HYPERTENSION

                                                                      HYPERTENSION 

Definition:

Hypertension is defined as the sustained increase in blood pressure more than 140/90 mm hg on average 2 times of sitting reading.

Pathophysiology :

Etiological factors will cause activation of vasoactive substance leading to vasoconstriction in peripheral arterioles causing activation of renin charecterized by Angiotensin II release leading to sodium & water retention resulting in high blood pressure

Etiology & risk factors :

• Primary Hypertension : elevation in BP without identified cause
• Secondary Hypertension : elevation of BP with exact cause

Causes of Secondary Hypertension:

• Congenital Narrowing of Aorta
• Renal disease
• Endocrine disorders like Cushing's syndrome
• Sleep Apnea
• Brain disorders including brain tumor or injury
• Medications like NSAIDs, cocaine
• Liver cirrhosis

Risk factors :

• Family history
• Genetics
• Obesity
• Age over 50 years
• Sedentary lifestyle
• Stress
• Alcoholism, Smoking

Types of HTN:

• Pre HTN :SBP- 120-139 mmHG  DSB80-89 mmHG
• Hypertension stage I - SBP140-159 mmHG   DBP-90-99 mmHg
• Hypertension Stage II - SBP: More or equal to 160 mmHg  DSB :More or equal to 100 mmHG
• Pregnancy induced Hypertension : Rise in BP more tha 140/90 mm Hg during pregnancy & subsides after 12 weeks of post partum 

Sign & Symptoms :

• Asymptomatic 
• Headache 
• Dizziness
• Blurred vision 
• Nausea/ vomiting
• Epistaxis
• Chest pain
• Shortness of breath
• Pappiledema

Medical & Nursing Management :

Step I : Non Pharmacological Measures :

• DASH diet
• No smokin, alcohol & caffeine reduction

Step II : Pharmac Measures

• Diuretics - Furosemide, Spironolactone, Bumetanide
• Beta Adrenergic Blockers to block agents to lower HR & Cardiac output - Propanolol, Atenolol, Metoprolol
• Calcium Channel Blockers to cause peripheral vasodilation - Nifedipine, Necardipine
• ACE inhinitors to inhibit Renin Angiotensin Aldosterone System-  Enalpril, Captopril

Step III- Increase dosages of currently administered medication
Step IV- Combination of multiple drugs

Distinctive Facts:

•  Ix- BP monitoring, EKG, BUN, Lipid Profile
• Also called as "SILENT KILLER "
• Complications include Stroke, Retinal Damage, Heart failure
• Identification of "WHITE COAT" Hypertension is mandatory
• Benign Hypertension distinguishes this type of high blood pressure from the more aggressive and rapidly developing accelerated hypertension which is also known as malignant hypertension.
• Malignant high blood pressure is more acute and severe rapidly reaching its end stage which may be stroke, heart attack or heart failure if left unattended.

Prognosis :

• Majority patients have primary HTN & patients are asymptomatic. 
• Life style modifications & medicine intake are must to reduce end organ damage to vital organs.