Effective Management of High Blood Pessure (Hypertension): Symptoms, Causes, and Nursing Care

What Hypertension (HPT)

Hypertension is defined as a systolic blood pressure (SBP) of 140 mmHg or more, or a diastolic blood pressure (DBP) of 90 mmHg or more, or taking antihypertensive medication.

Classification of Blood Pressure for adults aged 18 years or older

Normal:Systolic lower than 120 mm Hg, diastolic lower than 80 mm Hg

Prehypertension:Systolic 120-139 mm Hg, diastolic 80-89 mm Hg

Stage 1:Systolic 140-159 mm Hg, diastolic 90-99 mm Hg

Stage 2:Systolic 160 mm Hg or greater, diastolic 100 mm Hg or greater

Causes of Hypertension

Blood pressure is determined by the force blood exerts against the walls of their blood vessels or the amount of blood the heart pumps and how hard it is for the blood to move through the arteries. This pressure depends on the resistance of the blood vessels and how hard the heart has to work. The more blood the heart pumps and the narrower the arteries, the higher the blood pressure.
Basically, there are two main types of high blood pressure namely primaryand secondary hypertension.

Primary Hypertension

Also called essential hypertension; the cause of this type of hypertension is often not known. It tends to develop gradually over many years. Many factors may contribute to primary hypertension such as;

• Having obesity
• Insulin resistance
• High salt intake
• Excessive alcohol intake
• Having a sedentary lifestyle
• Smoking

Secondary Hypertension

Secondary hypertension is caused by an underlying condition. It tends to develop suddenly from co-morbid conditions causing higher blood pressure than primary hypertension does. Some conditions and drugs that secondary hypertension develops from include:

• Heart attack
• Cerebrovascular accident
• Adrenal gland tumors
• Blood vessel problems present at birth
• Kidney disease
• Obstructive sleep apnea
• Thyroid problems
• Illegal drugs, such as cocaine and amphetamines
• Drugs such as cough and cold relief drugs, some pain relievers, birth control pills, among others

Risk factors of Hypertension

Risk factors can be categorized into Modifiable (changes can be made to lifestyle to reduce the risk of getting high blood pressure) and non-Modifiable (changes cannot be made but can be managed).

Modifiable risk factors include;

• Unhealthy diets i.e. excessive salt consumption, a diet high in saturated fat and trans fats, low intake of fruits and vegetables
• Physical inactivity
• Consumption of tobacco and alcohol
• Being overweight or obese.
• Co-existing or comorbidity diseases such as diabetes or kidney disease.

Pathophysiology of Hypertension

Hypertension is a chronic elevation of blood pressure that, in the long-term, causes end-organ damage and results in increased morbidity and mortality. The regulation of blood pressure involves an intricate interplay between various physiological systems, including the cardiovascular system (arterial baroreceptors), renal system (the renin-angiotensin-aldosterone system (RAAS), atrial natriuretic peptide (ANP), endothelins, and mineralocorticoid and glucocorticoid steroids.), and hormonal control mechanisms. Together, these complex systems manage the degree of vasodilatation or vasoconstriction within the systemic circulation, and the retention or excretion of sodium and water, to maintain an adequate circulating blood volume. Disruptions in any of these components can contribute to the pathogenesis of hypertension. This may be through increased cardiac output, increased systemic vascular resistance, or both.

One major contributor to hypertension is an increase in systemic vascular resistance (SVR), which refers to the resistance encountered by blood flow within arterial vessels. Elevated SVR can result from structural changes within arterial walls or dysregulation of vasoactive substances that influence vessel tone. Endothelial dysfunction plays a crucial role in initiating these structural changes. Under normal conditions, endothelial cells produce nitric oxide (NO), a potent vasodilator that helps maintain vascular homeostasis by promoting relaxation of smooth muscle cells lining arterial walls. However, when endothelial function is impaired due to factors such as oxidative stress or inflammation, there is reduced NO production and increased release of vasoconstrictors like endothelin-1.

Renin-angiotensin-aldosterone system (RAAS) also play an important role in regulating blood pressure. When triggered by low blood volume or decreased perfusion pressure sensed by specialized cells called baroreceptors located in kidney arterioles, the juxtaglomerular apparatus, renin secretion increases. Renin then cleaves angiotensinogen into angiotensin I, which gets converted into angiotensin II via ACE (angiotensin-converting enzyme).

Angiotensin II acts on arteriolar smooth muscle cells directly to induce vasoconstriction and indirectly stimulates aldosterone release from adrenal glands leading to sodium reabsorption at the kidneys and subsequent water retention. This fluid accumulation further contributes to increased blood volume and elevated blood pressure.
Furthermore, the sympathetic nervous system's activation can also drive hypertension. Increased sympathetic outflow leads to vasoconstriction, cardiac stimulation (increased heart rate and contractility), and sodium retention by the kidneys resulting in higher blood pressure levels.

Signs & Symptoms of Hypertension

Most people with hypertension don`t show any signs and symptoms, even if their pressure reading reached above their normal. Only few people with very high blood pressures manifest with the following symptoms

• Headaches,
• Blurred vision,
• Chest pain
• Dizziness
• Difficulty breathing
• Nausea
• Vomiting
• Anxiety
• Confusion
• Buzzing in the ears
• Nosebleeds
• Abnormal heart rhythm

Medical Management of Hypertension

In managing hypertension, most groups, such as AHA recommend lifestyle modification as the initial step in managing hypertension. To achieve a greater results, 2 or more lifestyle modifications are combined. Among these modifications, other recommendations are as follows;

• Exercises to lose Weight
• Limit alcohol intake to no more than 1 oz (30 mL) of ethanol per day for men or 0.5 oz (15 mL) of ethanol per day for women
• Reduce sodium intake to no more than
• 2.4g or 100 mmol/day
• Maintain adequate intake of dietary potassium (approximately 90 mmol/day)
• Maintain adequate intake of dietary calcium and magnesium for general health
• Stop smoking and reduce intake of dietary saturated fat and cholesterol for overall cardiovascular health
• The recommended diet according to AHA is diet low in sodium, high in potassium, low-fat dairy products, and consumption more fruits and vegetables to lower the risk of stroke and reduce high blood pressure.

Pharmacologic therapy

Next to lifestyle modifications, there are several drug options for treating and managing hypertension if lifestyle modifications are insufficient to treat and manage hypertension.

• Thiazide diuretics, an angiotensin-converting enzyme inhibitor (ACEI) /angiotensin receptor blocker (ARB), or calcium channel blocker (CCB) are the preferred agents in nonblack populations, whereas CCBs or thiazide diuretics are favored in black populations.
• Angiotensin converting enzyme ACE inhibitors including enalapril and lisinopril relax blood vessels and prevent kidney damage.
• Angiotensin-2 receptor blockers (ARBs) including losartan and telmisartan relax blood vessels and prevent kidney damage.
• Calcium channel blockers including amlodipine and felodipine relax blood vessels.
• Diuretics including hydrochlorothiazide and chlorthalidone eliminate extra water from the body, lowering blood pressure.

Nursing Management of Hypertension

• Monitor blood pressure frequently to assess for changes in blood pressure levels and adjust medication dosages as needed
• Check patient`s lab data (cardiac markers, blood cell count, electrolytes, ABGs, etc.) to determine contributing factors.
• Observe patient`s skin color, moisture, temperature, and capillary refill time.
• Listen to the heart for murmurs and lungs for rales and crackles
• Check if the patient has edema
• Check renal function and electrolyte levels
• Monitor intake and output
• Encourage rest and provide a quiet room
• Administer antihypertensive medications as prescribed and monitor the patient for adverse reactions to medications.
• Educate patient on a low salt diet, exercise, and healthy eating
• Educate the patient on the importance of taking antihypertensive medications
• Educate the patient on lifestyle changes such as dietary approaches to stop hypertension (DASH) guidelines, exercise, and stress management techniques.
• Teach the patient on stress management techniques such as deep breathing exercises, meditation, and progressive muscle relaxation.
• Provide oxygen if the saturations are low (less than 94%)
• Limit fluid intake if the patient is in heart failure
• Assess ECG to ensure the patient is not having a heart attack

Complications of Hypertension

Uncontrolled High blood pressure can cause severe problems, among other complications, hypertension can cause serious damage to the heart. Excessive Pressure can harden arteries, decreasing blood flow and oxygen to the heart. This elevated pressure and reduced blood flow may lead to serious health problems such as;

1. Chest pain (angina)
2. Heart attack
3. Heart failure
4. Death as a result of irregular heart beat
5. Coronary artery disease (CAD).
6. Stroke.
7. Peripheral artery disease.
8. Kidney disease and kidney failure.
9. Pre eclampsia and eclampsia
10. Eye damage.
11. Vascular dementia.

Preventions of Hypertension

High blood pressure can be prevented by modifying lifestyle activities and or by talking prescribed medication to lower blood pressure. Reducing hypertension prevents heart attack, stroke and kidney damage, as well as other health problems. These lifestyle changes can help prevent and lower high blood pressure.

• Eat more vegetables and fruits.
• Be more physically active, which can include walking, running, swimming, dancing or activities that build strength, like lifting weights
• Get at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous aerobic activity.
• Exercise to lose weight if you`re overweight or obese.
• Limit alcohol intake to not more than 1 oz (30 mL) of ethanol per day for men or 0.5 oz (15 mL) of ethanol per day for women and people of lighter weight (range of approximate SBP reduction, 2-4 mm Hg)
• Reduce sodium intake to not more than 100 mmol/day (2.4 g sodium or 6g sodium chloride; range of approximate systolic BP reduction, 2-8 mm Hg)
• Maintain adequate intake of dietary potassium (approximately 90 mmol/day)
• Take prescribed medications
• Avoid eating foods high in saturated or trans-fats
• Avoid smoking or using tobacco
• Reducing and managing stress
• Checking blood pressure regularly managing other medical conditions.