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Michelle Gardner RN
NUR-224
OBJECTIVES
 Define normal blood pressure and categories of
abnormal pressure
 Identify risk factors for hypertension
 Describe treatment approaches for
hypertension, including lifestyle and
medication therapy
 Use the nursing process as a framework for
care of the patient with hypertension
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A systolic pressure greater than 140 mm Hg
and a diastolic pressure greater than 90 mm
Hg, based on the average of two or more
accurate blood pressure measurements taken
during two or more contacts with a health care
provider.
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28-31% of the adult population of the U.S. have
hypertension.
90-95% of this population with hypertension
have primary hypertension.
The remaining 5%-10% have secondary
hypertension
Incidence is greater in southeastern U.S. and
among African-Americans.
Silent Killer
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BP = CO x peripheral resistance
Normal circulation  pressure transfers from
the heart muscle to blood each time the heart
contracts, and then pressure is exerted by the
blood as it flows through the vessels
Hypertension  increases CO, and increases
peripheral resistance
No precise cause can be identified for
hypertension  multifactorial condition
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Increased sympathetic nervous system activity
Increased reabsorption of sodium, chloride and
water by the kidneys
Increased activity of the renin-angiotensin
system
Decreased vasodilatation
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Smoking
Obesity
Physical inactivity
Dyslipidemia
Diabetes mellitus
Impaired renal function
Older adult
Family history
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Usually NO symptoms other than elevated
blood pressure
Symptoms may be related to target organ
damage
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Retinal and other eye changes
Renal damage
Confusion
N/V
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History and Physical
Laboratory tests
Urinalysis
 Blood chemistry
 Cholesterol levels
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ECG
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Lifestyle Modifications:
•Weight loss
•Reduced alcohol intake
•Smoking cessation
•Regular physical activity
• DASH Diet:
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Initial medication treatment  diuretic, a beta
blocker, or both.
Low doses are initiated and the medication
dosage is increased gradually if blood pressure
does not reach target goal.
Additional medications may be added
Multiple medications may be needed to control
blood pressure.
Lifestyle changes initiated to control BP must
be maintained.
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Diuretic and related drugs
Beta blockers
Alpha blockers
Angiotensin-converting enzyme (ACE)
inhibitors
Calcium channel blockers
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History and risk factors
Assess potential symptoms of target organ
damage
Personal, social, and financial factors that will
influence the condition or its treatment
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Patient understanding of disease process.
Patient understanding of treatment regimen.
Patient participation in self-care.
Absence of complications.
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Knowledge deficit regarding the relation of the
treatment regimen and control of the disease
process.
Noncompliance with therapeutic regimen
related to side effects of prescribed therapy.
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Patient teaching- nutrition, excess fluid volume
Support groups
Follow-up care
Emphasize control rather than cure
Rebound hypertension
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Noncompliance
Understanding of therapeutic regimen
Reading instructions
 Monotherapy
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Hypertensive emergency
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Blood pressure >180/120 and must be lowered
immediately to prevent damage to target organs.
Hypertensive urgency
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Blood pressure is very high but no evidence of
immediate or progressive target organ damage.
Oral agents – beta-adrenergic blocking agents labetalol(Trandate), ACE inhibitors-captopril
(Capoten)
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Reduce BP 25% in first hour
Reduce to 160/100 over 6 hours
Then gradual reduction to normal over a
period of days
Exceptions are ischemic stroke and aortic
dissection
Medications
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IV vasodilators: sodium nitroprusside (Nitropress),
nicardipine (Cardene), fenoldopam mesylate
(Corlopam), enalaprilat, nitroglycerin
Need very frequent monitoring of BP and
cardiovascular status
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Blood pressure is very elevated no evidence of
target organ damage.
Associated with: severe headaches, nosebleeds,
anxiety
Normalize B/P within 24-48 hours
Medications
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Fast-acting oral agents: labetalol (Trandate),
captopril (Capoten) or clonidine (Catapres)
THE END