Hypertension

1. Hypertension By Dr. Hanan Said Ali

2. Learning Objectives • Define hypertension. • Identify etiology and risk factors of hypertension . • Mention types of hypertension. • Describe Pathophysiology of hypertension. • Enumerate Clinical Manifestations of hypertension. • Identify diagnostic Studies of hypertension. • Explain management of hypertension. • Identify nursing responsibilities for hypertensive client.

3. Definition of hypertension • Hypertension is defined as a consistent constant elevation of systolic or diastolic pressure above 140/90 mm Hg.

4. Aetiology The etiology of hypertension can be classified as either primary (essential) or Secondary . • Primary (essential) hypertension It is accounts more than 90 % of all cases and has no cause. Contributing factors • Overproduction of sodium retaining hormones and vasoconstriction • Increased sodium intake • More than ideal body weight (central abdominal obesity) • Diabetes mellitus and excessive alcohol intake.

5. Aetiology cont. Primary hypertension Risk Factors 1- Age and Sex The risk of high blood pressure increases, as you get older.Through early middle age, high blood pressure is more common in men. Women are more likely to develop high blood pressure after menopause. 2- Race High blood pressure is particularly common among blacks.

6. Aetiology cont. Primary hypertension 3- Family History Level of BP is strongly familial 4- Smoking Nicotine constricts blood vessels 5- Elevated Serum Lipids It leads to atherosclerosis. Narrowing of arteries increases blood pressure

7. Aetiology cont.Primary hypertension 6- Alcohol Alcohol increases plasma catecholamine. (epinephrine and no epinephrine) 7- Sedentary life styles Regular physical activity can help control weight and reduce cardiovascular risk.

8. Aetiology cont.Primary hypertension 8- Socioeconomic status It is more prevalent in low socioeconomic groups and among the less educated. 9- Emotional stress Stress stimulate sympathetic nervous systems.

9. Secondary Hypertension • It develops as a consequence of a particular underlying disease or condition. Causes • Congenital narrowing of the aorta. • Renal diseases such as renal artery stenosis ,renal failure, glomerulonephritis. • Endocrine disorders such as hyperaldosteronism

10. Secondary Hypertension Cont.Causes • Neurologic disorders such as brain tumour , head injury • Medication such as sympathetic stimulation (cocaine), nonsteroidal anti-inflammatory • Pregnancy- induced hypertension, generalized vasospasm may be a contributing factor.

11. Pathophysiology Cont. Inability of the kidneys to excrete sodium, resulting in factors being secreted to promote salt excretion with the side-effect of raising total peripheral resistance (Is the force opposing the movement of blood within the blood vessels ).

12. Pathophysiology Cont. An overactive rennin / Angiotensin leads to vasoconstriction and retention of sodium and water. The increase in blood volume leads to hypertension. An overactive sympathetic nervous system, leading to increased stress responses.

13. Clinical Manifestations Hypertension is called the (SILENT KILLER) because it is a disease that usually occurs without any symptoms until it become more severe and target organ disease has occurred It include Fatigue, reduced activity tolerance, dizziness, palpitation, angina, and dyspnoea, early morning headache, blurred vision, spontaneous nose- bleed ,and depression.

14. Diagnostic Studies • The initial diagnosis of hypertension is made on the basis of two or more elevated blood pressure reading , supine and sitting obtained on at least two separate occasions • The diagnostic test include: • Electrolytes (sodium, potassium) • Glucose - to identify diabetes mellitus • Cholesterol

15. Diagnostic Studies cont. • Creatinine (renal function), Testing of urine samples for proteinuria • Also a baseline for later monitoring the possible side-effects of certain antihypertensive drugs.

16. Diagnostic Studies cont. • Electrocardiogram (EKG/ECG) May show (left ventricular hypertrophy) or the previous silent cardiac disease even a myocardial infarction). • Chest X-ray - again for signs of cardiac enlargement or evidence of cardiac failure.

17. Management • Lifestyle modification. • Weight reduction and regular mild exercise reduce resting heart rate and blood pressure. • Reducing sodium (salt)diet is proven very effective: it decreases blood pressure in about 60% of people • diet should be rich in fruits and vegetables and low fat .

18. Management Lifestyle modification cont. • Discontinuing tobacco use and alcohol consumption. • Relaxation therapy, such as meditation, that reduces environmental stress, reducing high sound levels

19. Management Drug Therapy A- Diuretics 1- Thiazide/Thiazide- Like diuretic It blocks or inhibits sodium reabsorbtion. (bebzythiazide)

20. Management Drug Therapy cont. • The nurse must monitor • Check vital signs before administering drug. • Monitor client weight. • Monitor lab value of electrolytes (potassium) • Teach client to: Take drug early, take drug with food if GIT upset occur, eat K –rich diet(fruits,, cereal and potato) • Report muscle weakness, cramping, fatigue.

21. Management Drug Therapy cont. 2- Beta-adrenergic blockers: It block beta-adrenergic receptors of sympath.N.S. Decreasing heart rate and blood pressure(atenolol) Nursing intervention • Be alert to the signs of hypoglycaemia.

22. Drug Therapy cont. Nursing intervention Cont. • Change position slowly. • Teach client to: • Avoid hot baths, steam room, saunas. • Use gum or hard candies to counteract dry mouth. • Be cautious in driving • Report any decline in sexual responsiveness

23. Management Drug Therapy cont. D- Angiotens in inhibitors 1- Angiotensin converting enzyme It blocking the release of aldosterone, thereby reducing sodium and water retention(captopril) Side Effects Hypotension, loss of taste, cough, Hyprekalaemia, acute renal failure, skin rash.

24. Management Drug Therapy cont. Nursing Management • Monitor for first dose syncope in client with CHF. • Monitor renal function and potassium levels. • Check BP before administration. • Teach the client to change position slowly, report any incidence of fatigue, skin rash, impaired taste, and chronic cough

25. Management Drug Therapy cont. E-Calcium channel blockers It inhibit influx of calcium into muscle cells; acts on vascular smooth muscle to reduce spasms and promote vasodilatation. Verapamol (Isoptin) Side Effects Nausea, headache, dizziness, reflex tachycardia, oedema. Nursing Intervention Check vital signs before administering Monitor renal and liver function tests.

26. Nursing Responsibilities of Hypertension • Provide the numerical value of the client's BP and explain that it exceeds normal limits. • Inform the client that hypertension usually asymptomatic. • Explain that long- term follow- up and therapy are necessary. • Explain that therapy will not cure but should control case • Be specific about the names, actions, dosages and side effects of prescribed medication.

27. Nursing Responsibilities of Hypertension • Tell the client not to discontinue drugs abruptly because withdrawal may cause a sever hypertensive reaction. • Tell the client not to double upon doses when a dose is missed • Tell the client to consult the health care provider about drugs or dosage if problems develop. • Tell the client to supplement diet with foods high in potassium. • Tell the client to avoid hot baths, excessive amounts of alcohol and strenuous exercises within 3 hours of taking drugs

28. Thank You