NSG 326 Adult Health ISlide 2Blood PressureSlide 4Etiology of HypertensionSlide 6Why should we care about HTN????HYPERTENSIONISOLATED SYSTOLIC HYPERTENSIONFactors Influencing Blood Pressure (BP)HypertensionSlide 12Hypertension Risk FactorsSlide 14Primary Hypertension ComplicationsSlide 16Slide 17Diagnostic StudiesSlide 19Gerontologic ConsiderationsGerontologic Considerations (cont.)Slide 22Nursing & Collaborative ManagementQuestionAnswerLifestyle Modification of Risk FactorsLifestyle ModificationsSlide 28Drug TherapySlide 30Slide 31Nursing ManagementSlide 33Slide 34Slide 35Slide 36NSG 326 Adult Health ISpring 2011Hypertension3Blood PressureBP is the force created by the difference in the pressure of the blood as it leaves the heart & the resistance it meets flowing out to the tissues.It must be adequate to maintain tissue perfusion during activity and rest.So, any factor that alters cardiac output or peripheral vascular resistance will alter BP.5Etiology of HypertensionPrimary (essential or idiopathic) hypertension: elevated BP without an identified cause; accounts for 90% to 95% of all cases of hypertension.Secondary hypertension: elevated BP with a specific cause; accounts for 5% to 10% of hypertension in adults.7Why should we care about HTN????One in 3 U.S. adults has HTN or HBP74,500,000 adults ≥20 years of age have HTNMore men than women until age 45 yearsMore women than men after 64 years of ageHTN 2-3 times more common in women taking oral contraceptivesPrevalence in Blacks in U.S. is 41.4% (28.1% Whites) & actually 44% in Black womenHTN death rate in 2006 17.8 overall 69% first MI, 77% first stroke, 74% with HF have BP > 140/90 mm Hg8HYPERTENSIONPersistent elevation of Systolic blood pressure ≥140 mm Hg or Diastolic blood pressure ≥90 mm Hg or Current use of antihypertensive medication(s)PrehypertensionSystolic blood pressure: 120–139 mm Hg orDiastolic blood pressure: 80–89 mm Hg Isolated systolic hypertension SPB ≥140 mm Hg with DPB ≤90 mm HgThere is a direct relationship between hypertension and cardiovascular disease (CVD).9ISOLATED SYSTOLIC HYPERTENSIONIsolated systolic hypertension (ISH): average SBP greater than or equal to 140 mm Hg coupled with an average DBP less than 90 mm Hg. ISH is more common in older adults. Control of ISH decreases the incidence of stroke, heart failure, cardiovascular mortality, and total mortality.10Factors Influencing Blood Pressure (BP)11Hypertension Contributing factors to the development of hypertension include cardiovascular risk factors combined with socioeconomic conditions and ethnic differences.Hypertension is generally an asymptomatic condition; the “silent killer”Individuals who remain undiagnosed and untreated for hypertension present the greatest challenge and opportunity for health care providers.13Hypertension Risk FactorsAgeGenderEthnicityFamily HistorySESCigarette SmokingExcessive AlcoholDiabetes MellitusElevated Serum LipidsExcessive Dietary SodiumObesitySedentary LifestyleStress15Primary Hypertension ComplicationsTarget organ diseases occur in the heart (hypertensive heart disease), brain (cerebrovascular disease), peripheral vasculature (peripheral vascular disease), kidney (nephrosclerosis), and eyes (retinal damage).Hypertension is a major risk factor for coronary artery disease (CAD).Sustained high BP increases the cardiac workload and produces left ventricular hypertrophy (LVH). Progressive LVH, especially in association with CAD, is associated with the development of heart failure.Hypertension is a major risk factor for cerebral atherosclerosis and stroke.17Primary Hypertension ComplicationsHypertension speeds up the process of atherosclerosis in the peripheral blood vessels, leading to the development of peripheral vascular disease, aortic aneurysm, and aortic dissection.Intermittent claudication (ischemic muscle pain precipitated by activity and relieved with rest) is a classic symptom of peripheral vascular disease involving the arteries.Hypertension is one of the leading causes of end-stage renal disease, especially among African Americans. The earliest manifestation of renal dysfunction is usually nocturia. The retina provides important information about the severity and duration of hypertension. Damage to retinal vessels provides an indication of concurrent vessel damage in the heart, brain, and kidney. Manifestations of severe retinal damage include blurring of vision, retinal hemorrhage, and loss of vision.18Diagnostic StudiesBasic laboratory studies are performed to (1) identify or rule out causes of secondary hypertension, (2) evaluate target organ disease, (3) determine overall cardiovascular risk, or (4) establish baseline levels before initiating therapy.Routine urinalysis, BUN, serum creatinine, and creatinine clearance levels are used to screen for renal involvement and to provide baseline information about kidney function. Blood glucose levels assist in the diagnosis of diabetes mellitus. Lipid profile provides information about additional risk factors that predispose to atherosclerosis and cardiovascular disease. ECG and echocardiography provide information about the cardiac status.20Gerontologic ConsiderationsThe prevalence of hypertension increases with age. The lifetime risk of developing hypertension is approximately 90% for middle-aged (age 55 to 65) and older (age >65) normotensive men and women.A number of age-related physical changes contribute to the pathophysiology of hypertension in the older adult.In some older people, there is a wide gap between the first Korotkoff sound and subsequent beats (auscultatory gap). Failure to inflate the cuff high enough may result in underestimating the SBP.Older adults are sensitive to BP changes. Reducing SBP to less than 120 mm Hg in a person with long-standing hypertension could lead to inadequate cerebral blood flow.21Gerontologic Considerations (cont.)Older adults produce less renin and are more resistant to the effects of antihypertensives.Orthostatic hypotension occurs often in older adults because of impaired baroreceptor reflex mechanisms.Orthostatic hypotension in older adults is often associated with volume depletion or chronic disease states, such as decreased renal and hepatic function or electrolyte