Hypertension

1. Hypertension

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

3. Learning Objectives By the end of this module students will • Compare and Contrast prehypertension, stage I and stage II parameters according to JNC7 Guidelines • Differential between essential and secondary hypertension • Describe effects of uncontrolled hypertension on body organs

4. 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

5. Outline • JNC guidelines for prehypertension and stage I & II Hypertension • Types of hypertension • Risk factors • Organ damage • Treatment

6. Introduction

7. 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.

8. 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

9. Parameters According to JNC 7 • Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) 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 S N a t i o n a l I n s t i t u t e s o f H e a l t h N 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 http://www.nhlbi.nih.gov/guidelines/hypertension/phycard.pdf

10. What is High Blood Pressure?JNC 7 Guidelines for Patients Age ≥18 Years JNC, Joint National Committee; DBP, diastolic blood pressure; HTN, hypertension; SBP, systolic blood pressure. http://www.nhlbi.nih.gov/guidelines/hypertension/phycard.pdf

11. JNC7 Parameters Key: SBP = systolic blood pressure DBP= diastolic blood pressure

12. Types of Hypertension • Essential 90% - 95% • Cause is unknown • Secondary 5% - 10% • High blood pressure that is caused by another medical condition or medication

13. 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

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

15. 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

16. Blood Pressure >140/90 mm Hg Damages Target Organs HBP Hemorrhage, stroke, dementia LVH, CHD, HF Peripheral vascular disease Renal failure Retinopathy CHD, coronary heart disease. Chobanian AV. JAMA. 2003;289:2560-2572.

17. Organ Damage • Vascular Effects • Artery damage and narrowing • Aneurysm • Cardiac Effects • Coronary artery disease • Enlarged left ventricle • Heart failure

18. 80-89 yrs 256 70-79 yrs 128 60-69 yrs 64 50-59 yrs 32 40-49 yrs 16 8 4 2 1 120 140 180 160 Usual SBP (mmHg) High Blood Pressure Increases Risk of Ischemic Heart Disease Death • 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 IHD mortality (floating absolute risks & 95% CI) CI, confidence interval; SBP, systolic blood pressure. Prospective Studies Collaboration. Lancet. 2002;360(9349):1903-1913.

19. Organ Damage • Cerebral Effects • Transient ischemic attack (TIA) • Stroke • Mild cognitive impairment • Dementia • retinopathy • Vision impairment • blindness

20. 80-89 yrs 256 70-79 yrs 128 60-69 yrs 64 50-59 yrs 32 16 8 4 2 1 120 140 160 180 Usual SBP (mmHg) High Blood Pressure Increases Risk of Stroke Death • 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 Stroke mortality (floating absolute risks & 95% CI) CI, confidence interval; SBP, systolic blood pressure. Prospective Studies Collaboration. Lancet. 2002;360(9349):1903-1913.

21. Organ Damage • Renal Effects • Kidney failure • Kidney scarring (glomerulosclerosis). • Kidney artery aneurysm healthtap.com

22. Treatment • Lifestyle changes • Weight • Exercise • Diet • Smoking • Alcohol use • Stress • Medication

23. JNC 7

24. Recommended by JNC 7

25. Recommended by JNC 7

26. Medications • See additional information on medication video in hypertension module • Refer to Drug and Medication Textbook • Review Medication Online Module

27. Nurses Help Patients Significantly Reduce Systolic BP Baseline BP P=0.02 165 After treatment P=0.28 160 160.7 155 157.6 150 Systolic blood pressure (mmHg) 151.1 145 140 141.1 135 130 Nurse-led program Standard care Denver E. Diabetes Care. 2003;26:2256-2260

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

29. plu.edu

30. 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

31. Hypertensive Crisis This is discussed in the next module digplanet.com