Hypertension is the amount of resistance of blood pumping through the arteries. Organs are susceptible to high blood pressure especially the brain and the kidneys. Cholesterol restricts blood vessels thus affects blood pressure.
Most hypertension cases can be without any visible bodily symptoms, going undiagnosed for a long time.
Hypertension can be classified as Primary (Essential) – originating from an unknown disorder affecting BP regulation mechanisms; or Secondary to other diseases processes. Secondary hypertension could be caused by Renal disease (polycystic kidneys, renal artery stenosis or pyelonephritis), drug-induced (eg. by oral contraceptives or corticosteroids), pregnancy (pre-eclampsia) or hormonal (cushing’s syndrome, phaeochromocytoma, hyper or hypothyroidism, or acromegaly – bone size increase).
Hypertension Risk Factors
Modifiable:
- excessive salt diet
- obesity
- lack of physical exercise
- excessive consumption of alcohol
- deprivation and socio-economic status
- mental health and stress
Non-modifiable:
- age
- ethnicity
- genetics
- gender
NICE guidelines suggest that the blood pressure is measured in both arms. In the case of a consistent high blood pressure of 140/90 mmHg or higher, a patient should seek hypertension diagnosis.
Hypertension affects:
- cardiovascular system (CHF)
- brain (causing a stroke)
- kidneys (renal failure)
- eyes (retina)
Always assume possible lack of compliance with correct medication intake.
Postural hypotension can be noted as a 20mmHg fall in the systolic reading at a standing position, after another reading in a sitting position.
As for athletic patients, note that athletics have a slower heart rate which is still considered to be healthy.
Hypertension Pharmacology as listed within the NICE guidelines suggest the following pharmacological steps in the treatment of hypertension:
First line agents for hypertension:
- ACEi
- ARB
- Calcium Channel Blocker
Add-on agents:
- Beta Blockers
- Alpha Blockers
- Thiazide Diuretics
- Aldosterone Antagonists / Spironolactone
ACE inhibitors are at times not tolerated by black African or African-Caribbean patients.
If a patient presents with hypertension, check for heart failure and current medication list and review.
Chronic Hypertension Drug Treatment During Pregnancy
- Methyldopa: traditionally used drug based on long term data supporting safety
- Beta Blockers: although considered generally safe, fetal growth retardation has been reported in the past, especially with the use of Atenolol
- Labetalol: contains less side effects than Methyldopa
- Clondine: mainly used in the third trimester (limited data)
- Calcium Channel Blockers: Nifedipine is used as long acting medication (limited data)
- Diuretics: probably safe in low doses if started prior to conception for essential hypertension (still controversial evidence)
- ACEi, ARBs, Direct Renin Inhibitors: CONTRAINDICATED.
Ideally, women planning to conceive should be encouraged to discontinue these medications under medical supervision.
Hypertensive Crisis is defined as severely elevated blood pressure associated with new or progressive target organ dysfunction. Although the absolute value of the blood pressure is not as important as the presence of end-organ damage, the systolic blood pressure is usually >180 mmHg and/or the diastolic BP is >120 mmHg. In such crisis, Sodium Nitroprusside is one of the most commonly recommended treatments (contraindicated in patients with chronic kidney disease)
Hypertension Pathophysiology, Treatment, Nursing Interventions and Pharmacology
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