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define HTN

  • Defined as a systolic pressure at or greater than 140 mmHg or diastolic pressure at or greater than 90 mmHg for 2 or more assessments of blood pressure
    • For those over 60, blood pressure should be less than 150/90
  • Prolonged, untreated, or poorly controlled HTN can cause peripheral vascular dz that primarily affects the heart, brain, eyes, and kidneys
  • Hypertrophy of the left ventricle can develop as the heart pumps against resistance caused by the HTN


essential HTN vs. secondary HTN

  • Essential HTN: AKA primary HTN
    • Most common
    • No known cause
  • Secondary HTN: caused by dz states, like kidney dz, or as an ADR of some meds
    • Tx: occurs by removing the cause (adrenal tumor, medication)



  • client’s with a SBP of 120-139 mmHg or a DBP of 80-89 mmHg
  • Lifestyle changes are necessary for these clients to help prevent cardiovascular disease


health promotion and dz prevention of HTN

  • Maintain body mass index of less than 30
  • Clients who have DM should keep blood glucose w/in a recommended reference range
  • Limit caffeine and alcohol intake
  • Use stress management techniques during times of stress
  • Stop smoking: nicotine patches or engaging in a smoking cessation class are potential strategies
  • Engage in exercise that provides aerobic benefits at least 3 times a week
  • Limit sodium and fat intake


explain the 4 mechanisms that regulate BP

  • Arterial baroreceptors:
    • Baroreceptors are located in the carotid sinus, aorta, and left ventricle
    • They control BP by altering the heart rate. They also cause vasoconstriction or vasodilation.
  • Regulation of body fluid volume: properly functioning kidneys retain fluid when a client is hypotensive and excrete fluid when a client is hypertensive
  • RAAS: renin is converted into Ang II, which causes vasoconstriction and controls aldosterone release, causing the kidneys to reabsorb sodium and inhibit fluid loss
  • Vascular autoregulation: maintains consistent levels of tissue perfusion


risk factors of essential HTN

  • Positive family hx
  • Excessive sodium intake
  • Physical inactivity
  • Obesity
  • High alcohol consumption
  • African American
  • Smoking
  • Hyperlipidemia
  • Stress
  • Age greater than 60 or postmenopausal


risk factors of secondary HTN

  • Kidney disease
  • Cushing’s disease (excessive glucocorticoid secretion)
  • Primary aldosteronism (causes HTN and hypokalemia)
  • Pheochromocytoma (excessive catecholamine release)
  • Brain tumors, encephalitis
  • Meds like estrogen, steroids, and sympathomimetics
  • Pregnancy


expected finidngs in clients who have HTN

  • Clients who have HTN can experience few or no manifestations. Monitor for the following.
    • HAs, particularly in the morning
    • Facial flushing
    • Dizziness
    • Fainting
    • Retinal changes, visual disturbances
    • Nocturia


stages of HTN

  • When a BP reading is elevated, take it in both arms and w/ the client sitting and standing
  • There are levels of HTN:
    • preHTN: 120-139/80-89
    • Stage I HTN: 140-159/90-99
    • Stage II HTN: greater than or equal to 160/greater than or equal to 100


lab tests for HTN

  • no lab tests can diagnose, but several can identify the causes of secondary HTN
    • BUN, creatinine: elevation is indicative of kidney dz
    • Elevated serum corticoids: detects Cushing’s dz
    • Blood glucose and cholesterol studies: identify contributing factors related to blood vessel changes


diagnostic procedures for HTN

  • ECG: evaluates cardiac functions
    • Tall R waves: often seen with left ventricular hypertrophy
  • CXR: shows cardiomegaly


meds for HTN

  • used when HTN is not responsive to lifestyle changes alone
  • Diuretics are first line, but many ppl require a combination of meds
  • Client edu: instruct clients to change positions slowly, and to be careful when getting out of bed, driving, and climbing stairs until the med’s effects are fully known
  • classes of HTN meds:
    • diuretics
    • CCBs
    • ACE Inhibitors
    • ARBs
    • Aldosterone receptor antagonists
    • beta blockers
    • central alpha 2 agonists
    • alpha adrenergic antagonists


what are the types of diuretics used to tx HTN and how do they work?

  • Thiazide diuretics: like HCTZ, inhibits water reabsorption and increases potassium excretion
  • Loop diuretics: like furosemide, dec Na reabsorption and inc K excretion
  • Potassium sparing diuretics: like spironolactone,  affect the DCT and prevent reabsorption of Na in exchange for K


nursing considerations and client edu for diuretics used to tx HTN

  • Nursing Considerations: monitor K levels and watch for muscle weakness, irregular pulse, and dehydration
    • Thiazide and loop diuretics: can cause hypokalemia
    • Potassium sparing: can cause hyperkalemia
  • Client edu:
    • Encourage client to keep all appts w/ provider to monitor efficacy of medications and possible electrolyte imbalance
    • If taking K wasting diuretic, encourage consumption of K rich foods


CCBs used to tx HTN

  • verapamil, amlodipine, diltiazem
    • After movement of calcium ions thru the cell membrane, vasodilation and lowered BP results
  • Nursing considerations:
    • Monitor BP and pulse and change client’s position slowly
    • Use cautiously if pt has HF
  • Client edu:
    • Verapamil: constipation is common so inc fluids and inc fiber intake
    • Dec or inc in HR and AV can occur
    • Teach client to take pulse and call provider if irregular or lower than expected
    • Avoid grapefruit juice


ACE Inhibitors used to tx HTN

  • lisinopril, enalapril
    • Prevent conversion of Ang I to Ang II which prevents vasoconstriction
  • Nursing considerations:
    • Watch BP and pulse
    • Watch for evidence of HF like edema
  • Client edu:
    • Teach client to report a cough (ADR)
    • Report signs of HF


ARBs used to tx HTN

  • valsartan, losartan
    • Good for clients who take ACE inhibitors but have a cough or have hyperkalemia
    • Do not require a dosage adjustment for older adults
  • Nursing considerations:
    • Watch for signs of angioedema or HF
  • Client edu:
    • Change positions slowly
    • Report signs of angioedema (swollen lips, face) or HF
    • Avoid foods high in K and have serum K levels monitored b/c ARBs can cause hyperkalemia


aldosterone receptor antagonists used to tx HTN: medication and action

  • eplerenone
    • Block aldosterone’s action which promotes the retention of K and excretion of Na and water


aldosterone receptor antagonists used to tx HTN: nursing considerations

  • Monitor kidney fcn, triglycerides, Na, and K
    • Risk of adverse effects inc with deteriorating kidney fcn
    • Risk inc as dose inc
  • Monitor K levels every 2 weeks for first few months and every 2 months thereafter
    • Avoid taking K supplements or K sparing diuretics


aldosterone receptor antagonists used to tx HTN: client edu

  • Teach client about food, med, herbal interactions like grapefruit juice and St. John’s wort can increase ADRs
  • Instruct the client not to take salt substitutes with K or other foods rich in K


beta blockers used to tx HTN

  • metoprolol, atenolol
    • For clients who have unstable angina or MI
    • Decrease cardiac output and block the release of renin, subsequently decreasing vasoconstriction of the peripheral vasculature
  • Nursing considerations:
    • Monitor BP and pulse
    • Meds mask hypoglycemia in clients who have DM
  • Client edu:
    • Teach the client that these meds can cause fatigue, weakness, depression, and sexual dysfunction
    • Do not d/c abruptly
    • Teach about S/S of hypoglycemia that do not include tachycardia, which beta blockers suppress


central alpha 2 agonists used to tx HTN

  • clonidine
    • Reduce peripheral vascular resistance and dec BP by inhibiting the reuptake of NE
  • Nursing considerations:
    • Monitor BP and pulse
    • Med is not for 1st line management of HTN
  • Client edu:
    • ADRs: sedation, orthostatic hypoTN, impotence


alpha adrenergic antagonists used to tx HTN

  • prazosin
    • Reduce BP by causing vasodilation
  • Nursing considerations:
    • Start tx w/ low dose of med and give at night
    • Monitor BP for 2 hours after starting tx
  • Client edu:
    • Rise slowly to prevent postural hypoTN


client education for HTN

  • Report S/S of hyperkalemia, hypokalemia, and hyponatremia
  • Adhere to medication regimen
  • Ensure client has resources to pay for meds
  • Teach how to manage BP at home
  • Report ADRs
  • Teach about how to make lifestyle changes
  • nutrition education
    • including weight reduction and maintenance
  • smoking cessation
  • stress reduction: yoga, massage, hypnosis


nutrition education for HTN

  • Monitor for hyperkalemia and salt substitute use
  • Consume less than 2.3 g/day of sodium
  • Diet should be low in fat, saturated fat, cholesterol
  • Limit alcohol intake to 2 servings/day for males and 1 serving/day for females
  • DASH diet: high in fruits, veggies, low fat dairy foods
  • Consume foods rich in Ca and Mg
  • If not taking a K sparing medication, should inc K consumption


weight reduction and maintenance with HTN

  • Begin slowly and gradually advance the program with the guidance of the provider and physical therapist
  • Exercise at least 3 times a week in a manner that provides aerobic benefits


complication of HTN

  • HTN crisis: often occurs when they don’t follow the medication regimen
  • Nursing actions:
    • S/S: severe HA, extremely high BP (usually over 240/120), blurred vision, dizziness, disorientation, epistaxis
    • Administer IV anti HTN meds: nitroprusside, nicardipine, labetalol
    • Monitor BP every 5-15 min
    • Assess neuro status, such as pupils, LOC, muscle strength to monitor for cerebrovascular change
    • Monitor ECG to assess cardiac status


what is acute coronary syndrome (ACS)?

  • continuum from angina to MI
  • symptoms due to an imbalance b/w myocardial O2 supply and demand


angina pectoris

  • warning sign of impending MI
    • Women and older adults do not always experience manifestations assoc with angina or MI


what improves outcomes following an MI?

clients treated w/ aspirin, beta blockers, and ACE inhibitors, or ARBs