Hypertension

Learning Outcome

Students will gain an understanding of hypertension, its disease process and management, and will apply that understanding to planned patient care.

Learning Objectives

By the end of this module students will• Compare and Contrast prehypertension, stage

I and stage II parameters according to JNC 7 Guidelines

• Differential between essential and secondary hypertension

• Describe effects of uncontrolled hypertension on body organs

Learning Objectives

• Name a minimum of four causes of secondary hypertension

• Define the term "silent killer“• Create a nursing care plan for a hypertensive

patient using the nursing process and following the provided rubric

Outline

• JNC guidelines for prehypertension and stage I & II Hypertension

• Types of hypertension• Risk factors• Organ damage• Treatment

Introduction

Introduction

• Nearly 60 million Americans, or 1 in 4 adults, have high blood pressure

• High blood pressure contributes to the deaths of almost 30 individuals every hour of every day

• An additional 45 million adults, or 22% of the population, have prehypertension

• Many individuals don’t even know they have hypertension

the JNC 7 report. JAMA. 2003;289:2560-72.

Manifestations of Hypertension

• Usually no symptoms other than elevated blood pressure

• Symptoms are related to organ damage and are seen late and are very serious

Parameters According to JNC 7

• Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)

http://www.nhlbi.nih.gov/guidelines/hypertension/phycard.pdf

U . S . D E PA RT M E N T O F H E A LT H A N D H U M A N S E RV I C E SN a t i o n a l I n s t i t u t e s o f H e a l t hN a t i o n a l H e a r t , L u n g , a n d B l o o d I n s t i t u t e

BP classification Systolic BP

(mmHg) Diastolic BP

(mmHg)

Normal <120 and <80

Prehypertension 120–139 or 80–89

Stage 1 hypertension 140–159 or 90–99

Stage 2 hypertension >160 or >100

JNC, Joint National Committee; DBP, diastolic blood pressure; HTN, hypertension; SBP, systolic blood pressure. http://www.nhlbi.nih.gov/guidelines/hypertension/phycard.pdf

What is High Blood Pressure? JNC 7 Guidelines for Patients Age ≥18 Years

JNC 7 Parameters

Key: SBP = systolic blood pressure DBP = diastolic blood pressure

Types of Hypertension• Essential 90% - 95%

– Cause is unknown• Secondary 5% - 10%

– High blood pressure that is caused by another medical condition or medication

Secondary Hypertension Causes

• Chronic kidney disease• Disorders of the adrenal gland

(pheochromocytoma or Cushing syndrome)• Pregnancy (preeclampsia)• Medications such as birth control pills, diet pills,

some cold medications, and migraine medications• Narrowed artery that supplies blood to the kidney

(renal artery stenosis)• Hyperparathyroidism

Risk Factors

• Factors that cannot be changed–Family history of high blood pressure–Family history of premature CVD–Diabetes–Race (African American)

Lifestyle Risk Factors

• Weight (body mass index > 30 kg/m2)• Stress• Sedentary lifestyle• Diet• Smoking• Alcohol (more than one drink per day for women

and more than two drinks per day for men)• Birth control pills

Blood Pressure >140/90 mm Hg Damages Target Organs

CHD, coronary heart disease.

HBP

Retinopathy

Peripheral vascular disease Renal failure

LVH, CHD, HFHemorrhage,stroke, dementia

Chobanian AV. JAMA. 2003;289:2560-2572.

Organ Damage

• Vascular Effects– Artery damage and narrowing– Aneurysm

• Cardiac Effects– Coronary artery disease– Enlarged left ventricle– Heart failure

High Blood Pressure Increases Risk of Ischemic Heart Disease Death

IHD

mor

talit

y(fl

oatin

g ab

solu

te ri

sks

& 9

5% C

I)

CI, confidence interval; SBP, systolic blood pressure. Prospective Studies Collaboration. Lancet. 2002;360(9349):1903-1913.

• Risk of IHD death increases with increasing age

• Risk of IHD death increases with increasing BP in each decade of life

• Increased risk begins at systolic BP >120 mmHg

• Trend begins at 40 years old

Usual SBP (mmHg)120 140 160 180

1

2

4

8

16

32

64

128

256

50-59 yrs

70-79 yrs

60-69 yrs

80-89 yrs

40-49 yrs

Organ Damage

• Cerebral Effects– Transient ischemic attack (TIA)– Stroke– Mild cognitive impairment– Dementia

• retinopathy – Vision impairment– blindness

High Blood Pressure Increases Risk of Stroke Death

Stro

ke m

orta

lity

(floa

ting

abso

lute

risk

s &

95%

CI)

CI, confidence interval; SBP, systolic blood pressure. Prospective Studies Collaboration. Lancet. 2002;360(9349):1903-1913.

120 140 160 180

1

2

4

8

16

32

64

128

256

Usual SBP (mmHg)

50-59 yrs

70-79 yrs

60-69 yrs

80-89 yrs• Risk of stroke death increases

with increasing BP in each decade of life

• Risk of stroke death increases with increasing age

• Increased risk begins at systolic BP >120 mmHg

Organ Damage

• Renal Effects– Kidney failure– Kidney scarring (glomerulosclerosis).– Kidney artery aneurysm

healthtap.com

Treatment

• Lifestyle changes– Weight– Exercise– Diet– Smoking– Alcohol use– Stress

• Medication

JNC 7

Recommended by JNC 7

Recommended by JNC 7

Medications

• See additional information on medication video in hypertension module

• Refer to Drug and Medication Textbook

• Review Medication Online Module

Nurses Help Patients Significantly Reduce Systolic BP

Denver E. Diabetes Care. 2003;26:2256-2260

130

135

140

145

150

155

160

165

Nurse-led program Standard care

Baseline BP

After treatment

Syst

olic

blo

od p

ress

ure

(mm

Hg)

160.7

141.1

157.6

151.1

P=0.02

P=0.28

Learning Activities

• Review module materials and videos• Form a group of 2-4• Create a nursing care plan for a hypertensive

patient using the nursing process and following the provided rubric as a guide

• Review the nursing process and nursing care plans as needed

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Discussion forum

• Review hypertension Case scenario• Using critical thinking answer questions in

discussion forum• Respond and reply to fellow students

concerning case scenario and nursing care

Hypertensive Crisis

This is discussed in the next module

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