Hypertension

Definition of Hypertension

• Resistance of blood pumping through the body/arteries.
• Narrowing of arteries increases blood pressure (analogy: squeezing a water hose).

Blood Pressure Ranges

• Normal: 120/80 or less.
• Pre-Hypertension: 120-139 systolic / 80-89 diastolic.
• Stage 1: 140-159 systolic / 90-99 diastolic.
• Stage 2: >160 systolic / >100 diastolic.

Organs Affected by Hypertension

• Silent Killer: Symptoms appear when body systems are affected.
• Mnemonic CAKE:
  • C - Cardiovascular: Congestive heart failure.
  • A - Brain: Risk of stroke.
  • K - Kidneys: Risk of renal failure.
  • E - Eyes: Vision problems due to retina damage.

Causes of Hypertension

• Primary/Essential Hypertension: Unknown cause, identified by risk factors.
• Mnemonic RISK FACTORS:
  • R - Race: Black males at higher risk.
  • I - Increased sodium/alcohol intake.
  • S - Smoking/stress.
  • K - Low potassium/vitamin D levels.
  • F - Family history.
  • A - Advanced age.
  • C - Cholesterol level.
  • T - Too much caffeine.
  • O - Obesity.
  • R - Restricted activity.
  • S - Sleep apnea.
• Secondary Hypertension: Caused by pre-existing conditions (e.g., pregnancy, Cushing syndrome, chronic renal failure, diabetes, thyroid issues).

Nursing Management

• Patients often asymptomatic at first.
• Common symptoms: Blurred vision, headache, chest pain.
• Responsibilities include assessment, evaluation, and education.
  • Measure blood pressure in both arms.
  • Take family history.
  • Assess sensory changes.
  • Monitor BMI and report high readings.
  • Ensure medication compliance.

Patient Education

• Limit sodium, alcohol, and caffeine.
• Smoking cessation.
• Encourage exercise and cardiovascular activities.
• Teach home blood pressure monitoring.

Pharmacological Management

• Initial Approach: Lifestyle changes for 1-3 months before medication.

Common Medications

1. Thiazide Diuretics

   • Drugs: Hydrochlorothiazide.
   • Action: Remove water and sodium via kidneys.
   • Not for renal patients, monitor lithium levels.
   • Education: Potassium supplements, photosensitivity precautions.

2. ACE Inhibitors

   • Drugs: Lisinopril.
   • Action: Prevent vasoconstriction.
   • Education: Dry cough warning, avoid potassium substitutes, risk of rebound hypertension.

3. ARBs

   • Drugs: Losartan.
   • Action: Block aldosterone and Angiotensin receptors.
   • Similar effects to ACE inhibitors minus the cough.

4. Calcium Channel Blockers

   • Drugs: Amlodipine, Verapamil.
   • Action: Lower heart rate, cause vasodilation.
   • Monitor for bradycardia and avoid in CHF or heart block patients.

5. Beta Blockers

   • Drugs: Metoprolol.
   • Action: Block sympathetic system, slow heart rate.
   • Not for asthma/COPD patients.
   • Education: Monitor glucose in diabetics, caution with low heart rate, orthostatic hypotension management.