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Hypertension PowerPoint Presentation

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Description : Check out this medical presentation on Antihypertensive, which is titled "Hypertension", to know about hypertension, sustained elevation of BP.

Tags : Antihypertensive, Hypertension, elevation of BP, blood pressure

Published on : May 25, 2021 | Views : 1427 | Downloads : 7

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Slide 1-

Hypertension
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Factors Influencing Blood Pressure Blood Pressure = Cardiac Output x Systemic Vascular Resistance
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Factors Influencing BP HR SNS/PNS Vasoconstriction/vasodilation Fluid volume Renin-angiotensin Aldosterone ADH
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Hypertension Definition Hypertension is sustained elevation of BP Systolic blood pressure  140 mm Hg Diastolic blood pressure  90 mm Hg
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Blood Pressure Classification
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Hypertension For persons over age 50, SBP is more important than DBP as a CVD risk factor Starting at 115/75 mmHg, CVD risk doubles with each increment of 20/10 mmHg throughout the BP range
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Classification of Hypertension Primary (Essential) Hypertension - Elevated BP with unknown cause - 90% to 95% of all cases Secondary Hypertension - Elevated BP with a specific cause - 5% to 10% in adults
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Classification of Hypertension Primary Hypertension - Contributing factors: •  SNS activity • Diabetes mellitus •  Sodium intake • Excessive alcohol intake
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Classification of Hypertension • Secondary Hypertension - Contributing factors: • Coarctation of aorta • Renal disease • Endocrine disorders • Neurologic disorders - Rx: Treat underlying cause
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Risk Factors for Primary Hypertension Age (> 55 for men; > 65 for women) Alcohol Cigarette smoking Diabetes mellitus Elevated serum lipids Excess dietary sodium Gender
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Risk Factors for Primary Hypertension Family history Obesity (BMI > 30) Ethnicity (African Americans) Sedentary lifestyle Socioeconomic status Stress
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Hypertension Clinical Manifestations • Frequently asymptomatic until severe and target organ disease has occurred Fatigue, reduced activity tolerance Dizziness Palpitations, angina Dyspnea
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Hypertension: Complications Complications are primarily related to development of atherosclerosis (“hardening of arteries”), or fatty deposits that harden with age
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Hypertension Complications The common complications are target organ diseases occurring in the Heart Brain Kidney Eyes
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Hypertension Complications Hypertensive Heart Disease Coronary artery disease Left ventricular hypertrophy Heart failure
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Left Ventricular Hypertrophy Fig. 32-3
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Hypertension Complications Cerebrovascular Disease Stroke Peripheral Vascular Disease Nephrosclerosis Retinal Damage
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Hypertension Diagnosis • Diagnosis requires several elevated readings over several weeks (unless > 180/110) • BP measurement in both arms - Use arm with higher reading for subsequent measurements
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Hypertension Diagnosis Ambulatory BP Monitoring For “white coat” phenomenon, hypotensive or hypertensive episodes, apparent drug resistance
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Hypertension BP Measurement See Table 32-12 (p. 794)
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Treatment Goals Goal is to reduce overall cardiovascular risk factors and control BP by the least intrusive means possible BP < 140/90 In patients with diabetes or renal disease, goal is < 130/80
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Benefits of Lowering BP Average Percent Reduction Stroke incidence 35–40% Myocardial infarction 20–25% Heart failure 50%
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Algorithm for Treatment of Hypertension Not at Goal Blood Pressure (<140/90 mmHg) (<130/80 mmHg for those with diabetes or chronic kidney disease) Initial Drug Choices Drug(s) for the compelling indications Other antihypertensive drugs (diuretics, ACEI, ARB, BB, CCB) as needed. With Compelling Indications Lifestyle Modifications Stage 2 Hypertension (SBP >160 or DBP >100 mmHg) 2-drug combination for most (usually thiazide-type diuretic and ACEI, or ARB, or BB, or CCB) Stage 1 Hypertension (SBP 140–159 or DBP 90–99 mmHg) Thiazide-type diuretics for most. May consider ACEI, ARB, BB, CCB, or combination. Without Compelling Indications Not at Goal Blood Pressure Optimize dosages or add additional drugs until goal blood pressure is achieved. Consider consultation with hypertension specialist.
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Hypertension Collaborative Care • Lifestyle Modifications - Weight reduction - Dietary changes (DASH diet) - Limitation of alcohol intake (< 2 drinks/day for men; < 1/day for women) - Regular physical activity - Avoidance of tobacco use - Stress management
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Hypertension Collaborative Care • Nutritional Therapy: DASH Diet = Dietary Approahes to Stop HTN - Sodium restriction - Rich in vegetables, fruit, and nonfat dairy products - Calorie restriction if overweight
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Hypertension Collaborative Care • Drug Therapy - Reduce SVR - Decrease volume of circulating blood
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Hypertension Collaborative Care • Drug Therapy Diuretics Adrenergic inhibitors β - Adrenergic blockers ACE Inhibitors Calcium channel blockers
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Hypertension: Drug Therapy Thiazide-type Diuretics Inhibit NaCl reabsorption Side effects: Electrolyte imbalances: ↓ Na, ↓ Cl, ↓ K** (advise K rich foods) Fluid volume depletion (monitor for orthostatic hypotension) Impotence, decreased libido
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Hypertension: Drug Therapy Adrenergic Inhibitors Reduce sympathetic effects that cause HTN by: Reducing sympathetic outflow Blocking effects of sympathetic activity on vessels Side effects Hypotension Varied, depending on specific drug
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Hypertension: Drug Therapy β – adrenergic blockers (suffix “olol”) (metoprolol, propranolol) Block β – adrenergic receptors ↓ HR, ↓ inotropy, reduces sympathetic vasoconstriction) Side effects Bradycardia, hypotension, heart failure, impotence
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Hypertension: Drug Therapy ACE Inhibitors (suffix “pril) Enalapril, captopril Prevents conversion of angiotensin I to angiotensin II, thereby preventing the vasoconstriction associate with A II. Side effects Hypotension, cough
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Hypertension: Drug Therapy Calcium Channel Blockers Block movement of calcium into cells, causing vasodilation Side effects Brdaycardia, heart block
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Hypertension Collaborative Care • Drug Therapy and Patient Teaching - Identify, report, and minimize side effects • Orthostatic hypotension • Sexual dysfunction • Dry mouth • Frequent urination
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Primary Hypertension Nursing Management Nursing Diagnoses - Ineffective health maintenance - Anxiety - Sexual dysfunction - Ineffective therapeutic regimen management r/t - lack of S/S of HTN, side effects of Rx, cost of Rx, etc.
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Primary Hypertension Nursing Management Nursing Implementation Health Promotion • Individual patient evaluation • Screening programs • Cardiovascular risk factor modification
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Hypertensive Crisis • Severe, abrupt elevation in BP • The rate of  in BP is more important than the absolute value • Most common in patients with a history of HTN who have failed to comply with medications or who have been under-medicated
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Hypertensive Crisis Clinical Manifestations - Hypertensive encephalopathy (H/A, N & V, seizures, confusion, coma) - Renal insufficiency - Heart failure - Pulmonary edema
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Hypertensive Crisis Nursing and Collaborative Management Hospitalization - IV drug therapy - Monitor cardiac and renal function - Neurologic checks - Determine cause - Education to avoid future crises
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Supporting Materials Website www.nhlbi.nih.gov For patients and the general public Facts About the DASH Eating Plan Your Guide to Lowering Blood Pressure For health professionals Reference Card