HYPERTENSION (HYPERTENSIVE URGENCY)

silent killer
Excessive tension exerted by blood on arterial walls which results in intermittent or sustained
elevation in blood pressure.
People with Diabetes Mellitus are 2-3x more likely to have hypertension than non-diabetics.

CLASSIFICATION OF HPN ACCORDING TO JNC VII

Normal <120
<80
Prehypertension 120-139
80-89
Stage 1 140-159
90-99
Stage 2 Greater than or equal 160
Greater than or equal 100
2 MAJOR TYPES OF HYPERTENSION
Primary essential/idiopathic
Risk Factors:
Non modifiable: Genetic, Gender, Race
Modifiable: Stress, Obesity, Excessive intake of sodium and saturated fats,
Excessive use of stimulants, Hormonal contraceptive use, Sedentary
Lifestyle
Secondary non essential
- result of another disease condition
Risk Factors:
Renal
Adrenal
Endocrine
Other associated factors
ADDITONAL TYPES
Hypertensive Crisis- acute elevation in arterial BP that can be life threatening
Hypertensive urgency- no organ damage therefore remains asymptomatic
- should be treated immediately to avoid further complications /
organ damage
Hypertensive emergency- life threatening
- signs and symptoms of deterioration are noted
- organ damage can occur
Isolated Systolic Hypertension- elevation in systolic BP greater than 140 mmHg without
Concurrent elevation in diastolic BP
FACTORS AFFECTING BLOOD PRESSURE:
1.
Blood Volume- decrease in blood volume results in decrease in blood pressure; vice versa
- fluid loss dehydration
- fluid retention
2.

Peripheral Resistance/Diameter of Arterioles

Decrease elasticity= increase in blood pressure because of Peripheral Vascular
Resistance
SNS activity
Renin/Angiotensin II
Increase blood viscosity

3.

Cardiac Output
SNS increases blood pressure
PNS decreases blood pressure

SIGNS AND SYMPTOMS

Headache
Dizziness
Tinnitus
Epistaxis
Blurred vision
Unsteadiness

PHARMACOLOGIC TREATMENT:
Diuretics (Loop diuretics, Thiazide diuretics, Potassium-sparing diuretics)
Calcium Channel Blockers (Amlodipine, Nicardipine)
ACE Inhibitors (Enalapril, Captopril)
Angiotensin II Receptor Blockers (Eplerenone)
Beta Adrenergic Blockers (Propanolol)
Alpha Adrenergic Blockers
Direct Vasodilators (Hydralazine, Nitroprusside or Nitropress)
NON-PHARMACOLOGIC TREATMENT
DASH stands for Dietary Approaches to Stop Hypertension. The diet is simple:

Eat more fruits, vegetables, and low-fat dairy foods

Cut back on foods that are high in saturated fat, cholesterol, andtrans fats
Eat more whole-grain foods, fish, poultry, and nuts
Limit sodium, sweets, sugary drinks, and red meats
In research studies, people who were on the DASH diet lowered their blood pressure within 2
weeks.

Another diet -- DASH-Sodium -- calls for cutting back sodium to 1,500 milligrams a day (about 2/3
teaspoon). Studies of people on the DASH-Sodium plan lowered their blood pressure as well.