MS1 Chapter 22

• Hypertension is defined as a consistent elevation in blood pressure
• Primary risk factor for cardiovascular disease and stroke
• In 2017, hypertension was the 13th leading cause of death
• Normal blood pressure is less than 120 systolic and 80 diastolic mmHg
• Hypertension is a risk factor for cardiovascular disease and stroke
• Hypertension prevalence is high
• Factors that impair normal blood pressure regulation may lead to hypertension
• Factors include sympathetic nervous system overstimulation, increases in hormones causing sodium retention, and impaired kidney function
• Types of hypertension:

  • Primary hypertension: Unknown cause, elevation of systolic and/or diastolic blood pressure
  • Secondary hypertension: Known cause, sign of another problem
• Signs and symptoms of hypertension:

  • Often a "silent killer"
  • Rare symptoms include headache, bloody nose, severe anxiety, and dyspnea
• Diagnosis of hypertension requires at least 2 blood pressure measurements taken at different times, usually a week apart
• Consider risk factors, signs and symptoms, history of kidney or heart disease, current medications, and blood pressure readings
• Nonmodifiable risk factors for hypertension:

  • Family history of hypertension
  • Age
  • Race or ethnicity
• Modifiable risk factors for hypertension:

  • Glucose level
  • Activity level
  • Smoking
  • Sleep
• Hypertension treatment is lifelong and includes lifestyle changes and consideration of antihypertensive medications
• Medication classes for hypertension include diuretics, beta blockers, ACE inhibitors, ARBs, calcium channel blockers, and others
• Complications of hypertension include coronary artery disease, stroke, heart failure, kidney/eye damage, left ventricular hypertrophy, and target-organ disease
• Hypertensive emergency:

  • SBP > 180 mmHg or DBP > 120 mmHg
  • Risk for or progression of target organ dysfunction
  • Immediate BP treatment required in ICU
• Patient education:

  • Lifelong BP control
  • Lifestyle changes
  • Do not stop prescribed medical regimen unless instructed by MD