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Caring for Adolescents, Adults, and Aging Adults
Volume 17, Issue 2
HYPERTENSION... ASSESSMENT & PATIENT EDUCATION
February 2012
Editor-in-Chief: Mary Myers Dunlap, MAEd, RN
BEHAVIORAL OBJECTIVES
AFTER
READING THIS NEWSLETTER THE
LEARNER WILL BE ABLE TO:
1. Discuss primary hypertension, including six common risk
factors.
2. Describe symptoms and assessment of hypertension, as
well as patient education related to lifestyle
modifications.
With hypertension, the pressure of the blood pumping
through the arteries is abnormally high. Blood pressure is
determined by blood flow and peripheral vascular
resistance. Blood flow is the volume of blood ejected from
the left ventricle with each contraction of the heart and the
heart rate. Peripheral vascular resistance refers to the size
of the peripheral blood vessels. The more constricted the
vessel, such as from atherosclerosis, build-up of plaque,
the greater the resistance to flow and blood pressure
becomes increased. Many other environmental factors can
affect blood pressure, including volume of water in the
body, salt content of the body, smoking, and obesity.
TYPES OF HYPERTENSION & RISK FACTORS
The prevalence of high blood pressure, or
hypertension, is on the rise in the United States.
Hypertension affects one in four adults, with the incidence
increasing in the aging population. Only about 30% of
people with high blood pressure are aware of it. About 50%
of people who suffer a first MI and about 66% of people
experiencing a first stroke have a blood pressure above
160/95 mm Hg. Of those who are aware, only 34% have
their high blood pressure controlled. Because hypertension
may not produce signs or symptoms initially, high blood
pressure is often discovered during a routine screening or
when another condition occurs.
This newsletter will describe types and common risk
factors of hypertension. Symptoms and assessment of
hypertension, as well as patient education related to
lifestyle modifications, will also be discussed.
HYPERTENSION
Normal blood pressure is defined as a systolic BP less
than 120 mm Hg and diastolic BP less than 80 mm Hg. There
are four
classifications of
BP CLASSIFICATION
blood pressure
Normal: Systolic <120 and diastolic <80
which are based
Prehypertension: Systolic 120 to 139 or
on the average of
diastolic 80 to 89
two or more
Stage 1 hypertension: Systolic 140 to 159
properly
or diastolic 90 to 99
measured,
Stage 2 hypertension: Systolic >/= 160 or
seated
diastolic >/= 100
measurements
made on each of
two or more office
visits. Hypertension is a major risk factor for cardiovascular
disease and renal disease, and studies suggest that
untreated high blood pressure shortens life expectancy by
approximately five years.
Essential or primary hypertension has no identifiable
cause and accounts for over 95% of all
cases of hypertension. However, it may
be linked to genetic factors and certain
environmental factors. The following are
factors believed to increase the risk of
primary hypertension:
Ø Genetic factors are thought to play a
significant role in hypertension.
Scientists believe that approximately 30% of high blood
pressure cases are due, at least in part, to genetic
factors. Individuals who have a parent with hypertension
are twice as likely to develop hypertension as the rest of
the population.
Ø Race: Hypertension is twice as prevalent among African
Americans and it is also usually more severe.
Ø Gender: Hypertension is more common among men than
women until after menopause, when the incidence in
women increases.
Ø Age: As people grow older, their blood pressure steadily
rises. About 75% of women and almost 66% of men, aged
75 or older, have high blood pressure. One in four people
between the ages of 20 and 74 have high blood pressure.
Ø Obesity: High blood pressure occurs twice as often in
people who are obese. Obesity is associated with
increased intravascular volume.
Ø Diet: Primary hypertension may occur in people who have
an excess level of salt intake. Salt consumption is thought
to be one of the most important factors contributing to high
blood pressure. Salt increases fluid retention around cells
and in the blood, thus causing more pressure on the walls
of the arteries, causing the heart to work harder.
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Diets high in cholesterol also lead to hypertension.
Cholesterol causes formation of plaque that narrows
arteries and restricts blood flow, causing increased
peripheral vascular resistance and workload on the heart,
thus increasing blood pressure.
Ø Chronic stress - stimulates the sympathetic nervous
system, causing catecholamines, such as epinephrine and
norepinephrine, to be released. These chemicals cause
vasoconstriction.
Ø Alcohol - consumption of three or more alcoholic beverages
per day appears to increase blood pressure by increasing
plasma catecholamines, causing vasoconstriction.
Ø Cigarette smoking - nicotine constricts blood vessels.
Secondary hypertension is high blood pressure that is
caused by an unrelated condition in the body. Causes of
secondary hypertension include prescription medications, such
as corticosteroids, and over-the counter medications, including
cold medications. Kidney disease or kidney surgery, as well as
preeclampsia and eclampsia in pregnancy, can also cause
secondary hypertension.
SYMPTOMS OF HYPERTENSION
Hypertension is often called the "silent killer" because
symptoms of high blood pressure do not appear for years.
Patients with hypertension may exhibit general signs, including
headaches, dizziness, blurred vision and swollen extremities,
such as the hands and fingers. The higher the blood pressure,
the greater the patient’s risk of MI, heart failure, angina, stroke,
atrial fibrillation, aneurysm, peripheral artery disease, and
kidney damage. The risk of cardiovascular disease doubles
with each 20 mm Hg incremental increase in systolic BP and/or
10 mm Hg incremental increase in diastolic BP. In younger
people, elevated diastolic BP is associated with more
cardiovascular disease risk than increased systolic BP.
However, starting at age 50, systolic BP becomes the more
important risk factor.
ASSESSMENT
A diagnosis of hypertension is
made if two or more elevated blood
pressure readings are obtained on at
least two separate occasions. High blood
pressure is often discovered during a
routine assessment. “White-coat hypertension,” the tendency
for blood pressure to rise when a patient is being assessed by
a healthcare provider, can also result in imprecise readings.
Measuring BP accurately is crucial to assessing hypertension.
Following are tips, regardless of the equipment used, to
accurately measure blood pressure, which are particularly
important to follow when the initial measurement is high:
§ For 30 minutes before a patient’s BP is taken, he or she
should avoid smoking or drinking beverages containing
caffeine. Nicotine can cause temporary fluctuations in BP
and after consuming caffeine, blood pressure increases
briefly.
§ Have the patient rest quietly for at least 5 minutes before
taking the patient’s BP to prevent a falsely high reading.
§ Apply the BP cuff to the patient's bare arm. The cuff should
cover at least 2/3 of the upper arm and fit evenly and
snuggly. The lower edge of the cuff should be about one
inch above where the bell of the stethoscope will be placed
over the brachial artery.
§
§
§
Palpate the patient's radial pulse. Inflate the cuff until a
pulse is no longer felt and then inflate the cuff 30 mm Hg
more. Having a BP checked should not be painful. For
example, if a patient’s BP is 118/78, inflating the cuff to 220
mm Hg, will hurt. Inflating the cuff to 150 mm HG should be
appropriate. The cuff should then be deflated slowly (about
2 to 3 mm Hg/second). When the first sound is heard that is
the systolic measurement. When the sound fades, record
the diastolic measurement.
If the patient's BP is elevated, wait at least 2 minutes, then
take it again in the other arm.
Taking the patient’s BP sitting, as well as standing, may
also provide pertinent information.
If the patient is newly diagnosed with hypertension, routine
studies are generally performed to establish a baseline to help
determine the extent of hypertensive target-organ damage, as
well as to identify other cardiovascular risk factors. Such
studies may include an electrocardiogram, fasting blood
glucose level, and cholesterol profile, including triglycerides.
PATIENT EDUCATION
Depending on the severity of
the patient’s hypertension, before
drug therapy is implemented,
lifestyle modifications are often
recommended. Patient education
should focus on:
Ø The DASH diet (Dietary Approaches to Stop Hypertension)
is an eating plan that emphasizes fruits, vegetables, and
low fat dairy foods. It is also low in saturated fat, total fat,
and cholesterol. DASH includes whole grains, poultry, fish,
and nuts and has reduced amounts of fats, red meats,
sweets, and sugared beverages.
Ø Weight reduction - a decrease in body weight will decrease
the work of the heart, thus decreasing blood pressure.
Ø Decreasing salt intake - strict sodium restriction is no longer
recommended. Patients with hypertension should be
instructed not to add salt at the table or when cooking.
Foods high in salt, such as ham, bacon, sausage,
sauerkraut, canned vegetables and soup and processed
foods, such as hot dogs and luncheon meats, should be
avoided.
Ø Exercise - research shows that as little as 30 to 60 minutes
of exercise per week can aid in weight reduction and can
help reduce blood pressure.
Ø Limit daily alcohol consumption.
Ø Quit smoking. Smoking cessation programs, which may
include medications, counseling and support groups, are
helpful.
Ø Utilize stress management, such as deep breathing and
relaxation techniques.
Hypertension has serious consequences, and, therefore, early
detection is critical. Hypertension can be identified easily and
treated effectively. If lifestyle modifications have not been
successful after 3 to 6 months, pharmacologic intervention is
appropriate, while lifestyle modifications are continued.
Growing Up With Us, Inc.
PO Box 481810 • Charlotte, NC • 28269
Phone: (919) 489-1238 Fax: (919) 321-0789
Editor-in-Chief: Mary M. Dunlap MAEd, RN
E-mail: [email protected]
Website: www.growingupwithus.com
GUWU Testing Center
www.growingupwithus.com/quiztaker/
Copyright © 2012 Growing Up With Us, Inc. All rights reserved.
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Name:_____________________________________________________
Date:___________________________________
Employee ID#:____________________________________________
Unit:____________________________________
POPULATION/AGE-SPECIFIC EDUCATION POST TEST
GROWN UP... Caring for Adolescents, Adults, and Aging Adults February 2012 Competency: Demonstrates Age-Specific Competency by correctly answering 9 out of
10 questions related to Hypertension...Assessment & Patient Education.
HYPERTENSION... ASSESSMENT & PATIENT EDUCATION
1. Sally Ree, 58 years old, is seen in the clinic for a diabetes check-up. Her blood pressure is 151/98
today. One month ago, at the same clinic, her BP was 155/99. Sally would be classified as having:
a. normal blood pressure.
b. prehypertension.
c. stage 1 hypertension.
d. stage 2 hypertension.
2. Which statement is correct about essential hypertension? It is:
a. also called secondary hypertension.
b. the most common type.
c. a type where the cause is clear.
d. a new hypertension classification.
3. Hypertension is diagnosed by:
a. any reading with a diastolic pressure over 90 mm Hg.
b. two or more elevated blood pressure readings obtained on at least two separate occasions.
c. a patient’s complaint of headache, dizziness and swollen fingers.
d. a systolic pressure over 140 mm Hg or above.
4. All of the following can cause vasoconstriction leading to high blood pressure EXCEPT?
a. Cigarette smoking
b. Stress
c. Alcohol abuse
d. A diet high in potassium
Copyright © 2012 Growing Up With Us, Inc. All rights reserved.
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Name:_____________________________________________________
Date:___________________________________
Employee ID#:____________________________________________
Unit:____________________________________
POPULATION/AGE-SPECIFIC EDUCATION POST TEST
GROWN UP... Caring For Adolescents, Adults, and Aging Adults HYPERTENSION... ASSESSMENT & PATIENT EDUCATION
5. Hypertension increases the risk of all of the following EXCEPT:
a. an aneurysm.
b. kidney damage.
c. heart failure.
d. asthma.
6. A patient’s blood pressure is initially 140/90. Before retaking it, the healthcare provider should:
a. have the patient take a few deep breaths.
b. realize the patient has “white coat” hypertension.
c. have the patient rest quietly for at least 5 minutes.
d. offer the patient a cup of coffee to relax.
7. With a diagnosis of hypertension, the patient should be taught to strictly limit salt intake.
a. True
b. False
8. Which of the following menus would be appropriate for the hypertensive patient?
a. A deli ham sandwich, potato chips and pickles.
b. Fried chicken, baked potato with butter and shortbread cookies.
c. Broiled fish, broccoli and whole grain rice.
d. Fried eggs, bacon and whole wheat toast.
9. The DASH diet has reduced amounts of which of the following?
a. Red meats
b. Fresh fruits
c. Green vegetables
d. Nuts
10. With aging, blood pressure normally increases.
a. True
b. False
Copyright © 2012 Growing Up With Us, Inc. All rights reserved.
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