 When Hypertension develops, one or more of
these mechanisms are defective
Sympathetic Nervous System
Vascular Endothelium
Renal System
Endocrine System
Hypertension
Pathophysiology
Primary (Essential) Hypertension:
Elevated BP without an identified cause
Accounts for 95% of all cases of
hypertension
Cause – unknown
Contributing Factors: Increased SNS
activity, overproduction of Na+ retaining
hormones & vasoconstrictors, increased
Na+ intake
Risk Factors: Modifiable & Non-modifiable
Primary Hypertension
Pathophysiology
 Heredity – interaction of genetic, environmental,
and demographic factors
 Water & Sodium Retention – 20% of pts with high
Na+ diet develop HTN
 Altered Renin-Angiotensin Mechanism – found in
20% of patients
 Stress & Increased SNS Activity
 Insulin Resistance & Hyperinsulinemia
 Endothelial Cell Dysfunction
Diagnosis of Hypertension
Dx is made after multiple readings over several
weeks
NIH/Joint Committee Definition:
Category
Optimal
Normal
High Normal
Systolic
<110
<120
130-139
and
and
or
Stage 1
Stage 2
Stage 3
140-159
160-179
=>180
or
or
or
Diastolic
< 80
<85
85-89
90-99
100-109
=> 110
Secondary Hypertension
Pathophysiology
 Specific cause of hypertension can be
identified
 Affects >5% of adults with hypertension
What conditions can lead
to or cause hypertension?
Primary Hypertension
Risk Factors





Age
Alcohol
Cigarette Smoking
Diabetes Mellitus
Elevated serum
lipids
 Excess Na+ in diet
 Gender
 Family History
 Obesity
 Ethnicity
 Sedentary
Lifestyle
 Socioeconomic
 Stress
Which risk factors are modifiable
or
non modifiable?
Primary Hypertension
Clinical Manifestations
 Organs that are affected by Hypertension:
Myocardium – angina / left ventricular
hypertrophy
Brain – TIA / CVA
Peripheral vascular – Peripheral pulse change
Kidney – renal failure Creatinine / Proteinuria
Eyes – Hemorrhages with or without papilledema
Primary Hypertension
Clinical Manifestations
“Silent Killer” – asymptomatic and
insidious
Severe HTN – fatigue, reduced activity
tolerance, dyspnea, dizziness,
palpitations, angina
Hypertension
Medical Diagnosis
History and Physical Examination
Renal Function
Serum Creatinine & Urine Creatinine
Clearance
Electrolytes – especially K+
Blood Glucose
Serum Lipids/EKG
Ambulatory BP Monitoring
Primary Hypertension
Medical Management
Risk Stratification
Level of BP
Presence of Target Organ
Disease
Other Risk Factors
Primary Hypertension
Medical Management
 Lifestyle modification
 Nutritional therapy
 Alcohol consumption
 Physical activity
 Tobacco avoidance
 Stress management
 Drug Therapy
Stepped Approach to
Manage Hypertension
Lifestyle modification
Not at Goal BP
Drug Therapy
Not at Goal BP
Substitute med / add a 2nd med/
increase dose
Not at Goal BP
Continue adding / changing meds until
control
Medical Management – Drug
Therapy
 Diuretics
 Thiazide
 Loop
 K+ Sparing
 Adrenergic Blockers/ Inhibitors
 B-Adrenergic Blockers
 Central Acting Adrenergic Antagonists
 Peripheral Acting Adrenergic Antagonists
 A-Adrenergic Blockers
 Vasodilators
 Angiotensin Inhibitors
 Calcium Channel Blockers
Antihypertensive Drug
Therapy
Lack of Responsiveness
to Therapy
 Nonadherence to Therapy
 Drug-Related Causes
 Associated conditions
 Secondary Hypertension
 Volume overload
Nursing Care for the
Patient with Hypertension
• What will you assess????
• What are some potential nursing
diagnosis?????
• What are your goals for those
diagnosis????
• What are your interventions?????
• How will you evaluate your
goals?????
Basic Human Needs
• What Basic Human Need is being
affected?
• What other Basic Human Needs are
effected by hypertension?
Nursing Care for the
Patient with Hypertension
Concept Map
• The patient with essential hypertension is
prescribes the beta blocker metoprolol
(Lopressor). Which assessment data
would make the nurse question
administering the medication?
•
•
•
•
A. The patients blood pressure is 112/90.
B. The patients apical pulse is 56.
C. The patients ha an occipital headache.
D. The patient is complaining of a yellow
haze.
• The nurse is preparing to administer the
following medications. Which medications
would the nurse question administering?
• A. Vasodilator hydralazine(Apresoline) to
the patient with blood pressure of 168/94.
• B. Beta Blocker Lopressor(metoprolol) to a
patient with a serum sodium level of 137.
• C. Calcium Channel blocker
diltiazem(Cardizem) to a patient with a
glucose level of 280.
• D. Loop Diuretic(Lasix) to a patient with a
K+ of 3.1.
Primary Hypertension
Case Study