1.1. Abnormal heart rhythm Anxiety Blurred vision or other vision changes Buzzing in the ears Chest pain Confusion Difficulty breathing (WHO, 2023) Dizziness Nausea Nosebleeds Severe headaches Vomiting (WHO, 2023).
2. Pathophysiology of Hypertension
2.1. The rapid changes in blood pressure are mediated by various changes through vasoactive hormones or sympathetic nervous system that alters cardiac output or vascular resistance (Harrison et al., 2021). • Increased sympathetic nervous system activation increases afterload and total peripheral resistance. • Chronic hypertension leads to a decrease in the elasticity of arteries (arteriosclerosis), reducing the caliber of the blood vessels, including systemic vascular resistance (Harrison et al., 2021). • Precapillary and postcapillary pulmonary hypertension results in arterial pressure against which the left ventricle needs to pump, leading to left ventricular hypertrophy (Harrison et al., 2021). • Reduced or increased perfusion pressure causes damage to the organs, such as kidneys, brain and eyes.
3. What is hypertension?
3.1. Hypertension is a health condition that occurs when the force of blood on the walls of the arteries is too high (National Heart, Lung, and Blood Institute, 2024). A normal blood pressure is less than 120/80mm Hg 130 to139/80 to 89 mm Hg is hypertension stage one More than 140/90mm Hg is hypertension stage two More than 180/120 mm Hg is a hypertensive crisis (National Heart, Lung, and Blood Institute, 2024)
4. Implications of Hypertension
4.1. Damage to the heart Coronary arteries Heart attack Heart disease Congestive heart failure Aortic dissection Atherosclerosis. Stroke Kidney damage Insulin resistance, increasing the risk of developing type II diabetes. Vision loss Sexual dysfunction
5. Treatment Options
5.1. Lifestyle Modifications: o Dietary changes (e.g., DASH diet, reduced sodium intake) o Limiting alcohol intake o Regular physical activity o Smoking cessation o Weight management
5.2. Medications: Medications are administered based on complications and severity. Various antihypertensive medications considered are; o ACE Inhibitors (lisinopril) o Angiotensin II Receptor Blockers (losartan) o Beta-Blockers (metoprolol) o Calcium Channel Blockers (amlodipine) o Diuretics (Hydrochlorothiazide) (Burnier et al., 2019)
5.3. Possible Referrals o Cardiologist: Referral to cardiologist is important, especially when hypertension is resistant to treatment. o Endocrinologist: This referral is important if hyperaldosteronism or pheochromocytoma causes are suspected. o Dietitian: This referral will help patient receive personalized dietary counseling
6. Risk Factors Related To Hypertension
6.1. Modifiable risk factors of hypertension Obesity Physical inactivity High salt intake (sodium) (World Health Organization (WHO), 2023) Excessive alcohol consumption Smoking Stress Lack of physical activity (WHO, 2023). Unhealthy food consumption (less fruits and vegetables, more saturated fats) (WHO, 2023).
6.2. Non-modifiable: Age: Persons aged 65 years and above. Presence of hypertension in the family (American Heart Association, 2019). Gender (men are at higher risk of getting hypertension earlier in life; women past menopausal age are at higher risk) Ethnicity: African Americans
7. Etiology of Hyperension
7.1. Essential/primary hypertension It is believed to be caused by lifestyle, genetics, environment, and diet Eating food high in salt causes blood pressure to increase Other causes include o Diabetes o Drinking too much alcohol o Getting older, age of 65 years and above o Having a family member with high blood pressure o Insufficient intake of calcium, potassium, and magnesium (Mitchell, 2023) o Obesity o Alcohol consumption o Lack of physical exercises o Stress
7.2. Secondary hypertension: Various health conditions and medications that contribute to secondary hypertension are: o Adrenal disorders o Birth control pills o Certain medications. Medications that constrict blood vessels, making it harder for the heart to pump blood. o Congenital heart defects o Cough, cold, and pain-relieving medications. o Illegal drugs. Amphetamines and cocaine can raise blood pressure (Mitchell, 2023). o Kidney disease o Obstructive sleep apnea. o Thyroid disorders
8. Impact of Hypertension Diagnosis on Other Body Systems
8.1. Brain: Hypertension causes dementia and cognitive dysfunction. Heart: It leads to heart attacks, heart disease, and heart failure. Eyes: It damages blood vessels, leading to vision loss (American Heart Association, 2019). Kidneys: It damages arteries around, hindering normal filtration. Digestive system: Hypertension increases bacteria in the gut, leading to intestinal inflammation. Peripheral artery disease: Hypertension can lead to cramps or pain in the leg. Aneurysm: Hypertension causes a bulge to form in the damaged artery.
9. Diagnostic Tests and Labs
9.1. Blood pressure measurement: Measuring blood pressure repeatedly in multiple visits to confirm the patient has persistently elevated blood pressure.
9.2. Blood tests o Basic Metabolic Panel (BMP) to check kidney function and electrolyte levels o Complete Blood Count (CBC) o Lipid Profile to assess cholesterol levels o Thyroid Function Tests if there are symptoms of thyroid disease
9.3. Urinalysis To check the possibility of kidney disease
9.4. Electrocardiogram (ECG): To assess if the patient has a heart-related concern that could be contributing to hypertension.
9.5. Electrocardiogram (ECG): To assess if the patient has a heart-related concern that could be contributing to hypertension.
