hypertension.pptx

A presentation hypertension
(what blood pressure is, what is hypertension, what are the risk factors of hypertension, how is it managed?) and other related knowledge on hypertension

1. HYPERTENSION By NGULAKEH BLAISE ALOT HND,BNS,MAR1

2. PLAN OF WORK Introduction Definition Classification/types of hypertension Risk factors Pathophysiology Clinical manifestation Assessment and Diagnosis Management Hypertensive Crisis Complications Conclusion

3. INTRODUCTION Blood pressure is the force exerted by circulating blood against the walls of the body’s arteries, the major blood vessels in the body. Hypertension is when blood pressure is too high. Blood pressure is written as two numbers. The first “systolic” (represents the pressure in blood vessels when the heart contracts or beats The second “diastolic” (represents the pressure in the vessels when the heart rest between beats).

4. INTRODUCTION Blood pressure is the product of cardiac output multiplied by peripheral resistance. BP= CO x PVR Cardiac output is the product of the heart rate multiplied by the stroke volume CO= HR x SV High blood pressure, known as hypertension, can result from a change in cardiac output, a change in peripheral resistance, or both.

5. DEFINITION Hypertension is a systolic blood pressure greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period, based on the average of two or more blood pressure measurements taken in two or more contacts with the health care provider after an initial screening.

6. CLASSIFICATION/TYPES OF HYPERTENSION Primary hypertension A lso called essential hypertension This is the type of hypertension in which the reason for the elevation in blood pressure is idiopathic. This form of high blood pressure is often due to obesity, family history and unhealthy diet. The condition is reversible with life style changes and drugs

7. CLASSIFICATION/TYPES OF HYPERTENSION Secondary hypertension Secondary hypertension is high blood pressure caused by another condition or disease. Conditions that may cause secondary hypertension include kidney and adrenal disease, thyroid problems and obstructive sleep apnea.

8. CATEGORIES OF HYPERTENSION CATEGORY SYSTOLIC (mm Hg) DIASTOLIC (mmHg) Optimal <120 <80   Normal <130 <85   Pre-hypertension 130–139 85–89   Stage 1 Hypertension 140–159 90–99   Stage 2 Hypertension ≥160 ≥100   Hypertensive crisis (emergency) Greater than 180 Greater than 120

9. RISK FATORS Obesity Age: above 50 years of age Alcohol, smoking and diabetes mellitus Family history Sedentary life style Diet: excessive intake of sodium(salt) Stress Gender(greater in men than in women)

10. PATHOPHYSIOLOGY hypertension is a multifactorial condition and the specific cause is not known. For hypertension to occur, there must be a change in one or more factors affecting peripheral resistance or cardiac output . Stimulation of the vas-motor center results in impulses travelling down over the sympathetic nervous system to the sympathetic ganglia

11. PATHOPHYSIOLOGY There is the release of catecholamines ;( adrenaline and nor-adrenaline) which result in constriction of blood vessels. At the same time the sympathetic nervous system to blood vessels is stimulated and the adrenal medulla. Vasoconstrictor effects also result to ischaemia of the kidney releasing renin. Renin helps in the conversion of angiotensinogen to angiotensin (II), which is a potent vasoconstrictor. This angiotensin in turn stimulate the release of Aldosterone by the adrenal medulla. This hormone then increase sodium and water retention by kidney tubules

12. PATHOPHYSIOLOGY This in turn increase water and electrolyte concentration in blood vessel wall to a level which enhance vasoconstriction response of the blood vessel. When artherosclerotic disease of the large blood vessel occurs in addition to HTA, the prognosis is poorer. Vasoconstrictor effect in the brain leads to thrombosis causing thrombo -embolic stroke or cerebro vascular accident (CVA). Increase pressure in the blood vessel of the brain may lead to rupture i.e hemorrhagic stroke

13. CLINICAL MANIFESTATIONS Hypertension is sometimes called “ the silent killer” because people who have it are often symptom free. Some patients may manifest the following: retinal changes Left ventricular hypertrophy Pathologic changes in the kidneys Dizziness Chest pain Severe headache Irregular heart beat Blurred vision Fatigue Nausea/vomiting Papilledema

14. ASSESSMENT AND DIAGNOSTIC EVALUATION History collection and physical examination : The retinas and other related part are examined, and laboratory studies are performed to assess possible target organ damage. Para clinical examinations : Routine examinations include: urinalysis, blood chemistry ( ie , analysis of sodium, potassium, creatinine , fasting glucose Total and high-density lipoprotein [HDL] cholesterol levels), lead electrocardiogram. Left ventricular hypertrophy can be assessed by echocardiography. Renal damage may be suggested by elevations in BUN and creatinine levels or by microalbuminuria or macroalbuminuria . Additional studies, such as creatinine clearance, renin level, urine tests, and 24-hour urine protein, may be performed

15. MANAGEMENT Drugs alone cannot be used to manage hypertension; treatment of hypertension can be classified into two Life style/dietary modifications Pharmacological therapy

16. MANAGEMENT Life style/dietary modifications The life style modifications needed to be employed in the management of hypertension include: Exercise Dietary sodium reduction Mechanisms to reduce weight Stress management measures Avoidance of a sedentary life style

17. MANAGEMENT PHARMACOLOGIC THERAPY For patients with uncomplicated hypertension and no specific indications for another medication, the recommended initial medications include diuretics, beta-blockers, or calcium channel blockers. Patients are first given low doses of medication. If blood pressure does not fall to less than 140/90 mm Hg, the dose is increased gradually, and additional medications are included as necessary to achieve control.

18. MANAGEMENT Drugs commonly used in the treatment of hypertension: Diuretics Calcium channel blockers Beta-Blockers propranolol) Angiotensin II Receptor Blockers Angiotensin-Converting Enzyme Inhibitors

19. 1 Diuretics

20. MANAGEMENT a) Thiazide Diuretics Major Action : 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 Advantages: Effective orally, effective during long-term administration, Mild side effects Enhance other antihypertensive medications, Counter sodium retention effect of other antihypertensive medications. Contraindications: Gout, known sensitivity to sulfonamide derived medications, and severely impaired kidney function

21. MANAGEMENT b) Loop Diuretics ( furosemide (Lasix) ) Major Action: Volume depletion Blocks reabsorption of sodium, chloride, and water in kidney Advantages: Action rapid Potent Used when thiazides fail or patient needs rapid diuresis Contraindications : Same as for thiazides but has a stronger hypokalemic effect than thiazide and not suitable for prolong used except other wise

22. c) Potassium-Sparing Diuretics eg spironolactone Major Action: Major Action: Volume depletion Blocks reabsorption of sodium, chloride, and water in kidney Advantages: spironolactone is effective in treating hypertension accompanying primary aldosteronism . Both spironolactone and triamterene cause retention of potassium. Contraindications: Renal disease, azotemia, severe hepatic disease, hyperkalemia

23. 2 Calcium channel blockers : nifedipine,nicardipine

24. Major Action : Inhibit calcium ion influx across membranes, Vasodilating effects on coronary and peripheral arteriole, Decrease cardiac work and energy consumption, increase delivery of oxygen to myocardium Advantages: Rapid action Effective by oral or sublingual route No tendency to slow SA nodal activity or prolong AV node conduction Isolated systolic hypertension Contraindications : heart failure

25. 3 . Angiotensin-Converting Enzyme Inhibitors eg captopril

26. Major Action : Inhibits conversion of angiotensin I to angiotensin II Lower total peripheral resistance Advantages : Fewer cardiovascular side effects Can be used with thiazide diuretic and digitalis Hypotension can be reversed by fluid replacement . Contraindications: Renal impairment, pregnancy

27. 4. Angiotensin II Receptor Blocker e.g candesartan

28. Major Action: Major Action: Block the effects of angiotensin II at the receptor Reduce peripheral resistance Advantages: Minimal side effects. Contraindications: : Pregnancy, renovascular disease Effects and nursing considerations: Monitor for hypokalemia

29. 5. BETA-BLOCKERS E,g propanolol

30. Major Action: Block the sympathetic nervous system (beta-adrenergic receptors), especially the sympathetic to the heart, producing a slower heart rate and lowered blood pressure Advantages: Reduce pulse rate in patients with tachycardia and blood pressure elevation and are useful as an adjunct with medications that act at the neuroeffector site of the blood vessel Contraindications : Bronchial asthma, allergic rhinitis, right ventricular failure from pulmonary hypertension, congestive heart failure, depression, diabetes mellitus, dyslipidemia, heart block, peripheral vascular disease, heart rate under 60 bpm .

31. 6) Central Alpha Agonists methyldopa ( Aldomet ) Major Action: Dopa -decarboxylase inhibitor; displaces norepinephrine from storage sites Advantages : Drug of choice for pregnant women with hypertension Useful in patients with renal failure Does not decrease cardiac output or renal blood flow Does not induce oliguria Contraindications: Liver disease

32. HYPERTENSIVE CRISES

33. Definition It is a clinical syndrome that is associated with abrupt increase in blood pressure, relative to the patient’s baseline, causing acute or rapidly progressing end-organ damage. There are two hypertensive crises that require immediate intervention: H ypertensive emergency and H ypertensive urgency.

34. HYPERTENSIVE CRISES Hypertensive emergencies and urgencies may occur in patients whose hypertension has been poorly controlled or in those who have abruptly discontinued their medications.

35. HYPERTENSIVE CRISES Hypertensive Emergency It is a severe elevation in blood pressure(above 180/120mmHg) complicated by impending or progressive target organ dysfuntion involving neurological, cardiac or renal systems Conditions associated with hypertensive emergency include acute myocardial infarction, dissecting aortic aneurysm, and intracranial hemorrhage. The medications of choice in hypertensive emergencies are those that have an immediate effect such as Intravenous vasodilators, including sodium nitroprusside ( Nipride , Nitropress ), nicardipine hydrochloride

36. HYPERTENSIVE CRISES Hypertensive Urgency It is a situation in which there is acute severe elevation in blood pressure above 180/120mmHg without evidence of end stage organ damage . Hypertensive urgencies are managed with oral doses of fast-acting agents such as loop diuretics ( bumetanide [ Bumex ], furosemide [Lasix]), beta-blockers propranolol (Inderal), M etoprolol (Lopressor), N adolol ( Corgard ),

37. NURSING MANAGEMENT Nursing management of a hypertensive patient follows the nursing process. A complete assessment of the patient is necessary in other to establish a good nursing diagnosis. The role of diet and life style modification should be given. IEC of the patient’s condition should also be given particular attention.

38. NURSING MANAGEMENT NURSING DIAGNOSES Based on the assessment data, nursing diagnoses for the patient may include the following: Deficient knowledge regarding the relation between the treatment regimen and control of the disease process Non compliance with therapeutic regimen related to side effects of prescribed therapy

39. NURSING MANAGEMENT NURSING DIAGNOSES Insufficient physiological or psychological energy to endure or complete required daily activity evidence by weakness ECG changes Intake of nutrients that exceeds metabolic needs, evidence by a 10-20% increase in weight more than the ideal for his/her height and frame.

40. COMPLICATIONS Left ventricular hypertrophy Myocardial infarction Heart failure TIAs Cerebrovascular accident (stroke or brain attack) Renal insufficiency and failure Retinal hemorrhage

41. CONLUSION “The silent killer ” as it is often called because most people who have it are often symptom free is a chronic disease in which proper management is essential for a healthy life. I t is important that, regular monitoring of blood pressure be practice by all adult and those with family history for hypertension in order to early diagnosed any existing HTA and initiate early treatment hence preventing it complications and enhancing the quality of life

42. THANKS