Hypertension

Question 1

Define hypertension according to Hypertension Canada guidelines.

Answer 1

Hypertension

• Consistently too high pressure on arterial walls

   - Non automated cuff greater than or equal to 140/90
   - Automated cuff greater than or equal to 135/85
   - Non automated/Automated (or in diabetes) greater than or equal to 130/80

Question 2

Explain the causes of primary, secondary and white coat HTN.

Answer 2

Primary (essential) hypertension

• Idiopathic – no known cause
• Correlation with family history
• Genetic predisposition

Secondary hypertension

• Symptom of underlying disease affecting blood volume, peripheral resistance, or cardiac function

   - Pregnancy
   - Cocaine use
   - Renal Disease
   - Hyperaldosteronism
   - Pheochromocytoma

White coat hypertension

• Anxiety causes sympathetic nervous system response

Question 3

List the major organs of the body that are damaged with persistent hypertension.

Answer 3

• Eyes - blindness
• Kidney - renal failure
• Heart - CHF
• Brain - Stroke or Dementia

Question 4

List four routine diagnostic tests used to monitor clients with hypertension.

Question 5

Explain the role of the kidney in regulating blood pressure.

Answer 5

Renin-Angiotensin-Aldosterone System (RAAS)

• The stimulus for the kidneys to release renin is decreased renal perfusion (lack of blood flow to the kidneys)
• RAAS activation leads to vasconstriction which increases systemic vascular resistance and raises blood pressure
• RAAS activation also stimulates the release of aldosterone, which signals the kidneys to retain sodium and water. This increases blood volume, helping to restore blood flow to the kidneys and raise blood pressure.

Question 6

Define blood volume and explain how its related to BP.

Question 7

Define Peripheral Resistance and explain how its related to BP.

Question 8

Define CO and explain how its related to BP.

Question 9

What non-pharmacologic interventions help to lower blood pressure?

Answer 9

• Weigh loss
• Regular physical activity
• DASH diet (Dietary Approaches to Stop Hypertension)
• Limit alcohol
• Relaxation therapy
• Smoking cessation

Question 10

Explain the use of diuretics for hypertension.

Answer 10

• Help lower blood pressure by promoting the excretion of excess sodium and water through the kidneys

Question 11

List health teaching points for diuretics.

Answer 11

• Monitor Blood Pressure Regularly
• Stay Hydrated, but Avoid Excessive Fluids
• Monitor for Electrolyte Imbalances
• Eat Potassium-Rich Foods (if using Thiazide or Loop Diuretics)
• Common side effects, such as dizziness, lightheadedness, or frequent urination

Question 12

Furosemide is the most widely prescribed diuretic for
treatment of hypertension. (True or False)

Answer 12

• False - Furosemide is primarily used to treat fluid retention associated with CHF. Hydrochlorothiazide is the most widely perscribed diuretic fot treatment of HTN.

Question 13

Diuretics frequently cause hyponatremia (low sodium) (True or False)

Answer 13

• False - Diuretics usually cause hypokalemia (low potassium) unless using a potassium sparing class.

Question 14

The most accurate indicator of diuretic effectiveness is comparison of daily weight measurements. (True or False)

Answer 14

• False - daily weight is a good indication for those in HF not HTN.

Question 15

All antihypertensive medications have the potential to cause
orthostatic hypotension. (True or False)

Answer 15

• True

Question 16

What direct effect do diuretics have on the heart?

Answer 16

• Reduce demand on heart