Case Study on Hypertension

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Jan 9, 2024

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1 Case Study on Hypertension Pavneet Kaur 138324231 Seneca College, King Campus CNC 108 KAA; Pathophysiology Miwa Sakakibara-Nguyen November 5, 2023
2 Hypertension When the pressure in the blood vessels is too high (140/90 mmHg or greater), it is called hypertension (high blood pressure). Blood pressure is represented by two digits. The first (systolic) value represents blood vessel pressure when the heart contracts or beats. The second (diastolic) number represents the pressure in the arteries when the heart beats. Hypertension is diagnosed when the systolic blood pressure readings on consecutive days are more than 140 mmHg and the diastolic blood pressure readings are more than 90 mmHg. (WHO,2023) Etiology Blood pressure is determined by two primary factors: the volume of blood the heart pumps and the resistance the blood encounters as it flows through the arteries. There are primarily two forms of hypertension. Primary hypertension can also be referred to as secondary hypertension and essential hypertension. Adults with primary hypertension usually get it slowly over several years. The main cause of it is atherosclerosis (Plaque accumulation in the arteries). Secondary hypertension, in contrast to primary hypertension, usually appears unexpectedly and raises blood pressure. Secondary hypertension can result from conditions, such as adrenal gland tumor, congenital heart defects, certain medications (such as painkillers, cold cures, and contraception pills), illegal drugs (like cocaine), kidney disease, thyroid issues, and obstructive sleep apnea. (Mayoclinic,2022) Risk factors Risk factors can be classified as nonmodifiable or modifiable. A family history of hypertension, advancing age, and ethnic or genetic predispositions are all nonmodifiable risk factors. Modifiable risk factors, include dietary variables, sedentary lifestyle, obesity or weight rise,
3 metabolic syndrome, elevated blood glucose levels or diabetes, elevated total cholesterol levels and consuming excessive amounts of alcohol and tobacco. (Mayoclinic,2022) Treatment High blood pressure is treated with a mixture of medication and lifestyle modifications. Changing one's lifestyle to a healthy, low-sodium diet, avoiding foods higher in trans or saturated fats, doing regular physical activity such as cardio and aerobics, and maintaining a healthy weight, and giving up chewing tobacco and alcohol are all important steps in treating hypertension. Other than lifestyle changes medication that treat hypertension includes ACE inhibitors (like lisinopril), Angiotensin-2 receptor blockers (like telmisartan), Calcium channel blockers (like amlodipine), and Diuretics (like hydrochlorothiazide). These drugs function by reducing water retention, protecting the kidneys, and relaxing blood arteries of the body. (WHO) Prognosis and Outcome The prognosis is dependent on blood pressure control and is only favourable if blood pressure is brought under proper control. Since hypertension is a progressive condition, problems may arise in some people. Effect of Hypertension On Cardiovascular System Hypertension can lead to arterial stiffness, reducing their elasticity and impairing blood flow to the heart. This can result in chest pain, known as angina (occurs due to inadequate oxygen supply to the heart). Uncontrolled hypertension can lead to heart attacks (which causes a blockage in the blood vessels) resulting damage to the heart muscle. Prolonged high blood pressure may also
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4 lead to heart failure (heart's inability to pump sufficient blood and oxygen to support the body's vital organs and tissues). On Renal System The arteries that carry blood in kidneys can begin to constrict due to high blood pressure, which lowers blood flow and prevents the kidneys from functioning properly. When this occurs, body's kidneys are unable to eliminate all waste products and excess fluid. Extra fluid in the blood arteries may accelerate renal failure by raising blood pressure and starting a deadly cycle of harm. Pathophysiology The cardiovascular system's pathophysiology of hypertension includes harmful alterations to the heart and blood arteries. Chronic stress from hypertension causes structural alterations in the blood arteries. Arteriosclerosis (thickening and constriction of the arteries), is one of these alterations. The flexibility of blood arteries is reduced by increased arterial stiffness, making it more difficult for them to expand and contract, which affects with blood pressure regulation. The development of plaques inside the arteries further narrow and stiffens the arteries. It may result in blood clots forming, which may induce myocardial infarctions, arrhythmias and heart failure. (Benjamin et al.,2019) Hypertension can cause renal function to deteriorate. The pathophysiology of hypertension in the context of chronic kidney disease is complicated and involves the interaction of numerous factors, such as endothelial dysfunction, sodium retention and volume expansion, increased sympathetic nervous system activity, and hormonal factors consisting of renin-
5 angiotensin-aldosterone system stimulation. The progression of end-stage renal disease can be accelerated by inadequately controlling hypertension. (Kalra.A.P et al.,2021) Interventions Several major priorities are involved in providing patients with hypertension. Achieving and sustaining appropriate blood pressure control is essential in order to lower the risk of major cardiovascular events. Encouraging and supporting lifestyle changes that may drastically decrease blood pressure and improve overall cardiovascular health include eating a heart-healthy diet, exercising regularly, controlling weight, and quitting smoking. Antihypertensive medication effectiveness depends on medication adherence because non-adherence increases the risk of side effects and results in uncontrolled hypertension. Planning routine follow-up discussions with healthcare experts facilitates patient education and support, medication modifications as needed, and monitoring. Reducing the overall risk of heart disease and stroke by managing blood pressure and evaluating cardiovascular risk factors. Patients who receive adequate knowledge are more equipped to take an active role in their care and modify their lifestyles as needed. It's critical to keep an eye out for hypertension-related concerns like renal disease, vision issues, and vascular damage in order to stop future harm and enhance general health. Evaluation The effectiveness of patient interventions is assessed using a structured procedure that involves multiple important stages. The patient's progress is continuously tracked and evaluated in relation to these established objectives both during and after the intervention. Regular evaluations of vital signs, symptoms, test results, and patient-reported outcomes may be a component of this. To find out if the intervention is producing the expected results, the data is
6 evaluated. The approach to treatment may be modified if the intervention does not produce the desired effects. To guarantee the best results, thorough data collection, impartial analysis, and a patient-centered approach are necessary for the assessment of patient treatments to be beneficial. References Benjamin, E. J., Muntner, P., Alonso, A., Bittencourt, M. S., Callaway, C. W., Carson, A. P., ... & Virani, S. S. (2019). Heart disease and stroke statistics—2019 update: a report from the American Heart Association. Circulation, 139(10), e56-e528. https://pubmed.ncbi.nlm.nih.gov/30700139/ Bhailis.A.M., Kalra.P.A.2022 May 2;Hypertension and the kidneys,83(5):1-11. https://pubmed.ncbi.nlm.nih.gov/35653320/#:~:text=In%20the%20setting%20of %20chronic,such%20as%20upregulation%20of%20the Centers for Disease Control and Prevention. (2021, May 18). High blood pressure. CDC. https://www.cdc.gov/bloodpressure/about.htm#:~:text=High%20blood%20pressure%20can %20damage%20your%20arteries%20by%20making%20them,and%20leads%20to %20heart%20disease Grol, R., Wensing, M., Eccles, M., & Davis, D. (2013). Improving Patient Care: The Implementation of Change in Health Care. John Wiley & Sons. https://onlinelibrary.wiley.com/doi/book/10.1002/9781118525975 James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J., ... & Ortiz, E. (2014). 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA, 311(5), 507-520. https://pubmed.ncbi.nlm.nih.gov/24352797/ Mayo Clinic. (2022, September 15). High blood pressure (hypertension). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms- causes/syc-20373410
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7 Mayo Clinic. (2022, August 9). Secondary hypertension. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/secondary-hypertension/symptoms- causes/syc-20350679?p=1 Seneca College. (n.d.). Course Outline. https://learn.senecacollege.ca/ultra/courses/_711554_1/outline/edit/document/_18156365_ 1?courseId=_711554_1 World Health Organization. (2023, March 16). Hypertension (high blood pressure). WHO. https://www.who.int/news-room/fact-sheets/detail/hypertension#:~:text=Hypertension %20(high%20blood%20pressure)%20is,get%20your%20blood%20pressure%20checked . World Health Organization. (n.d.). Hypertension (high blood pressure). WHO. https://www.who.int/news-room/fact-sheets/detail/hypertension#:~:text=Hypertension %20(high%20blood%20pressure)%20is,get%20your%20blood%20pressure%20checked .

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