HYPERTENSION, CAUSES AND RISK FACTORS.pptx

This presentation talks about hypertension, it's causes, risk factors and management

1. HYPERTENSION PERSIS TIMUGIBWA 21/U/19951/PS BSN III

2. PRESENTATION OUTLINE Definition of hypertension Epidemiology Etiology, Risk factors Clinical presentation /Signs and symptoms Pathophysiology and Classification Diagnosis Complications Medical/ Pharmacological management and side effects Nursing process/ Nursing care plan

3. DEFINITION Is defined as a systolic blood pressure greater than 140 mmHg and a diastolic pressure greater than 90 mmHg based on the average of two or more accurate blood pressure measurements.(WHO). Hypertension can be primary( high blood pressure from an unidentified cause) or secondary ( high blood pressure related to identified causes).

4. EPIDEMIOLOGY According to WHO, about 1.28billion adults aged 30-79years live with HTN. About two-thirds of these live in low and middle income countries. An estimated 46% of adults are unaware that they have the condition. Less than half(42%) of adults with hypertension are diagnosed and treated, and 1 in 5 adults (21%) have it under control. Globally , the goal is to reduce the prevalence by 33% by 2030.(WHO)

5. Epidemiology In uganda , prevalence is estimated at 31.5% (Uganda national Institute of Public Health Report, Jan 2024). According to the report, Prevalence was highest in the central region at 28.5 %, followed by western region at 26.4% ,and northern at 23.3%.

6. Etiology and Risk factors Hypertension is classified into two main types; Primary (Essential) hypertension: Has no single identifiable single cause. Develops gradually over time. Risk factors to primary hypertension include; Genetics: Family history of hypertension can increase risk. Age: The risk of developing hypertension increases with age. Lifestyle Factors: High salt intake, obesity, physical inactivity, smoking and excessive alcohol consumption. Diet: Poor dietary habits, including low intake of potassium and high intake of saturated fats Stress: Chronic stress may contribute to high blood pressure.

7. Risk factors ..cont’d Secondary Hypertension: R esults from an underlying condition or identifiable cause. This type is less common. Causes: Kidney Disease: Conditions such as chronic kidney disease or renal artery stenosis can lead to hypertension. Endocrine Disorders: Hormonal disorders like hyperthyroidism, hypothyroidism, and pheochromocytoma can elevate blood pressure. Medication: Certain medications, including birth control pills, decongestants, and some antidepressants, can cause secondary hypertension. Sleep Apnea: Obstructive sleep apnea is linked to high blood pressure.

8. Risk factors ….cont’d • 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(RAAS), resulting in expansion of extracellular fluid volume and increased systemic vascular resistance. • Decreased vasodilation of the arterioles related to dysfunction of the vascular endothelium.

9. Signs and symptoms People with hypertension may be asymptomatic and remain so for many years. However, when specific signs and symptoms appear, they usually indicate vascular damage, with specific manifestations related to the organs served by the involved vessels. These include; Severe headaches Dizziness Difficulty breathing Nausea Vomiting Blurred vision Anxiety Confusion Nose bleeding Abnormal heart rhythm

10. Pathophysiology and Classification Blood pressure is the product of cardiac output (C.O) and peripheral resistance (PR) Cardiac output is the product of the Heart rate (HR) and stroke volume(SV). Therefore, hypertension can result from an increase in cardiac output, an increase in peripheral resistance (constriction of the blood vessels), or both. For hypertension to occur there must be a change in one or more factors affecting peripheral resistance ( eg blood viscosity and size of arteries and arterioles) or cardiac output( Heart rate and stroke volume).

11. Pathophysiology …cont’d The pathophysiology of hypertension involves the impairment of renal pressure natriuresis , the feedback system in which high blood pressure induces an increase in sodium and water excretion by the kidney that leads to a reduction of the blood pressure. Pressure natriuresis can result from impaired renal function, inappropriate activation of hormones that regulate salt and water excretion by the kidney (such as those in the Renin-Angiotensin-Aldosterone System), or excessive activation of the sympathetic nervous system.

12. Pathophysiology and Regulation of blood pressure. ANP interplay HEART- OVERLOAD ANP vasodilation Increase in Na+excretion Decrease in BP Decrease in bld volume Increased volume • Excess dietary sodium • Inadequate excretion (renal failure) • Hyperaldosteronism • Increased sodium reabsorption Increased resistance • Increased sympathetic tone (e.g., pheochromocytoma) • Increased renin-angiotensin-aldosterone axis

13. Classification of hypertension Based on the average of two or more accurately measured readings in the same position taken on each of two visits. Adopted from the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. (2003). BP CLASSIFICATION SYTOLIC( BP-mmHg) DIASTOLIC BP(mmHg) Normal < 120 < 80 Prehypertension 120 - 139 80 – 89 Stage -1 hypertension 140 - 159 90 - 99 Stage-2 hypertension ≥ 160 ≥ 100 Hypertensive crisis >180 >120

14. Other subtypes of hypertension Resistant hypertension Resistant hypertension is high blood pressure that’s difficult to manage and requires multiple medications. Hypertension is considered resistant when your blood pressure stays above your treatment target even though you’re taking three different types of blood pressure-lowering medications, including a diuretic. An estimated 10% of people who have high blood pressure have resistant hypertension. People with resistant hypertension may have secondary hypertension with a cause that hasn’t yet been identified.

15. Subtypes ..cont’d Malignant hypertension Malignant hypertension is high blood pressure that causes damage to your organs and is an emergency condition. Malignant hypertension is the most severe type, involving elevated blood pressure that is usually higher than 180 mmHg out of 120 to 130 mm Hg plus damage to multiple organs. The prevalence of malignant hypertension is low ( about 1 to 2 cases in 100,000). But rates may be higher in Black populations.

16. Subtypes ..cont’d Isolated systolic hypertension Isolated systolic hypertension is defined as systolic blood pressure above 140 mm Hg and diastolic blood pressure below 90 mm Hg. It’s the most frequent type of hypertension in older adults. An estimated 15% of people ages 60 years or older have isolated systolic hypertension. The cause is thought to be the stiffening of arteries with age.

17. Diagnosis of hypertension A diagnosis of high blood pressure is usually based on the average of two or more readings taken on separate occasions. High blood pressure (hypertension) is diagnosed if the blood pressure reading is equal to or greater than 140/90 millimeters of mercury (mm Hg). Blood pressure measurement A blood pressure reading indicates two values: Systolic pressure.  The first, or upper value which measures the pressure in the arteries when the heart beats. Diastolic pressure.  The second, or lower value which measures the pressure in the arteries between heartbeats.

18. Procedure for measuring BP Blood pressure (BP) is measured using a sphygmomanometer (blood pressure cuff) and a stethoscope Procedure Find a quiet environment to help hear the sounds clearly. Ensure the person is relaxed and seated comfortably with their back supported and legs uncrossed. The arm should be supported at heart level, usually resting on a table. Select the right cuff size. A cuff that's too small or too large can give inaccurate readings.

19. Procedure …cont’d Wrap the cuff around the upper arm, about 1 inch above the elbow, ensuring it’s comfortable but not too tight. The bladder of the cuff should be centered over the brachial artery (the artery that runs down the inner side of the arm). Place the stethoscope's diaphragm over the brachial artery just below the cuff’s edge. Make sure it’s in direct contact with the skin. Squeeze the bulb rapidly to inflate the cuff until the pressure is about 20-30 mmHg above the point where you can no longer hear the pulse (usually around 180 mmHg). This will temporarily stop blood flow in the artery. Slowly release the air from the cuff at a rate of about 2-3 mmHg per second. You should listen carefully through the stethoscope.

20. Procedure …cont’d The point at which you hear first sound (a rhythmic thumping) is the systolic pressure , which is the pressure in the arteries when the heart beats. The point at which the sound disappears completely is the diastolic pressure , which is the pressure in the arteries when the heart rests between beats. Record the systolic and diastolic pressures in millimeters of mercury (mmHg), for example, 120/80 mmHg. Note : It’s often a good idea to take two or three readings, and if there's a significant difference, take an average. Ensure you wait for at least 1-2 minutes between readings.

21. Complications Based on the assessment data, potential complications that may develop include the following: Left ventricular hypertrophy Myocardial infarction • Heart failure Transient Ischemic Attacks ( TIAs)- temporary stroke-like symptoms. Cerebrovascular accident ( stroke, or brain attack) Renal insufficiency and failure Retinal hemorrhage

22. Medical/ Pharmacological management and side effects Medications Major Action Contraindications Side Effects Thiazide Diuretics E.g Chlorthalidone Chlorothiazide Hydrochlorothiazide Indapamide Metolazone Decrease of blood volume, renal blood flow, and cardiac output Depletion of extracellular fluid Negative sodium balance (from natriuresis ), mild hypokalemia . Directly affect vascular smooth muscle Gout, known sensitivity to sulfonamide derived medications, severely impaired kidney function, and history of hyponatremia Dry mouth, thirst, weakness, drowsiness, lethargy, muscle aches, muscular fatigue, tachycardia, GI disturbance. Loop Diuretics . E.g furosemide bumetanide torsemide Volume depletion. Blocks reabsorption of sodium, chloride, and water in kidney Same as for thiazides Same as for thiazides

23. Pharmacological management Medications Major Action Contraindications Side Effects hydralazine Decreases peripheral resistance but concurrently elevates cardiac output . Acts directly on smooth muscle of blood vessels Angina or coronary disease, heart failure, hypersensitivity Headache, tachycardia, f lushing , and dyspnea may occur.. May produce lupus erythematosus -like syndrome. Tachycardia, angina pectoris, ECG changes, edema. minoxidil Direct vasodilating action on arteriolar vessels, causing decreased peripheral vascular resistance; reduces systolic and diastolic pressures Pheochromocytoma Causes hirsutism . Dizziness, headache, nausea, edema, tachycardia, palpitations. sodium nitroprusside , nitroglycerin Peripheral vasodilation by relaxation of smooth muscle Sepsis, azotemia ( biuld up of BUN and creatinine ), high intracranial pressure Can cause thiocyanate and cyanide intoxication.

24. Medications Major Action Contraindications Side Effects Angiotensin -Converting Enzyme (ACE) Inhibitors. Eg captopril , enalapril , fosinopril lisinopril Inhibit conversion of angiotensin I to angiotensin II. Lower total peripheral resistance Renal impairment, pregnancy Dry cough, hyperkalemia , headaches, loss of taste. Angiotensin II Receptor Blockers (ARBs). Eg Losartan , telmisartan , valsartan Block the effects of angiotensin II at the receptor Reduce peripheral resistance Pregnancy, renovascular disease Hyperkalemia , diziness , headaches, fatigue. Calcium Channel Blockers. Eg Amlodipine , Nifedipine , nicardipine , felodipne Inhibit calcium ion influx across membranes Vasodilating effects on coronary arteries and peripheral arteriole Decrease cardiac work and energy consumption, increase delivery of oxygen to myocardium None (except heart failure for nifedipine irregular heartbeat, constipation, shortness of breath, edema. May cause dizziness.

25. Nursing process/ Nursing care plan ASSESMENT Subjective data Presence of any symptoms, history of HTN and patients knowledge on HTN . Presence of early morning headache, blurred vision,confussion and exertional dyspnea . Presence of risk factors.

26. Objective data Two or more bp measurements are taken in both arms in supine and sitting positions after a period of rest . Weight and height measurements-identification of obesity. examination of neck for bruits abdominal bruits.-narrowing of vessels Auscultation of heart for abnormal sounds S3 ,S4,murmurs-evidence of left ventricular hypertrophy. palpation of peripheral pulses-rate, amplitude ,bilateral symmetry-signs of peripheral vascular narrowing. Funduscopic eye examination –presence of arteriolar narrowing and hemorrhage. diagnostic tests

27. Nursing care plan Nursing diagnosis Outcome/plan implementation evaluation Knowledge deficit. lack of exposure, Unfamiliarity with information resources evidenced by patients inability to describe nature of HTN. - Increase patients Understanding on nature of HTN and its effects on heart kidneys and brain. -used simple words to define HTN,systolic and diastolic bp. -explained to the patient the effects of HTN on the heart, brain and kidneys. (Refer to complications) -teach patient about self monitoring of blood pressure. -patient taught on importance of documentation of daily BP results. - patient taught about risk reduction:- exercise ,salt reduction ,smoking ceasation,reduction of alcohol use ,stress reduction .diet modification -patient explains the nature of HTN and its effects on the heart ,kidneys and brain clearly. -patient demonstrates correct procedure for self –measurement of BP and recording of BP. -patient involved in stress reduction activities, diet modification, stopped smoking . -patient reduced consumption of saturated fats-magnesium and potassium reach foods used.

28. Nursing care plan.. Cont’d Nursing diagnosis Outcome/plan implementation evaluation Noncompliance R/T lack understanding for the need of medication in controlling BP , cost of therapy, side effects of medications. The client will demonstrate understanding of the seriousness of high blood pressure ,effects of poor adherence and participation in the making of the treatment plan. Ensuring adequate follow up, communicating often with the client, teaching the client and the family that absence of symptoms does not indicate control of blood pressure -patient advised against abrupt withdrawal of medication to avoid rebound hypertension. -patient helped to remember times for taking medication by attaching it to meal times or writing it on medication bottles. -include family or a close friend to provide support and promote adherence to Rx regimen. -patient taking antihypertensive drugs as prescribed. -Reports no changes in vision . Exhibits no retinal damage on vision testing . Maintains BP ,pulse rate , rhythm and respiratory rate within normal ranges . Reports no dyspnea or edema, Maintains urine output consistent with intake . Has renal function test results within normal range. Demonstrates no motor, speech, or sensory deficits. Reports no headaches, dizziness, weakness, changes in gait, or falls -

29. reference Bruner and Saddarth’s , text book medical-surgical nursing, 12 th Edition. Volume 1 www.who.int/news-room Thomas Kiggundu , Sarah Zalwango and others(2023). Trends and distribution of hypertension in Uganda, 2016-2021. uganda national institute of public health (UNIPH).