Lilith Hutchinson BSN, RN

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Determine factors regulating blood pressure

Classify the characteristics of hypertension Review current national recommendations

for treatment of hypertension Review classifications of hypertensive

medications Nursing Care Practices Identify treatment of hypertension in

specific populations2

There are intrinsic, neurological, hormonal, renal mechanisms to control the blood pressure.

Blood pressure (BP) is the forced exerted by the blood(cardiac output) against the walls of the blood vessel (vascular resistance)

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Hypertension (HTN) develops when any one or a combination of the systemic and local peripheral mechanisms are defective.

The blood flow can’t overcome the opposing forces of resistance to maintain cardiac output and over time the arterial pressure will fall. 4

Initial therapy is directed by:Blood Pressure Readings

Primary and secondary causes

The guidelines are based on the mean of two

or more properly measured seated B/P.

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Obesity( central) Insulin resistance or

overproduction is its own hypertensive risk factor

Dyslipidema is the metabolic dysfunction of the lipids

Maintaining B/P >130/80 6

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Intrinsic: tissue perfusion Coractation, SNS overacting

Neurological: vasomotor center Brain injuries, tumors

Hormonal: vasomotor tone and volume Aldosteronism

Renal mechanisms Cushing’ Disease, Polycystic Kidneys

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Blood Pressure

(B/P)Classificatio

n

Systolic DiastolicInitial Drug

Therapy

Normal <120 and< 80 None

Pre Hypertension

120-1 39 OR 80-89 Treat indicators

Stage 1 Hypertension

140-159 OR 90-99 Treat the pressure

Stage 2

Hypertension>160 OR > 100 Diuretic

Ace InhibitorB-Blocker

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Enhances Drug Regimens Affordable B/P Control~ Underused Slow demineralization in Osteoporosis

Side Effects:, decreased libido, glucose intolerance, potentiates digoxin toxicity

Contraindications: Gout and Low NA+ 10

Heart Failure Potent with short duration of action

Side Effects: Ototoxicity, lipid increase, Non-potassium sparing the K+

Nursing Implications Orthostatic changes Electrolyte abnormities Medicine Compliance

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Stable angina Asymptomatic ventricular dysfunction Arial tachyarrhythmia/ fibrillation Preoperative hypertension: direct arterial

vasodilatation

Contraindications: asthmatic, heart block, restrictive airway disease

Implications: monitor pulses, Check blood sugars due to its masking effect of hypoglycemia,

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Asymptomatic ventricular dysfunction Arrhythmias

Action: Block extracellular calcium in to cells Vasodilatation and decreases vascular resistance

Side effects: reflex tachycardia, hypotension

Contraindication: 2nd and 3rd heart block

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Peripheral: Prevent the release of norepinephrine or deplete the stores to cause vasodilatation Avoid with elderly and coronary or cerebral

compromise a Adrenergic Blockers: Block adrenergic receptors

causes vasodilatation and orthostatic hypotension Central: reduce sympathetic out from CNS to cause

vasodilatation Clonidine, Methyldopa

Daytime sedation. Dry mouth, Caution use with Bradycardia with conduction disorders

Sudden withdrawal: Rebound HTN, Tachycardia, HA, tremors and sweating

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ACE: ANGIOTENSION-CONVERTING ENZYME

ARB’S:ANGIOTENSION II RECEPTOR BLOCKERS

Prevents vasoconstriction

SE: loss of taste, cough, renal failure

Meds: (Ramipril, Vasotec) Not with CVVH

Produces vasodilatation Na and water retention

SE: Hyperkalemia, Decrease renal function

Meds: (Lorstan, Cozaar)

Ace and ARB’s Cause fetal morbidity and mortality

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Potassium-Sparing Diuretics End- Sage Heart Disease Combines with Ace inhibitors and BB

Decreased Renal excretion or filtration Inhibit bodies ability to retain NA and excrete K+

Hormonal SE: gynecomastia, impotence, decreased libido and menstrual irregularities

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The presence of a silent gap should be recorded

White Coat HTN is the elevation of the B/P without organ injury

Knowledge: Illness and Management

Physical Findings

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Documentation Goal directed Follow-up / Reinforcement Mechanisms Written: Medications /Reactions

Support Systems Include pharmacists, social services, and

dietitians Evaluate diuretic uses Cost and barriers to access medical care Eating to change health

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Ambulatory B/P monitoring EKG Chest Labs

CBC BMP Creatinine/BUN U/A Lipids

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Malignant hypertension related to noncompliance Degree of crisis is related to target organ damage

Vision Disturbances /level of consciousness (LOC)

Level 160/100: Manage the rate the B/P is rising

Clinical : Headache, N/V, Seizures, Changes in LOC Meds: IV Nipride (Nitroprusside) protect from light

Caution direct dilators with left ventricular hypertrophy

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Absence of target organ damage

No IV Medications to control B/P

Managed outpatient basis Rest Oral medications

Next day follow-up

Education 21

Support the need to expression of fears and any reactions to treatments

Hispanic and American Indians least controlled population

Understand cultural differences builds trust

Dispel cultural misunderstandings Lack of symptoms = no disease Medications = ill health

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Oral contraceptive increases risk of HTN

Watch for Creatinine levels of >1.3 for women 1.5 men

Women and lighter weight persons are caution to limit one drink per day

Pregnant and sexually active girls should not be on ARB’s or ACE inhibitors

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The use of anabolic steroids causes fluid retention and increase LDH

80 % of the children have an identifiable cause Kidney disease , coarctation of the aorta

Repeated B/P measurements at 95 percentile Diastolic determined by the fifth Korotkoff

sound

No restriction of physical activities Medications instituted when lifestyle changes

fail Adjusts doses for child's body makeup24

Isolated Systolic Hypertension: Sustain >160/90Difficult to get systolic control

Loss of tissue elasticity: stiff myocardium Decreased physiological response to sodium

and water depletion

Increased of orthostatic hypotension >10mmHg Dementia /Cognitive impairments related to

HTN

Decreased renal and liver function affects medication absorption ,metabolism, and, excretion 25

Degree of Participation Dietary Exercise B/P levels

Lipid management ~ Preventive

Smoking Drinking Cessation Efforts

Documented Reactions

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Chobanian, A., Bakris, G., Black, H., Cushman, W., Green, L., Izzo, J., Jones, D., Materson, B., Oparil, S., Wright, T., Roccella, E., and the National High Blood Pressure Education Program Coordinating Committee. The seventh report of the Joint National Committee on Prevent, Detection, Evaluation and Treatment of High Blood Pressure. Hypertension. 2003;42:1206-1252.

Hall, J., Granger, J., Reckelhoff, J. Sandberg, K. Hypertension and Cardiovascular Disease in Women. down loaded on February 11, 2008 www.ahajournals.org/cgi/reprint/HYPERTENSIONAHA.107.009813v1

Lewis, S., Heitkemper, M., and Dirksen, S., (6th ed). (2004). Medical-surgical nursing – Assessment and management of clinical problems. St. Louis: Mosby.

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