Hypertension PPT.pptx High blood pressure it's cause and management

High blood pressure it's cause and management

1. HYPERTENSION

2. HYPERTENSION Hypertension or high blood pressure is a condition in which the blood pressure in the arteries is chronically elevated. Hypertension is defined as “an average systolic blood pressure above 140mmHg and a diastolic blood pressure above 90mmHg or both.”

3. Incidence & Prevalence 1 in 4 persons suffer from hypertension 5 million people suffering from hypertension in US Prevalence of hypertension in India is about 29.8%. (33% in urban area & 25% in rural area)

4. Causes and risk factors Retention of sodium and water Altered renin-angiotensin aldosteron mechanism Stress and increased sympathetic activity. Decreased prostaglandin activity.

5. Contd.. Other risk factors include.. Age Sex Race Family history of HTN Obesity Stress Smoking Alcohol intake Elevated serum lipids etc..

6. Classification I. AHA classifies hypertension as.. Classification Systolic BP mmHg Diastolic BP mmHg Normal Pre- hypertension Hypertension stage I Hypertension stage II Isolated systolic HTN 120 120-139 140-159 ≥160 ≥140 80 80-89 90-99 ≥100 <90

7. Contd.. Classification II. 1.Essential Hypertension (Primary HTN) : It is the most common form of hypertension where cause is unknown. 2.Secondary Hypertension : It is a type of hypertension which is caused by an underlying condition. 3.White Coat Hypertension : It is a type of hypertension which occurs when B.P is measured by health care personnel. 4.Isolated Systolic Hypertension : It occurs when systolic BP is 140mmHg or higher but diastolic BP remains less than 90mmHg. 5.Accelerated and Malignant Hypertension : It is a persistent severe hypertension combined with organ damage.

8. Clinical Features “ Silent Killer”: Often asymptomatic initially Severe headache, dizziness & blurred vision Nausea & vomiting Fatigability Palpitations Epistaxis Chest pain & shortness of breath Irregular heart beat Papilloedema

9. Complications Heart attack & heart failure Coronary artery disease Stroke & TIA Renal failure Eye damage with progressive vision loss Peripheral arterial disease Aneurisms Hypertensive crisis a. Hypertensive emergency b. Hypertensive urgency

10. Normal Regulation of BP

11. Pathophysiology

12. Diagnostic Evaluation By signs/symptoms, Physical examination and History collection. ECG to determine effects of HTN on heart. Urinalysis for proteinuria , elevated BUN levels, and creatinine levels indicate kidney disease Urine for catecholamines - usually increased in pheochromacytoma . Renal scan to detect renal vascular diseases Doppler ultrasound to detect vascular changes Serum cholesterol & triglyceride levels

13. Management Life style modification loose weight if BMI is greater than normal Limit or stop alcohol & smoking Regular exercises Cut sodium intake to 2.4g or less per day Reduce coffee / tea intake Stress reduction by yoga, meditation & music therapy

14. Contd... Nutrition Follow DASH Diet ( Dietary Approaches to Stop Hypertension) i.e patient should consume diet rich in fruits, vegetables , reduced sodium in diet, low fat dairy products, fibre and low in saturated & total fat. If despite of lifestyle changes and nutrition therapy BP remains at or above 140/90 mmHg over 3-6 months drug therapy should be initiated.

15. Pharmacological Management I. Diuretic Drugs A. Thiazide Diuretics : Benzothiazide , chlorthiazide , cyclothiazide etc B. Loop Diuretics : Furosemide , ethacrynic acid etc C. Potassium Sparing diuretics : Spironolactone , Amiloride , Triamterene MOA: These drugs will prevent re-absorption of sodium and chloride.

16. Contd.. II. Vasodilators. e.g. Hydralazine , Minoxidil , Nitropruside etc.. MOA: It causes vasodilatation and reduces peripheral resistance. III. Central acting adrenergic inhibitors e.g. Clonidine , methyldopa etc. MOA: Drug inhibits impulse through sympathetic nerve pathways causes central alpha receptor stimulation, which decreases sympathetic tone resulting into dilatation of arterioles & veins.

17. Contd... IV. Peripheral acting adrenergic inhibitors. e.g. Reserpine , Guanadrel sulfate . MOA: Prevents the release of norepinephrine , resulting in peripheral vasodilation. V. Alpha- Adrenergic Inhibitors. e.g. Prozacin , phentolamine MOA: Blocks peripheral vascular alpha adrenergic receptors resulting in dilation of both arterioles & veins.

18. Contd.. VI. Beta Adrenergic Blockers E.g. Atenolol , Metaprolol , propranolol . MOA: It reduces blood pressure by decreasing cardiac output, decreasing sympathetic stimulation and decreasing rennin secretion by the kidney. VII. Angiotensin converting enzyme inhibitors. e.g. Captopril , Elanopril MOA: Inhibitor of angiotensin converting enzyme which lowers total peripheral resistance.

19. Contd.. VIII. Calcium channel blockers E.g. Nifedipine , verapamil . MOA: It acts by blocking movement of extra cellular calcium into cells, vasodilation of peripheral arterioles occurs, resulting in decreased peripheral vascular resistance. IX. Combined alpha & beta adrenergic blockers. E.g. Labetolol . MOA: Non selective beta blocker that also has alpha adrenergic blocking properties.

20. Nursing Management Take thorough history of the client. Assess heart rate, palpate peripheral pulses, determine respirations. Auscultate for bruits over peripheral arteries to determine the presence of atherosclerosis. Thorough cardiovascular other associated systems examination. Monitor blood pressure periodically. Educate the client about life style modification to control hypertension

21. Nursing Diagnosis Deficient knowledge regarding relationship between the treatment regimen & control of the disease process. Ineffective therapeutic regimen management related to medication adverse effects and difficult lifestyle adjustments.