4.3 Hypertension and vascular disorders

Hypertension, or high blood pressure, is a silent but dangerous condition affecting millions. It's often symptomless but can lead to serious health problems if left unchecked. Understanding its causes, symptoms, and management is crucial for preventing complications.

Nurses play a vital role in hypertension care. They monitor blood pressure, administer medications, and educate patients on lifestyle changes. By focusing on prevention and management, nurses help patients maintain healthy blood pressure and reduce their risk of heart disease and stroke.

Understanding Hypertension

Definition and classifications of hypertension

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• Hypertension is a chronic condition characterized by persistently elevated blood pressure levels in the arteries
  • Normal blood pressure maintains systolic reading < 120 mmHg and diastolic reading < 80 mmHg
  • Elevated blood pressure shows systolic readings between 120-129 mmHg while diastolic remains < 80 mmHg
  • Stage 1 hypertension presents with systolic readings of 130-139 mmHg or diastolic readings of 80-89 mmHg
  • Stage 2 hypertension involves systolic readings ≥ 140 mmHg or diastolic readings ≥ 90 mmHg
  • Hypertensive crisis occurs when systolic exceeds 180 mmHg and/or diastolic surpasses 120 mmHg, requiring immediate medical attention

Risk factors and symptoms of hypertension

• Risk factors for developing hypertension include:
  • Advanced age as the likelihood of hypertension increases with aging
  • Genetic predisposition, especially if there is a family history of hypertension
  • Obesity, which places additional strain on the cardiovascular system
  • Sedentary lifestyle lacking regular physical activity
  • High sodium intake from dietary sources (processed foods)
  • Excessive alcohol consumption, which can raise blood pressure levels
  • Chronic stress exposure, leading to persistent elevation of blood pressure
  • Presence of certain medical conditions like diabetes or chronic kidney disease
• Signs and symptoms of hypertension may include:
  • Hypertension often remains asymptomatic, particularly in the early stages
  • Recurrent headaches, especially in the morning
  • Dizziness or lightheadedness upon standing
  • Shortness of breath during physical exertion
  • Chest pain or discomfort (angina)
  • Nosebleeds, particularly if severe or frequent
  • Vision changes such as blurred vision or seeing spots
• Vascular disorders commonly associated with hypertension:
  • Atherosclerosis involves the gradual narrowing and hardening of arteries due to plaque accumulation
    • Atherosclerosis can lead to coronary artery disease (heart), peripheral artery disease (limbs), and stroke (brain)
  • Aneurysms are weakened, bulging areas in the arterial wall that can potentially rupture
    • Ruptured aneurysms can cause life-threatening internal bleeding (hemorrhage)

Managing Hypertension and Vascular Disorders

Management approaches for hypertension

• Non-pharmacological management focuses on lifestyle modifications:
  • Maintaining a healthy body weight through balanced nutrition and regular exercise
  • Engaging in regular physical activity (aerobic exercise, strength training)
  • Reducing dietary sodium intake by limiting processed and high-salt foods
  • Limiting alcohol consumption to moderate levels (1 drink/day for women, 2 drinks/day for men)
  • Managing stress through relaxation techniques (deep breathing, meditation)
  • Following a heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins (DASH diet)
• Pharmacological management involves the use of antihypertensive medications:
  • Diuretics help promote sodium and water excretion, reducing blood volume (hydrochlorothiazide)
  • ACE inhibitors relax blood vessels and decrease the workload on the heart (lisinopril)
  • Angiotensin receptor blockers (ARBs) have similar effects to ACE inhibitors (losartan)
  • Calcium channel blockers relax blood vessels and reduce heart rate (amlodipine)
  • Beta-blockers reduce heart rate and cardiac output, lowering blood pressure (metoprolol)
  • Medication adherence is crucial for achieving and maintaining optimal blood pressure control

Nursing care for hypertension patients

• Nursing interventions for hypertension management include:
  • Regularly monitoring blood pressure using proper technique and calibrated equipment
  • Assessing for signs and symptoms of hypertension and related vascular disorders
  • Administering prescribed antihypertensive medications and monitoring for side effects
  • Encouraging lifestyle modifications and providing support for behavior change
  • Providing emotional support and addressing patient concerns or barriers to treatment
• Patient education is a key component of nursing care:
  • Teaching patients how to accurately measure and record their blood pressure at home
  • Explaining the importance of medication adherence and strategies to improve compliance
  • Educating patients on the benefits of lifestyle modifications and providing practical tips
  • Discussing the potential complications of uncontrolled hypertension (heart disease, stroke, kidney damage)
  • Encouraging regular follow-up with healthcare providers to monitor progress and adjust treatment
  • Teaching patients to recognize signs and symptoms that require immediate medical attention
    1. Severe headache
    2. Chest pain or pressure
    3. Sudden vision changes or loss of vision
    4. Numbness or weakness in face, arm, or leg
    5. Difficulty speaking or understanding speech
  • Providing patients with reliable resources for additional information and support (handouts, websites, support groups)