ANATOMY & PHYSIOLOGY OF THE HEART: A QUICK REVIEW

HYPERTENSION

DEFINITION & STAGES

Hypertension is defined as systolic blood pressure ≥140 mmHg or

diastolic blood pressure ≥90 mmHg.

Hypertension is divided into two stages.

BP classification Systolic BP (mmHg) Diastolic BP (mmHg)

Normal <120 <80

Prehypertension 120–139 80–89

Stage 1 hypertension 140–159 90–99

Stage 2 hypertension or ≥160 ≥100

There is another Classification according to causes:

•Essential ( primary) hypertension, of unknown cause.

•Secondary hypertension, due to specific causes as renal disease,

medications, adrenal disease and hypertension in pregnancy.

Risk factors

•Genetic

•High sodium, cholesterol and saturated fat intake

•Increased alcohol intake

•Smoking

•Psychological and environmental stressors

•Old age

CAUSES OF HYPERTENSION

Clinical manifestation

•It can be asymptomatic

•When symptoms appear, they usually indicate vascular damage

with specific manifestations related to the organ systems served by

the involved vessels

•Coronary artery disease with angina

•Left ventricular hypertrophy

•Left ventricular failure

•Pathologic changes in the kidneys may be manifested by

nocturia and azotemia

Diagnosis of hypertension Blood pressure measurement Condition of the patient

Posture • Sitting pressures are usually adequate for routine measurement of blood pressure.

Circumstance

•A quiet warm setting is required.

•No caffeine, smoking or alcohol for preceding 30 minutes.

•Question about the most recent meal or evacuation of bowels or bladder. Distended abdominal viscera

cause blood pressure elevation presumably because of anxiety, sympathetic stimulation and pain.

•Older persons typically have lower blood pressure post-prandially.

•No exogenous adrenergic stimulants e.g. nasal decongestants or eye drops for papillary dilatation.

Blood pressure measurement

•Take THREE readings (ignore the first) on THREE SEPARATE occasions unless there is

evidence of end organ damage

• Use an efficient DEVICE ONLY i.e. mercury device & NOT an anaeroid one

• Ensure that an appropriate sized cuff is used for overweight patients

• Measure BP in both arms as part of the initial assessment to detect stenosis / occlusion of

a large artery. A difference of >20 mmHg is significant and may indicate a stenosis in the

arm with the lower BP. The arm with the higher BP reading should be used subsequently

INVESTIGATIONS ROUTINELY INDICATED: (FIRST VISIT)

•• Urinalysis for protein / blood

•• Serum electrolytes, bicarbonate and creatinine

•• Random plasma glucose – if elevated, repeat with fasting sample

•• Random lipid profile (including total cholesterol, HDL, LDL and triglyceride levels)

•• ECG

•For selected patients:

•• Echocardiography

•• Plasma renin level

•• Plasma aldosterone level - especially if the renin is low

Management

Goal: To achieve and maintain an arterial blood pressure below 140/90 mm

Hg whenever possible.

Non pharmacologic approaches:

•Weight reduction

•Restriction of sodium, tobacco and alcohol

•Exercise

•Relaxation

Medications:

•Diuretics

•Beta blockers

1. Assessment

•Monitor blood pressure at frequent intervals then at routine

schedule intervals.

•Nosebleeds

•Anginal pain

•Shortnees of breath

•Alteration in vision

•Vertigo, headache

•Rate and rhythm of apical and peripheral pulse

2. Nursing diagnosis

•Knowledge deficit regarding the relationship between the treatment

regimen and control of the disease process

•Potential noncompliance to the self-care program related to side

effects of prescribed therapy

3. Planning and intervention

Goal: Understanding the disease process and its treatment, compliance

with the self-care program, and absence of complication

•Patient/Family Education in Hypertension

General information

• Information on the disease process, the disease promoting factors and

the complications,

• Assistance to recognize personal risk factors

• Explanation of what BP is

• Explanation of the systolic and diastolic BP, teaching BP reading and

interpretation.

Symptoms which must be reported

• Chest pain,

• Dyspnea,

• Edema (weight gain of 1-2 kg/day or 3-5 kg/week),

• Epistaxis,

• Vision changes,

• Headache (in the morning, at the occipital region),

• Vertigo,

• Palpitation.

Specific Education

• Explaining the aim of the treatment of hypertension

• • Instructions on how and when to measure BP at home:

Daily at the same time,

Reading and recording BP,

Avoiding eating and activities before the measurements,

Informing the physician or the nurse if BP is high

Specific Education

• Explanation of necessary life-style changes (dieting, exercising,

coping with stress, controlling BP, regular medication)

• Explaining the necessity of stop all tobacco products,

• Explaining the necessity of preventing obesity.

DRUGS

• Activity

• Walking rapidly for 30-45 minutes, at least 3-4 times per week

• Avoid isometric exercises (lifting or pushing heavy weights, opening jars or

windows)

• The aim, dose, administration times and routes

• The necessity of taking drugs on time and of reporting side effects are

emphasized.

DIET

Water retentive effects of salt and

ways of minimizing intake of salt

• Foods with high salt content (fast

foods) are avoided

• Salt cellar is removed from the table.

• Alcohol intake is restricted

• Care is taken to ingest potassium

with diet including fresh fruits and

vegetables,

• Diet is planned by consulting the

dietitian.