Hypertension- Assignment 2
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Hypertension Donna McKinty, SJ6 Unitek College Savella 01/11/2024
Hypertension Often called the silent killer, high blood pressure, or hypertension is a noncommunicable disease that affects the heart and arteries. It is estimated that 1.28 billion adults between 30 and 79 years of age have hypertension, and nearly half of adults with the disease do not even know they have it (World Health Organization, n.d.). This is the reason hypertension is called the silent killer. Most people with high blood pressure do not have any symptoms or contribute their symptoms to other causes and so their blood pressure can reach dangerous levels without them ever knowing it (Mayo Clinic, n.d.), which is why it is important to have regular checkups with your healthcare providers. Hypertension is dangerous on its own, but it can potentially lead to other life-threatening diseases as well, so getting it under control is extremely important. What is Hypertension? Blood pressure is a measurement of how much pressure your blood is putting on your arteries as it flows through them and consists of systolic and diastolic pressures. Systolic pressure is the first, or higher number of the measurement and indicates the pressure of your heart’s ventricles pumping blood out of the heart. Diastolic pressure is the
second, or lower number of the measurement and indicates that your heart is filling with blood. Measurements should look something like this: 120/80 mm Hg. Blood pressure can be classified according to how low or high an individual’s readings are, with
normal blood pressure considered to be less than 120 mm HG systolic and less than 80 mm Hg diastolic. Stage one of hypertension is measured as systolic pressure of 130 - 139 mm Hg or higher, or diastolic pressure of 80 - 89 mm Hg or higher, stage two hypertension is 140 mm Hg or higher systolic, or 90 mm Hg or higher diastolic, and patients with measurements higher than 180/120 mm Hg are considered to be
having a hypertensive crisis, which is a medical emergency and requires immediate medical intervention. (AHA, n.d.). Causes and Risk Factors for Hypertension Hypertension typically falls into two categories: primary hypertension, and secondary hypertension. Risk factors include advanced age, family history and genetics, race (high blood pressure is more common among Black people), obesity or excessive weight, lack of exercise, tobacco use, including vaping, excess sodium in your diet, low potassium, alcohol abuse, stress, some chronic health conditions, and pregnancy (Mayo Clinic, n.d.). Hypertension is more common in adults and is also found in children due to issues with their heart or kidneys, but it is increasingly related to living an unhealthy lifestyle. Primary, or essential hypertension does not have a cause that can be identified, and usually has a slow onset over several years of a person’s life.
Atherosclerosis may increase the risk of developing this type of hypertension, but it is not the cause. Secondary hypertension is due to an identifiable underlying condition, and there are many different contributors to secondary hypertension. They include kidney disease, adrenal disease, hyperparathyroidism, thyroid dysfunction, obstructive sleep apnea, and coarctation of the aorta. Side effects of some medications are also responsible for secondary hypertension, such as hormonal contraceptives, NSAIDs, diet pills, decongestants, antidepressants, immune system suppressants, and stimulants (Cleveland Clinic, n.d.) Hypertension causes excessive pressure on the walls of your arteries, which can lead to damaged blood vessels and hypertrophy of the ventricles. This damage may present as stenosis of the arteries, atherosclerosis, pulmonary embolism (PE), cerebral vascular accident (CVA), myocardial infarction (MI), weakening of the arteries which can lead to aneurism formation,
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heart failure, kidney damage, hypertensive retinopathy, metabolic syndrome (collectively referred to as metabolic syndrome, this refers to a group of disorders related to the body’s metabolism), changes to memory and cognition, and dementia (Mayo Clinic, n.d.). Diagnosing Hypertension As mentioned above, most people experiencing hypertension have few or no symptoms. Those who do experience symptoms can have symptoms that widely vary, from headaches, blurred vision or other vision changes, angina, shortness of breath, anxiety, tinnitus, dyspnea, nausea, vomiting, confusion, epistaxis, and dysrhythmias. Only a healthcare provider can diagnose hypertension. To do this, your healthcare provider must take at least three separate blood pressure measurements a week apart. Prior to having your blood pressure measured, make sure to prepare by avoiding coffee, nicotine, and exercise for at least 30 minutes, relax for 5 minutes before the test, do not cross your legs, or talk, and rest your arm so that your arm is at the level of your heart. Other methods of diagnosing hypertension may include diagnostic imaging, such as chest XRAY, electrocardiogram, and echocardiography. Your healthcare provider may order lab work to determine any underlying causes, or to determine if you have conditions that may worsen your hypertension including a complete blood count (CBC), comprehensive metabolic panel (CMP), and urinalysis (MedlinePlus, n.d.). Medications, Treatments, and Prevention of Hypertension There are many options available for the treatment and prevention of hypertension. Prevention should include lifestyle modification, including changes in diet and exercise. Diet modification should include calorie restriction if you are overweight or obese, eating more vegetables and fruit, while reducing the amount of sodium, trans and saturated fats, and alcohol,
and exercise should include getting at least 30 minutes of vigorous exercise a day. These should also help you lose weight, which is important if you are overweight or obese. Treatments include the above and medications to help lower your blood pressure. Medications to treat hypertension include angiotensin-converting enzyme, or ACE inhibitors that work via vasodilation (lisinopril, benazepril). Angiotensin II receptor blockers, or ARBs work via vasodilation (candesartan, losartan). Calcium channel blockers relax blood vessels (amlodipine, diltiazem). Diuretics, sometimes called water pills, help to eliminate excess water from the body, come in different classes, and contain several drugs. Thiazide diuretics (hydrochlorothiazide, chlorthalidone) (NCBI.NLM.NIH, n.d.), loop diuretics (furosemide, torsemide, bumetanide), and potassium sparing diuretics (spironolactone, amiloride, eplerenone). Beta-adrenergic blockers work by slowing the heart rate (atenolol, metoprolol, propranolol). Nursing diagnoses for hypertension include “ineffective health maintenance related to lack of knowledge about hypertension management
” as evidenced by poor diet and exercise practices. Interventions include monitoring the patient’s blood pressure and educating the patient on lifestyle changes. The patient can either purchase a machine for use at home, go to a local pharmacy, or regularly visit their doctor to have their blood pressure monitored, and they should keep a log of their blood pressure measurements. Lifestyle changes will require education on exercise and a recommendation to the provider for a referral to an RD for education on dietary changes and meal planning. Interim meal recommendations should include eating more fruits and vegetables, reducing intake of trans and saturated fats, and reducing sugary foods and drinks. Another nursing diagnosis may be “excess fluid volume
related to excess sodium intake
”
as evidenced by weight gain and peripheral edema. Interventions include daily weigh-ins at home on the same scale at the same time of day, and blood pressure monitoring, again the patient
can either purchase a machine for use at home, go to a local pharmacy, or regularly visit their doctor to have their blood pressure monitored, and should log their blood pressure measurements. Pt should not use different scales to avoid inaccurate results. Recommend RD for diet and meal planning, in conjunction with hydrochlorothiazide to encourage natriuresis. The patient should be taught to take their medication as prescribed and to monitor for any weakness, dehydration, nausea, vomiting, or other symptoms of hyponatremia. They should be instructed to return for lab work to monitor electrolyte levels. Conclusion Hypertension, the silent killer, is a serious disease that affects more than a billion people worldwide. As it is often undetected, many people are unaware that they have it. To reduce the number of people who have hypertension, efforts should be made to teach prevention, and to encourage people to do self-checks of their blood pressure regularly, or to regularly visit their healthcare provider’s office to monitor their blood pressure. If treatment is required, the provider may prescribe medications, and diet and lifestyle changes should be encouraged as these prevention methods may also help in the treatment of hypertension.
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References
(n.d.). High blood pressure
. National Heart, Lung, and Blood Institute. Retrieved December 29, 2023, from https://www.nhlbi.nih.gov/health/high-blood-pressure (n.d.). High blood pressure (hypertension)
. Mayo Clinic. Retrieved December 29, 2023, from https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-
causes/syc-20373410 (n.d.). Hypertension
. World Health Organization. Retrieved December 29, 2023, from https://www.who.int/news-room/fact-sheets/detail/hypertension (n.d.). Secondary Hypertension
. Cleveland Clinic. Retrieved December 29, 2023, from https://my.clevelandclinic.org/health/diseases/21128-secondary-hypertension Hegde S, Ahmed I, Aeddula NR. Secondary Hypertension. [Updated 2023 Jul 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544305/ Voorbrood, V. M. I., de Schepper, E. I. T., Bohnen, A. M., Ruiterkamp, M. F. E., Rijnbeek, P. R., & Bindels, P. J. E. (2024). Blood pressure measurements for diagnosing hypertension in primary care: room for improvement. BMC primary care
, 25
(1), 6. https://doi.org/10.1186/s12875-023-02241-z Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA, M. A., & Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team, D. C. (n.d.). High Blood Pressure Tests
. MedlinePlus. Retrieved December 29, 2023, from https://medlineplus.gov/ency/imagepages/19232.htm
Akbari, P., & Khorasani-Zadeh, A. (n.d.). Thiazide Diuretics
. National Library of Medicine National Center for Biotechnology Information. Retrieved December 29, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK532918/
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