HYPERTENSION

DEFINITION:-

Hypertension is a disease of vascular regulation in which elevation of arterial pressure above the normal range.
Normal blood pressure: 120/80mm of Hg.
In Hypertension: 140/90 or above

CAUSES/TYPES:-

  1. Primary Hypertension:
    It is due to unknown causes or without systemic cause.

    2. Example:

    • Family history
    • Prolonged mental tension
    • Arterial degeneration
    • Hormonal or metabolic disturbance.


  2. Secondary Hypertension:
    It is due to pathological conditions.

    Example:

    • Due to kidney disease, e.g., Pyelonephritis.
    • Due to endocrine disorders, e.g., cushing Syndrome, diabetes mellitus.
    • Congenital deformities, e.g., Renal artery obstruction.

      • Others:

    • Enlarged Prostate
    • Toxaemia in pregnancy
    • Excessive body weight
    • Excessive sodium intake
    • Obesity
    • Smoking.


  3. Borderline Hypertension:
    It is defined as intermittent elevation of B.P. with normal readings.
  4. Malignant Hypertension:
    It is a Syndrome of markedly elevated blood pressure (above 140 mm of hg).
  5. Benign Hypertension:
    Also known as uncomplicated hypertension, usually of long duration and mild to moderate severity, may be Primary or Secondary.
  6. White Coat Hypertension:
    It is due to anxiety only at a time of measuring blood pressure by doctor or nurse in hospital or clinic.


PATHOPHYSIOLOGY:-

    There are three control system play a major role in monitoring blood pressure.

  1. Arterial baroreceptor: They are found in carotid sinus and walls of ventricles. Baroreceptors help to maintain B.P.
  2. Regulation of body fluid volume
    3. Change in body fluid that affect systemic arterial pressure
    ↓
    Abnormalities in transport of Na+ ion and water
    ↓
    Increase Na, K, H20 in blood
    ↓
    Increase blood volume
    ↓
    Increase blood pressure



  3. The renin-angiotensin system

    4. Angiotensin-I
    ↓
    Angiotensin-II/III
    ↓
    Increases sympathetic nervous system activity
    ↓
    Inhibit sodium excretion
    ↓
    Increases blood pressure


SIGNS AND SYMPTOMS:-

  • Morning occipital headache
  • Fatigue
  • Dizziness
  • Bluring vision
  • proteinuria
  • Haematuria (blood in urine)
  • Cardiac asthma
  • Anginal Pain
  • Epistaxis (Nose bleeding)
  • Palpitation
  • Tinnitus (Ringing in ears)
  • Breathlessness.


DIAGNOSTIC EVALUATION:-

  • By measuring B.P.
  • Chest X-ray
  • Urine test
  • Blood test
  • History collection
  • Physical examination


COMPLICATIONS:-

  • Heart disease
  • Renal failure
  • Cerebral haemorrhage
  • Angina pectoris.


MEDICAL MANAGEMENT:-

  1. Diuretic:
    They increase frequency of urine.
    Example:
    • Thiazide - 40mg
    • Furosemide - 20mg.


  2. Beta blocker:
    Prevents stimulation of beta-adrengeic receptors of sympathetic nervous system. Because beta adrenergic receptors are responsible for vasoconstriction in blood vessels.

    Example:

    • Atenolol
    • betaxolol
    • Timolol
    • propranolol.


  3. Vasodilators:
    These drugs acts as blood vessel dilator and open vessels by relaxing their muscular walls and decreased blood pressure.
    Example: Nitrates.
    • Short acting: Nitroglycerine - 15-12 mg (sublingual)
    • Long Acting: Isosorbide dinitrate - 5-10 mg.


  4. Calcium channel blockers (calcium Antagonist):
    They are used to decrease oxygen demand in Heart and improve coronary blood flow.
    Example:
    • Verapamil (Antiarrhythmic) (Administer empty stomach before meal).
    • Nifedipine.


  5. Angiotensin Converting Enzyme inhibitor:
    They inhibit Angiotensin I and II Conversion.
    Example:
    • Captopril
    • ramapril
    • Benazepril


NURSING MANAGEMENT:-

ASSESSMENT:

  • Assess the Anxiety level of patient.
  • Take medical history of patient.
  • Ask diet pattern of patient.
  • Assess educational level of patient.

Nursing Diagnosis And Intervention:

  1. Anxiety related to disease
    2. Nursing Intervention
    • Provide proper knowledge about disease condition to patient.
    • Provide comfortable rest to patient.
    • Restrict quantity of visitors.
    • Give answer to the questions of patient.


  2. knowledge deficit about disease condition
    3. Nursing Intervention
    • Provide proper knowledge about disease to the patient also try to increase Knowledge of patient about its disease.


  3. Alteration in comfort related to disease
    4. Nursing Intervention
    • Provide comfortable Position as well as provide rest to patient with raised head of bed or use pillow.
    • Provide general care to patient.
    • Give health education to patient.
    • Advice patient to Avoid alcohol and smoking

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