Hypertension

Question 1

What is blood pressure?

Answer 1

The amount of pressure placed on the arterial muscle walls to propel blood through the body.

Question 2

What are the two types of hypertension?

Answer 2

• Essential/Primary – no known cause but risk factors are considered
• Secondary – diseases and/or medications that cause hypertension

Question 3

What is normal BP?

Answer 3

systolic < 120 and diastolic < 80

Question 4

What is hypertensive crisis BP?

Answer 4

systolic > 180 and diastolic > 120
(consult your doctor immediately)

Question 5

Where can hypertension headaches be located?

Answer 5

• Diffuse (holocephalic)
• Sides of the head
• Back of the head (occiput)
• Behind the eye(s)

Question 6

What can patients feel when experiencing hypertension headaches?

Answer 6

• Pressure
• Pulsation
• Nausea
• Dizziness
• Blurred vision

Question 7

What are some nonspecific symptoms a patient can have when initially diagnosed with HTN?

Answer 7

• headaches
• dizziness
• fainting
• nose bleeds

Question 8

What are some manifestations on vasculature present in patients experiencing long-term complications of HTN?

Answer 8

• HTN will affect ALL arteries
• affects macrovasculature (heart) and microvasculature
• can impact microvasculature supply blood to the brain, eyes, kidneys
  
  • brain = stroke

Question 9

What diagnostic tests can be ordered to determine if a patient is experiencing long-term complications of HTN?

Answer 9

• There are no lab tests that can definitively diagnose hypertension.
• Some lab tests can be indicative of secondary hypertension.
  
  • Hematuria, proteinuria, elevated BUN and creatinine indicate renal disease.
  • Chest x-ray may indicate cardiomegaly (heart gets bigger b/c it has to work harder)
  • Left atrial and left ventricular enlargement can be detected via x-ray and ECG.

Question 10

How much sodium should patients with HTN have per day?

Answer 10

• Less than 2300 mg per day (avoid/limit salt intake)
• TEACH patients how to read food labels

Question 11

What are some weight reduction interventions for patients with HTN?

Answer 11

• Weight loss encouraged if BMI is elevated
  
  • Total fat: 20%-35% of daily caloric intake.
  • Saturated fat: less than 10%
  • Cholesterol: less that 300 mg/d

Question 12

What are some alcohol intake interventions? What is considered a drink?

Answer 12

• Limit alcohol intake to no more than 1-2 drinks daily.
  
  • 1.5 ounces of liquor (spirits)
  • 5 ounces of wine
  • 12 ounces of beer

Question 13

What are some physical activity interventions?

Answer 13

• Emphasize starting slowly and gradually
  
  • 30-45 minutes (3-5 x/week)
  • Work up to more vigorous
  • Report shortness of breath, fainting, or chest pain

Question 14

What are some medications used to treat HTN?

Answer 14

• Diuretics
• Thiazides
• ACE-Inhibitors
• ARBs
• Calcium Channel Blockers
• Beta Blockers

Question 15

What is Orthostatic Hypotension?

Answer 15

Orthostatic hypotension is a decrease in blood pressure (20 mm Hg systolic and/or 10 mm Hg diastolic) when the client changes position.

Question 16

How do you take orthostatic blood pressure?

Answer 16

Take blood pressure with the client in the supine (lying) or sitting position, wait at least 2 minutes later and take reading with the client standing.

Question 17

Why does hypertension lead to so many complications?

Answer 17

High blood pressure can constrict and narrow the blood vessels, which eventually damages and weakens them throughout the body, leading to decreased tissue perfusion.

Question 18

What are some long-term complications of HTN on the cardiovascular system?

Answer 18

• Coronary disease
• Cerebral disease
• Peripheral vascular disease
• CAD
  
  • Angina
  • Myocardial Infarct/Heart Attack

Question 19

What are some long-term complications of HTN on the nervous and urinary system?

Answer 19

• Cerebrovascular Accidents/Stroke
• Transient Ischemic Attacks/”Little strokes”
• Retinal Changes – Vision Problems
• Kidney Changes – Chronic Kidney Disease

Question 20

What vision changes can HTN cause?

Answer 20

• Cotton Wool Spots – indicate ischemia
  
  • A block in the artery that brings blood to the retina may cause the ischemia.
  • Cotton wool spots are made up of swollen debris from local cells.
    - spots are not harmful, but indicate underlying issue to blood vessels in the eye
• Flame Hemorrhages – indicate blood that has leaked out of the blood vessels

Question 21

Compare hypertensive urgency and hypertensive crisis.

Answer 21

• hypertensive urgency: BP is a potential risk, but has not yet caused acute end-organ damage (BP controlled over days/weeks)
• hypertensive crisis: severe HTN with acute impairment of an organ system (BP lowered aggressively over mins/hours)