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Hypertension occurs in systolic blood pressure is at or above 140 mmHg or diastolic blood pressure is at or above 90 mmHg.
Normal adult blood pressure
Less than 120 and mmHg systolic and 80 MmHg diastolic
Also called primary hypertension accounts for most cases of hypertension. No known cause.
Can because by certain disease states such as kidney disease, or an adverse reaction of some medications
Treatment secondary hypertension
Occurs by removing the cause; adrenal tumor, medication
Diagnosis of hypertension
Is an average of two or more accurate measurements taken during two or more contacts with a healthcare provider
Stage 1 hypertension
Systolic 140-159 mmHg; diastolic 90-99 mmHg
Systolic grater or equal to 160 mmHg; diastolic grater than or equal to 100 mmHg
Increased prevalence with age, African-Americans have highest prevalence, silent killer people who have it often Are symptom-free.
Hypertension risk factors
Atherosclerotic heart disease, dyslipidemia, obesity, diabetes, metabolic syndrome, sedentary style.
Hypertension as a disease
Major contributor to death from cardiac, cerebrovascular, renal and peripheral vascular disease
Pathophysiology of hypertension
•Blood pressure is the product of cardiac output multiplied by peripheral resistance.
• pressure is exerted by the left ventricle each time it contracts.
•Pressures exerted by the blood is it flows through the blood vessels.
•If there is an increasing cardiac output, and/or an increase in peripheral resistance - blood-pressure rises.
Hypertension in geriatric population
Structural and functional changes in heart and blood vessels contribute to increased blood pressure.
• accumulation of plaque in arteries
• arteries less elastic
• increase collagen deposits
• impaired vasodilation
Hypertension in geriatric population
Changes decreased elasticity of the major blood vessels leads to the aorta and Large arteries inability to accommodate blood volume leading to elevated systolic blood pressure with no change in diastolic
Clinical manifestations of hypertension
Physical exam may be normal except elevated blood pressure, retinal changes may occur first, and specific signs and symptoms of hypertension occur they indicate vascular damage.
Assessment and diagnostic findings
Health history and physical exam including retinas
- uninanalysis, sodium, potassium, fasting blood glucose, total cholesterol, HDL, BUN, creatinine, ECG, echocardiography.
Blood pressure can be reduced by
- Reduced alcohol and sodium intake
- Regular physical activity
- Pharmacologic therapy
•Increase blood pressures increases risk of death, stroke and heart failure
•Start with lifestyle modifications
•Starting dose of medication should be half of that prescribed for younger patients
Patient understanding of disease process, treatment; patient participation in care; absence of complications.
-Focus on lowering pressure and controlling blood pressure without adverse effects or intensive cost.
-Elderly would do better if only required to take 1 medication
-Watch for rebound if meds abruptly stopped
-Promote home and community-based care
Occurs when; hypertension has been poorly controlled, undiagnosed hypertension, medications abruptly discontinued.
Hypertensive crisis: hypertensive emergency
Blood-pressure extremely elevated more than 180/1 20
- must be lowered to halt or prevent damage to target organs
- acute and life-threatening
- goal is to decrease blood pressure by 25% in the first hour.
- further reduce BP to goal of 160/100 over next six hours then gradually reduced pressure over a period of days.
- exception is with ischemic stroke and aortic dissection.
health promotion and disease prevention
Body mass index less than 30, limit caffeine and alcohol intake, stress management techniques, stop smoking, exercise at least three times a week
Dietary approach to stop hypertension
Consume: low-fat dairy foods, high fruits and vegetables; Rich in potassium, calcium, and magnesium.
Avoid: foods high in sodium and fat- trans and saturated fat.
Blood pressure very elevated but no evidence of impending or progressive target organ damage; elevated blood pressure is associated with severe headache, nosebleeds, anxiety are urgencies; normalization of blood pressure within 24-48 hours is goal.
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