1 / 54

Focus on Hypertension

Focus on Hypertension. Hypertension Definition. Persistent elevation of Systolic blood pressure ≥140 mm Hg or Diastolic blood pressure ≥90 mm Hg or Current use of antihypertensive medication(s). Prehypertension Definition. Systolic blood pressure:120–139 mm Hg Or

zeke
Download Presentation

Focus on Hypertension

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Focus on Hypertension

  2. HypertensionDefinition • Persistent elevation of • Systolic blood pressure ≥140 mm Hg or • Diastolic blood pressure ≥90 mm Hg or • Current use of antihypertensive medication(s)

  3. PrehypertensionDefinition • Systolic blood pressure:120–139 mm Hg Or • Diastolic blood pressure:80–89 mm Hg

  4. Factors Influencing Blood Pressure (BP) Systemic Vascular Resistance Blood Pressure Cardiac Output x =

  5. Factors Influencing BP

  6. Hypertension classifications • Primary hypertension • Also called idiopathic or essential • Increased blood pressure without an identified cause • Covers 90-95% of all cases of HTN • Secondary hypertension • Increased blood pressure with a specific cause that can be identified and corrected

  7. Causes of secondary hTN • Cirrhosis • Narrowing of the aorta • Endocrine disorders • Medications • Neurologic disorders • Pregnancy induced HTN • Renal disease • Sleep apnea

  8. Blood Pressure Classification

  9. Hypertension • For persons over age 50, SBP is more important than DBP as a CVD risk factor • Persons who are normotensive at age 55 have a 90% lifetime risk for developing HTN

  10. Risk Factors for Primary Hypertension • Age • Alcohol • Cigarette smoking • Diabetes mellitus • Elevated serum lipids • Excess dietary sodium • Gender • Family history • Obesity • Ethnicity • Sedentary lifestyle • Socioeconomic status • Stress

  11. HypertensionClinical Manifestations • Referred to as the “silent killer” because patients are frequently asymptomatic until target organ disease occurs

  12. HypertensionClinicalManifestations • Symptoms are often secondary to target organ disease and can include • Fatigue, reduced activity tolerance • Dizziness • Palpitations, angina • Dyspnea

  13. HypertensionComplications • Target organ diseases occur most frequently in the • Heart • Brain • Peripheral vasculature • Kidney • Eyes

  14. HypertensionComplications • Hypertensive heart disease • Coronary artery disease • Left ventricular hypertrophy • Heart failure Fig. 33-3: Top, normal heart; Bottom, left ventricular hypertrophy

  15. HypertensionComplications • Cerebrovascular disease • Stroke • Peripheral vascular disease • Nephrosclerosis • Retinal damage

  16. HypertensionDiagnostic Studies • History and physical examination • BP measurement in both arms • Use arm with higher reading for subsequent measurements • BP highest in early morning, lowest at night

  17. HypertensionOffice BP Measurement • Use auscultatory method with a properly calibrated instrument • Patient should be seated quietly for 5 min in a chair, feet on the floor, and arm supported at heart level • Appropriate-sized cuff is necessary to ensure accurate reading • At least two measurements should be obtained

  18. The correct technique for blood pressure measurements includes • Always taking the blood pressure in both arms • Releasing the pressure in the cuff at a rate of 1 mm Hg per second • Inflating the cuff 5 mm Hg higher than the expected systolic pressure • Taking additional readings if the first two readings differ more than 10 mm Hg

  19. HypertensionDiagnosticStudies • Urinalysis, creatinine clearance • Serum electrolytes, glucose • BUN and serum creatinine • Serum lipid profile • ECG • Echocardiogram

  20. HypertensionDiagnosticStudies • “White coat” phenomenon may precipitate the need for ambulatory blood pressure monitoring (ABPM) • Uses a noninvasive, fully automated system that measures BP at preset intervals over a 24-hour period

  21. Treatment Algorithm for Hypertension

  22. Hypertension CollaborativeCare • Overall goals • Control blood pressure • Reduce CVD risk factors • Strategies for adherence to regimens • Empathy increases patient trust, motivation, and adherence to therapy • Consider patient’s cultural beliefs and individual attitudes in formulating treatment goals

  23. Benefits of Lowering BP

  24. HypertensionCollaborativeCare • Lifestyle modifications • Weight reduction: • Weight loss of 10 kg (22 lb) may decrease SBP by ~ 5 to 20 mm Hg • Dietary Approaches to Stop Hypertension (DASH) Diet • Low sodium • <2.4 g of sodium/day • Low fat • Limited starchy foods • Increased vegetable and fruit intake

  25. HypertensionCollaborativeCare • Lifestyle modifications • Moderation of alcohol consumption: • Men: no more than 2 drinks/day • Women: no more than 1 drink/day • Physical activity: • Regular physical (aerobic) activity, at least 30 minutes, most days of the week • Avoidance of tobacco products • Stress management

  26. HypertensionCollaborativeCare • Drug therapy: • Primary actions of drugs to treat hypertension • Reduce SVR • Reduce volume of circulating blood • Classifications of drugs used to treat HTN • Diuretics • Adrenergic inhibitors • Direct vasodilators • Angiotensin inhibitors • Calcium channel blockers

  27. HypertensionCollaborative Care • Diuretics • Inhibit NaCl reabsorption in the tubules • Increases excretion of Na and Cl • Potassium-sparing diuretics reduce excretion of K+ • Types: • Thiazide diuretics: • hydrochlorothiazide (HydroDiuril), metolazone (Zaroxolyn) • Loop Diuretics: • bumetanide (Bumex) furosemide (Lasix), torsemide (Demadex) • Potassium-sparing diuretics: • triamterene (Dyrenium) • Aldosterone Receptor Blockers: • spironolactone (Aldactone)

  28. HypertensionCollaborativeCare • What will you monitor in patients taking diuretics? • I & O • Daily Weight • Electrolyte abnormalities • Potassium • Sodium • BP • Orthostatic hypotension • Ototoxicity (Lasix) • Dizziness, vertigo

  29. HypertensionCollaborative Care • Adrenergic inhibitors • Central-Acting α-1 Adrenergic Antagonists • Reduce sympathetic outflow from CNS • Reduces peripheral sympathetic tone, produces vasodilation, decreases SVR and BP • Types: • Clonidine (Catapress) • Methyldopa (Aldomet)

  30. HypertensionCollaborativeCare • Adrenergic inhibitors • α-1 Adrenergic Blockers • Block α-1 adrenergic effects, producing peripheral vasodilation (decreases SVR and BP) • Types: • Doxazosin (Cardura), Prozosin (Minipress), Terazosin (Hytrin) • β-Adrenergic Blockers • Decrease CO and reduce vasoconstrictor tone • Types: • Atenolol (Tenormin), metoprolol (Lopressor), propranolol (Inderal)

  31. HypertensionCollaborativeCare • What will you monitor in patients taking Adrenergic-Blockers? • Dry mouth • Central-Acting α-1 Adrenergic Antagonists • BP • Orthostatic hypotension • Retention of salt and water • α-1 adrenergic blockers • Bronchospasm • β-Adrenergic Blockers • Bradycardia • β-Adrenergic Blockers

  32. HypertensionCollaborative Care • Direct vasodilators • Reduce SVR and BP by arterial vasodilation • Types: • Hydralazine (Apresoline), nitroglycerin (Tridil), sodium nitroprusside (Nipride) • What will you monitor for? • BP • Tachycardia • Flushing • Palpitations • Dizziness • Angina • Headache

  33. HypertensionCollaborativeCare • Angiotensin inhibitors • Angiotensin-Converting Enzyme (ACE) Inhibitors • Reduce conversion of Angiotensin I to angiotensin II, prevent vasoconstriction • Types: captopril (Capoten), enalapril (vasotec), lisinopril (Prinivil) • Angiotensin II Receptor Blockers • Prevent action of angiotensin II and produce vasodilation and increased salt and water excretion • Types: irbesartan (Avapro), valsartan (Diovan)

  34. HypertensionCollaborative Care • What will you monitor? • Angiotensin-Converting Enzyme (ACE) Inhibitors • BP • Dizziness • Loss of taste • Hyperkalemia • ARF • Angiotensin II Receptor Blockers • Hyperkalemia • Decreased RF

  35. HypertensionCollaborative Care • Calcium channel blockers • Block movement of extracellular calcium into cells, causing vasodilation and decreased HR, contractility, and SVR • Types: • Amlodipine (Norvasc), diltiazem (Cardizem), nifedipine (Procardia), verapamil (Calan) • What will you monitor? • BP • Bradycardia • Headache, dizziness, peripheral edema, flushing

  36. HypertensionCollaborative Care • Drug therapy and patient teaching • Identify, report, and minimize side effects • Orthostatic hypotension • Sexual dysfunction • Dry mouth • Frequent urination

  37. HypertensionNursing Management • Nursing Assessment • Subjective data • Past health history • CV, renal, thyroid disease, DM, obesity • Medications • Prescription and OTC • Functional health patterns • Family history • Diet • Activity level • Stress • Objective data • Target organ damage • Peripheral pulses, abnormal heart sounds, BP >140/90

  38. HypertensionNursing Management • Nursing Diagnoses • Ineffective health maintenance r/t lack of knowledge • Anxiety r/t management regimen or lifestyle changes • Sexual dysfunction r/t medication side effects • Ineffective therapeutic regimen management r/t lack of knowledge, side effects of medications, return of blood pressure to normal while on medications • Ineffective tissue perfusion r/t complications of HTN (cerebral, CV, renal, retinal)

  39. HypertensionNursing Management • Collaborative problems • Potential complications: • Adverse effects from antihypertensive therapy (hypokalemia) • Hypertensive crisis • Stroke • Coronary artery disease (CAD) • Myocardial infarction

  40. Hypertensive Crisis • Severe, abrupt increase in DBP • defined as DBP >140 mm Hg • Rate of increase in BP is more important than the absolute value • Often occurs in patients with a history of HTN who have failed to comply with medications or who have been undermedicated

  41. Hypertensive Crisis • Hypertensive Emergency • Develops within hours to days • BP > 180/120 mm Hg • Acute target organ damage • May precipitate: • Hypertensive encephalopathy, cerebral hemorrhage • Acute renal failure • Myocardial infarction • Heart failure with pulmonary edema • Hyptertensive Urgency • Develops within days to weeks • No clinical evidence of target organ damage

  42. Hypertensive CrisisClinical Manifestations • Hypertensive Emergency • Hypertensive encephalopathy • Sudden rise in BP associated with HA, N/V, seizures, confusion, coma • May also have blurred vision and transient blindness • Due to increased cerebral capillary permeability leading to cerebral edema and disruption in cerebral function • Renal insufficiency • CV decompensation • Unstable angina • MI • Pulmonary edema

  43. Hypertensive CrisisNursing and Collaborative Management • Hospitalization • IV drug therapy • Sodium nitroprusside (Nipride) – MOST EFFECTIVE • Titrated to mean arterial pressure (SBP + 2 DBP) 3 MAP =

  44. Hypertensive CrisisNursing and Collaborative Management • Nursing Interventions • Monitor BP and HR every 3-5 minutes • Titrate med based on MAP • DO NOT DECREASE BP TO QUICKLY – may cause stroke, MI • Continual ECG monitoring • Hourly UO • Strict BP • Neurologic checks • LOC, pupil checks, movement and strength of extremities • CV and Respiratory assessment • pulmonary edema, HF, angina

  45. Hypertensive CrisisNursing and Collaborative Management • Hypertensive Urgency • Managed with oral medications • Difficult to regulate drugs • Need follow-up within 24 hours • May not need hospitalization • Nursing Interventions • Provide quiet environment • Encourage patient to verbalize concerns • Answer questions • Eliminate stimuli • Determine cause • Education to avoid future crises

  46. HypertensionNursing Management • Planning: Patient will • Achieve and maintain the individually determined goal BP • Understand, accept, and implement the therapeutic plan • Experience minimal or no unpleasant side effects of therapy • Be confident of ability to manage and cope with this condition

  47. HypertensionNursing Management Nursing Implementation • Health Promotion • Individual patient evaluation • Risk factors • Routine BP • Health assessment • Weight patterns • Family history • Blood pressure measurement • Screening programs • Cardiovascular risk factor modification • Modifiable: HTN, DM, obesity, tobacco cessation, physical inactivity

  48. HypertensionNursing Management Nursing Implementation Ambulatory and Home Care • Patient and family teaching includes • Nutritional therapy • Drug therapy • Physical activity • 30 minutes/day most days of week • Home monitoring of BP (if appropriate) • Rest 3-5 minutes prior to taking BP • No smoking, exercise or caffeine 30 minutes prior • Take daily and record in log • Tobacco cessation (if applicable)

  49. HypertensionNursing Management Nursing Evaluation • Patient will • Achieve and maintain goal BP as defined for the individual • Understand, accept, and implement the therapeutic plan • Experience minimal or no unpleasant side effects of therapy

  50. Hypertension in Older Persons • Isolated systolic hypertension (ISH) is the most common form of hypertension in individuals age >50 • The lifetime risk of developing hypertension is approximately 90% for middle-aged (age 55 to 65) and older (age >65) normotensive men and women • Why? • Loss of elasticity, increased PVR, blunting of baroreceptors, decreased renal function, decreased renin production

More Related