Essential Hypertension
Definition
Essential hypertension (also called primary hypertension or idiopathic hypertension) - no identifiable cause
It is BP >140 mm Hg systolic & >90 mm Hg diastolic over a sustained period based on the average of two or more BP measurements
most common type , affecting 95% of hypertensive patients
Can be primary or secondary to some other disease
Aetiology
Familial
An interaction between environmental and genetic factors
Genetic - familial
Aging
Obesity
Salt - salt sensitivity
Alcohol - excessive alcohol consumption
Renin Angiotensin system abnormalities
Diabetes - insulin resistance
Smoking - though it does not directly cause High BP
Lack of exercise
multiple etiologies, including renal, vascular, and endocrine causes
Pathophysiology
Aging - atherosclerosis - decreased elasticity of vessels - increased peripheral resistance - increased prssure damages blood vessels in organs such as the heart, kidneys, brain and eyes which may lead to myocardial infarction, cerebrovascular accidents, retinopathy, nephropathy, Hypertensive heart failure, Hypertensive encephalopathy
The classification of BP for adults aged 18 years or older has been as follows:
Classification
Normal: Systolic lower than 120 mm Hg, diastolic lower than 80 mm Hg
Prehypertension: Systolic 120-139 mm Hg, diastolic 80-89 mm Hg
Stage 1: Systolic 140-159 mm Hg, diastolic 90-99 mm Hg
Stage 2: Systolic 160 mm Hg or greater, diastolic 100 mm Hg or greater
Clinical Manifestations
May be asymptomatic and end in one of the complications
Head ache
Pain in the shoulder and back of neck mimicking cervical spondylosis
Giddiness
Palpation of all peripheral pulses : Absent, weak, or delayed femoral pulses suggests coarctation of the aorta
Look for carotid bruits, distended veins, or enlarged thyroid gland.
Renal artery bruit over the upper abdomen : renal artery stenosis.
Signs of LVH : Displacement of apex, a sustained and enlarged apical impulse, and the presence of an S4.
Investigations
Retina examined
Urne analysis
Blood chemistry ( Na, K, creatinine, blood glucose, HDL leves)
A 12 lead ECG - LVH
BUN
Creatinine
Renin level
24 hour urine protein
Microalbuminuria
Medical Management
Aim : Achieving and maintaining a BP of 140/90
Reduce Sodium intake
Exercise
Reduce weight
Stop smoking
Limit alcohol
Nursing Process
Assessment : Periodical check up of BP,
Nursing diagnosis : knowledge deficiency identified, non compliance detected
Collaborative problems / Potential complications : LVH, MI, Heart Failure, TIAs, CVA
Drug Management
Uncomplicated Hypertension : Diuretics, Beta-blockers, ACE inhibitors, Angitensin II receptor blockers, Alpha-blockers. betablockers, calcium antagonists, diuretics
Compelling indications :
DM type I with proteinuria : ACE inhibitors
Heart failure : ACE inhibitors, diuretics
Isolated systolic hypertension : (older people) : Diuretics preferred, Long acting dihydropyridine (calcium antagonist)
Myocardial infarction : beta blockers, ACE inhibitors (with systolic dysfunction)
Start with a low dose of long acting once daily and titrate dose.
Low dose combinations are appropriate
Drugs : Diuretics : thiazide diuretics: Chlorthalidone, Chlorothazide, hdrochlorothiazide (Esidrex, Hydro DIURIL)
Loop diuretics : Furosemide; Potassium-sparing diuretics : spironolactone (Aldactone, tiamterene)
Adrenergic agents : reseroine (Serpasil)
Central Alpha Agonists : methyldopa (Aldomet)
Clonidine hydrochloride (Catapres)
Beta blockers : Propranolol (Inderal), metoprolol (Lopresor), nadolol (Corgard)
Alpha blocer : Prazosin hydrochloride (Minipres)
Vasodilators : Fenoldopam mesylate, hydralazine hydrochloride (Apresoline), minoxidil, Sodium nitroprusside, nitroglycerin, diazoxide (Hyperstat, NitroBid IV, Tridil)
Angiotensin-Converting Enzyme Inhibitors : benazepril, captopril, enalapril, lisinopril, ramipril, trandolapril
Angiotensin II Receptor Blockers : Candesartan, losartan,valsartan, irbesartan
Calcium antagonists : Diltiazem, verapamil (Isoptin SR)
Dihydropyridines : nifedipine, amlodipine, felodipine, nicardipine, nisoldipine
Nursing Interventions
Life style changes taught
Encourage periodical monitoring of BP
Teach how to lose weight
Make the patient realize that BP is only controlled not cured.
Mr.Kaja 50 years old is admitted with hypertension. Write signs and symptoms of HTN. Describe the medical and nursing management of Mr.Kaja.
