Hypertension
Introduction
Hypertension is a systolic blood pressure greater than 140 mm Hg and a
diastolic pressure greater than 90 mm Hg over a sustained period
This is based on the average of two or more blood pressure measurements
taken in two or more contacts
Classification of Blood Pressure
SYSTOLIC (mmHg) DIASTOLIC (mm Hg)
CATEGORY
Optimal <120 and <80
Normal† <130 and <85
High-normal 130–139 or 85–89
Hypertension‡
Stage 1 140–159 or 90–99
Stage 2 160–179 or 100–109
Stage 3 ≥180 or ≥110
Types of Hypertension
Primary hypertension
Majority of pts reason for the elevation in blood pressure cannot be
identified
A few of the pts the high BP is associated wit:
narrowing of the renal arteries
renal parenchymal disease
hyperaldosteronism (mineralocorticoid hypertension)
certain medications
Pregnancy
coarctation of the aorta
Types of Hypertension
Secondary hypertension
The high blood pressure from an identified cause
Pathophysiology
Most cases of hypertension cannot be identified
Its understood that hypertension is a multifactorial condition
Because hypertension is a sign
It is most likely to have many causes
For hypertension to occur, there must be a change in one or more factors
affecting;
peripheral resistance
or
cardiac output
Pathophysiology
In addition, there must also be a problem with the control systems that
monitor or regulate pressure
Genetics
Single gene mutations have been identified for a few rare types of
hypertension
most types of high blood pressure are thought to be polygenic
(mutations in more than)
Pathophysiology
Hypertension may be caused by:
Increased sympathetic nervous system activity related to dysfunction of the autonomic
nervous system
Increased renal reabsorption of sodium, chloride, and water related to a genetic variation in
the pathways by which the kidneys handle sodium
Increased activity of the renin-angiotensin-aldosterone system, resulting in expansion of
extracellular fluid volume and increased systemic vascular resistance
Decreased vasodilation of the arterioles related to dysfunction of the vascular endothelium
Resistance to insulin action, which may be a common factor linking hypertension, type 2
diabetes mellitus, hypertriglyceridemia, obesity, and glucose intolerance
Pathophysiology
Gerontologic Considerations
Structural and functional changes in the heart and blood vessels
contribute to increases in blood pressure that occur with age
The changes include:
accumulation of atherosclerotic plaque
fragmentation of arterial elastins
increased collagen deposits
impaired vasodilation
Pathophysiology
Gerontologic Considerations
The result of these changes is a decrease in the elasticity of the major
blood vessels
Consequently, the aorta and large arteries are less able to accommodate
the volume of blood pumped out by the heart (stroke volume)
and
the energy that would have stretched the vessels instead elevates the
systolic blood pressure
Isolated systolic hypertension is more common in older adults
Clinical Manifestations
Initial stages: Asymptomatic
high blood pressure
In late stages: Symptoms depend on the organ affected and the degree of effects
retinal changes such as;
Hemorrhages
exudates (fluid accumulation)
arteriolar narrowing
cotton wool spots (small infarctions)
papilledema (swelling of the optic disc)
Coronary artery disease with angina or myocardial infarction is a common consequence of
hypertension
Clinical Manifestations
Left ventricular hypertrophy occurs in response to the increased workload
placed on the ventricle
Pathologic changes in the kidneys
increased blood urea nitrogen [BUN] and creatinine levels)
Clinical Manifestations
Cerebrovascular involvement:
stroke or transient ischemic attack (TIA)
alterations in vision
speech,
Dizziness
Weakness
sudden fall
temporary paralysis on one side (hemiplegia)
NB: Cerebral infarctions account for most of the strokes and TIAs in
patients with hypertension
Lifestyle Modifications for Hypertension Prevention and
Management
Lose weight if overweight
Limit alcohol intake
Increase aerobic physical activity
Reduce sodium intake
Lifestyle Modifications for Hypertension Prevention
and Management
Maintain adequate intake of dietary potassium (approximately 90
mmol per day)
Maintain adequate intake of dietary calcium and magnesium
Stop smoking
reduce intake of dietary saturated fat and cholesterol
Medical Management
Antihypertensive
