Causes of Hypertension (HTN)

Hypertension (HTN) A persistent or intermittent elevation of the systolic BP above 140 mm Hg or diastolic BP above 90 mm Hg.

Primary (Essential) HTN
Incidence: Most common type.

Onset: Gradual (over many years).

Etiology: Underlying cause is unknown.

Clinical Findings:Typically asymptomatic, primary HTN is usually not recognized until secondary complications develop, including atherosclerosis, transient ischemic attacks (TIAs), strokes, myocardial infarction (MI), left ventricular hypertrophy, congestive heart failure (CHF), and renal failure.

Secondary HTN
Incidence: Less common.

Onset: Varies according to etiology.

Etiology: Can result from any condition that impairs normal regulation of blood pressure, such as renal, endocrine, vascular, or neurological disorders.

Clinical Findings: Variable, but most common symptoms are CV and neurological (malaise, weakness, fatigue, flushing of the face, HA, dizziness, lightheadedness, nose bleeds, ringing in the ears, or blurred vision) as well as symptoms associated with the underlying etiology.

Four Stages of HTN
■ Normal: Systolic BP < 120 mm Hg and Diastolic BP < 80 mm Hg
■ Prehypertension: SBP 120–139 mm Hg or DBP 80–89 mm Hg
■ HTN Stage I: SBP 140–159 mm Hg or DBP 90–99 mm Hg
■ HTN Stage II: SBP ≥ 160 mm Hg or DBP ≥ 100 mm Hg

Nursing Focus
■ Monitor vital signs and document response to prescribed therapies for reducing blood pressure.
■ Assess for signs of end-organ dysfunction (angina, low serum potassium levels, elevated serum creatinine and blood urea nitrogen [BUN], proteinuria, and uremia).
■ Implement collaborative care such as administering antihypertensive meds.
■ Caution: It is critical that BP be reduced gradually; an excessive and rapid reduction in BP can precipitate cerebral, myocardial, and renal ischemia.

Patient Teaching
■ Provide Pt with literature on reducing high blood pressure.
■ Encourage necessary lifestyle modifications including weight reduction (for Pts who are overweight), limiting alcohol intake to 1 drink per day, increased physical activity (30–45 minutes a day), and smoking cessation.
■ Review dietary guidelines and stress importance of reading food labels to avoid processed foods high in sodium, saturated fats, trans fats, and cholesterol.
■ Provide information to help Pt reduce intake of sodium, saturated fats, and cholesterol, and keep consumption of trans fats to an absolute minimum.
■ Explain importance of maintaining adequate intake of potassium, calcium, and magnesium.
■ Explain the actions, dosages, side effects, and adverse reactions of HTN meds.