Hypertension

1. Major Classes of Anti-Hypertensive Drugs 1. ACE inhibitors such as lisinopril, benazepril etc. 2. Angiotensin II receptor blockers such as candesartan (Atacand), losartan (Cozaar) and others. 3. Diuretics such as thiazide, chlorthalidone, hydrochlorothiazide 4. Vasodilators such as hydralazine and minoxidil.

2. Goals of anti-hypertensive treatment

2.1. •Adequate blood pressure control - < 140/90 mmHg, alter relative risk . •Prevent target organ damage . •Control other cardiovascular risk factors.

3. Treatment

3.1. Three main treatment pathways

3.2. Non-pharmacological, e.g. Life-style modifications

3.2.1. Quit smoking Weight control Eat less salt Regular exercise Reduce alcohol intake Behavioral therapies – CBT

3.3. Pharmacological treatment

3.4. Surgical, e.g. Conn’s syndrome

3.4.1. Open surgical repair of coarctation Balloon angioplasty of coarctation Adrenalectomy Renal artery stenting Renal artery denervation Rheo carotid baroreceptor activation therapy

4. COLLABORATIVE PROBLEMS/POTENTIAL COMPLICATIONS

4.1. Left ventricular hypertrophy

4.2. Myocardial infarction

4.3. Heart failure

4.4. TIAs

4.5. Cerebrovascular accident (stroke or brain attack)

4.6. Retinal haemorrhage

4.6.1. Renal insufficiency and failure

5. Clinical Presentation

5.1. • Elevated BP • Dizziness • Headache • Fatigue • Angina • Palpitations • Impaired vision • dyspnea • Can also be asymptomatic

6. Risk factors

6.1. • Cigarette smoking • Obesity • Physical inactivity • Dyslipidaemia • Diabetes mellitus • Microalbuminuria • Age • Family history of CAD

7. Assessment

7.1. Check laboratory data

7.1.1. 1. The retinas are examined, and laboratory studies are performed to assess possible target organ damage.

7.1.1.1. Routine laboratory tests include urinalysis, blood chemistry (i.e., analysis of sodium, potassium, creatinine, fasting glucose, and total and high-density lipoprotein [HDL] cholesterol levels), and a 12-lead electrocardiogram.

7.1.2. 2. Echocardiography: for left ventricular hypertrophy

7.1.3. 4. Urinalysis

7.1.3.1. 3. CBC: analysis of sodium, potassium, creatinine, fasting glucose

7.1.4. 5. Lipid panel

7.1.5. 6. BUN, Creatinine and Albuminuria

7.2. Note presence, quality of central and peripheral pulses.

7.3. Monitor and record Blood Pressure

7.3.1. Blood Pressure checks. Normal BP is less than 120/80. Prehypertension SBP 120 – 139 and DBP 80-89. Stage 1 SBP 140 -159 and DBP 90-99. Stage 2 SBP ≥ 160 and DBP ≥ 100

7.4. Auscultate heart tones and breath sounds.

7.5. Evaluate client reports or evidence of extreme fatigue, intolerance for activity, sudden or progressive weight gain, swelling of extremities, and progressive shortness of breath.

7.6. Observe skin color, moisture, temperature, and capillary refill time, retina.

7.7. Note dependent and general edema.

8. Diagnosis

8.1. Based on the assessment data, nursing diagnoses for the patient may include the following: •Deficient knowledge regarding the relation between the treatment regimen and control of the disease process • Perceived barrier (cost of medications) • Insufficient social support • Difficulty navigating complex health care systems • Powerlessness • Disturbed body image related to alteration in self-perception •Noncompliance with therapeutic regimen related to side effects of prescribed therapy. •Risk for Decreased Cardiac Output •Activity Intolerance •Acute Pain •Ineffective Coping •Imbalanced Nutrition

9. Pathology

9.1. • Hypertension is an abnormal elevation of the diastolic pressure leading to strains on the arterial wall, which overtime causes thickening and calcification of the arterial media (stenosis) and eventually narrowing of the blood vessel lumen.