ESSENTIAL HYPERTENSION Hypertension is an intermittent or sustained elevation in systolic blood pressur e greater than or between 120 and 139mmHg

or a diastolic blood pressure lesser t han or between 80 and 89mmHg. It is a major risk factor for coronary, renal, cer ebral, and peripheral vascular diseases. About 20% of the adult population devel ops hypertension. In an individual over the age of 50, the systolic pressure is more important value to note than the diastolic pressure regarding the need for treatment. Three stages of HPN: Sytolic (mmHg) Stage I 140-159 Stage II 160-179 Stage III >=180 Diastolic (mmHg) or 90-99 or 100-109 or >=110

Two Kinds of Hypertension: A. Primary or Essential Hypertension. Has no identifiable medical cause. 1. Non-modifiable risk factor include: Family history Gender (men are at greater risk than women) Race 2. Modifiable risk factor include: Stress Obesity High dietary intake of sodium and saturated fats Excessive caffeine, alcohol or tobacco use Hormonal contraceptive use Sedentary lifestyle B. Secondary Hypertension. Conditions associated with secondary hypertensio n include: Renal vascular disease Primary hyperaldosteronism Pheochromocytoma Coarctation of the aorta Thyroid, parathyroid or pituitary dysfunction Pregnancy-induced hypertension Complications: o Visual changes o Cerebrovascular accident, o Heart failure o Hypertensive crisis o Renal failure Assessment Findings: 1. Clinical manifestations a. HPN usually produces no symptoms until vascular changes occur in the hea rt, brain or kidneys. b. Physical examination may reveal no abnormalities, but changes may be see n in the retina. c. Client may exhibit epistaxis, occipital headache or a flushed face if sy mptomatic. 2. Laboratory and diagnostic study findings a. Urinalysis detects an increase protein level and the inability to concen trate urine. b. IV pyelography and a renogram show a renovascular disease. c. Blood ure nitrogen and creatinine levels are increased because of renal involvement d. ECG and chest radiograph shows left ventricular hypertrophy. Medical Management: Diuretics, which initially increase urination to reduce salt and water retention

and lower blood volume. Beta-blockers (BBs), which slow the heart rate and lower the output of the heart. Angiotensin converting enzyme (ACE) inhibitors, which block production of a spec ialized hormone called angiotensin II. Angiotensin II causes the arteries to con strict and also stimulates the release of another hormone that causes the kidney s to retain salt. Angiotensin II receptor blockers (ARBs or A II As), which relax blood vessels by blocking the action of angiotensin II. Calcium channel blockers (CCBs) of which there are two types: Dihydropyridines (D HPs), and heart rate slowing calcium channel blockers. Both types relax blood ve ssels by slowing the entry of calcium into cells. The DHPs increase the heart ra te a little while the others slow it a little. Alpha-1 blockers work on the blood vessels to block the effect of constricting h ormones such as norepinephrine. These are also commonly used to treat prostate p roblems. Alpha-2 agonists, which work in the brain to decrease the action of the nervous system to constrict blood vessels. Direct vasodilators, which relax the artery walls. Sympathetic nerve blockers, which prevent those nerves from constricting blood v essels. Pharmacological Interventions 1. Goal: -One treatment goal is to reduce the BP. -Another treatment goal is to prevent or lessen the extent of organ da mage. 2. Question the client regarding the signs and symptoms indicative of HPN. 3. Obtain the BP 2 or more times on both arms with the client supine and st anding. 4. Compare BP with prior documentation 5. Determine family history of HPN. 6. Identify current medication therapy. 7. Obtain weight. 8. Evaluate dietary patterns lowering sodium intake. 9. Assess for visual changes or retinal damage. 10. Assess for cardiovascular changes such as distended neck veins, increase d HR, dysrrhythmias. 11. Evaluate chest x-ray film for heart enlargement. 12. Assess neurological system. 13. Evaluate renal function. 14. Evaluate results of diagnostic laboratory studies. Nonpharmacological Interventions 1. Weight reduction, if necessary or maintenance of ideal weight. 2. Dietary sodium restriction to 2g daily as prescribed. 3. Moderate intake of alcohol and caffeine- containing products. 4. Initiation of regular exercise program. 5. Avoidance of smoking. 6. Relaxation technique and biofeedback therapy. 7. Elimination of unnecessary medications that may contribute to HPN.