Hypertension

Hypertension: A systolic BP between 120- and 139-mmHg or diastolic pressure between 80- and 89-mmHg is classified as prehypertension.

S – igns and symptoms

• Maybe asymptomatic

• Headache

• Visual changes

• Dizziness

• Chest pain

• Tinnitus

• Red face

• Epistaxis

I – nterventions

• Decrease blood pressure through diet and exercise

• Decrease sodium intake

• Moderation in alcohol and caffeine

• Avoidance or smoking cessation

• Relaxation techniques

• Elimination of unnecessary medication that may lead to hypertension.

Medical interventions:

1.     Diuretics e.g., furosemide (Lasix), hydrochlorothiazide (Hydrodiuril), spironolactone (Aldactone).

2.     Beta-adrenergic blockers e.g., metoprolol (Lopressor), nadolol (Corgard), atenolol (Tenormin), propranolol (Inderal).

3.     Angiotensin-Converting Enzyme (ACE) Inhibitors e.g., captopril (Capoten), enalapril (Vasotec), lisinopril (Zestril).

4.     Angiotensin II Receptor Blocker e.g., candesartan (Atacand), Irbesartan (Avapro), losartan (Cozaar), valsartan (Diovan).

5.     Calcium Channel Blockers e.g., verapamil (Isoptin), nifedipine (Procardia), diltiazem (Cardizem).

M – ain causes

• Primary hypertension: No known cause (aging, family history, race, obesity, smoking, stress, alcohol, hyperlipidemia, high salt or caffeine).

• Secondary hypertension: Cause by other disorders or condition (cardiovascular disorders, renal disorders, endocrine disorders, pregnancy, medications [estrogen, corticosteroids]).

P – otential complications

• Stroke

• Heart failure

• Hypertensive crisis

• Renal failure

• Visual changes

L – aboratory assessments/Diagnostic Test

• Monitor blood pressure

• Obtain weight

• Assess visual changes or retinal damage

• Assess cardiovascular changes (e.g., jugular vein distention and dysrhythmia)

• Chest X-ray for cardiomyopathy

• Assess neurological status

• Evaluate renal function

E – ducation 

• Emphasize compliance of following the treatment plan and in taking their medication as prescribed. Do not stop the medication abruptly to prevent severe hypertensive reaction.

• Emphasize the importance of following the proper diet and exercise. Avoiding high sodium and cholesterol foods.

• Instruct the patient and family the importance of monitoring the blood pressure and maintaining a diary of blood pressure readings.

• Advise the patient about the actions and possible side-effects of the medications and when to contact the physician.

• Stress the importance of follow-up care.

• Instruct the patient to avoid over-the-counter drugs.

• Encourage to avoid stress and use relaxation techniques.

• Rise slowly to decrease orthostatic hypotension, lie or sit down if dizziness occurs.

• Have a diet rich in potassium (e.g., citrus fruits, banana, and green leafy vegetables) if taking potassium losing diuretics.

• Inform the patient that medication side-effects may diminish in time.

NB: White coat hypertension – elevated blood pressure readings in a clinical setting and normal readings when blood pressure is measured elsewhere. Masked hypertension – Normal blood pressure reading in a clinical setting but elevated blood pressure at home.