SBP > 140 &/or DBP > 90

Pt with DM or heart disease - BP should be < 130/90 (b/c vessel integrity already compromised)

Caused by disease state or medication:

• Renal Vascular Disease - most common
• Pregnancy
• Brain Tumors
• Cushing's
• Estrogen (oral contraceptives)
• Glucocorticoids, Sympathomimetics
• Any med that causes vasoconstriction (directly or by hormone manipulation)

Avg pressure in cardiac cycle:

• 60-70 mmHg
• Necessary to maintain perfusion of all major body organs

Difference between SBP and DBP:

• 30 - 40 mmHg

Factors affecting SVR

• SNS
• Vasoconstrictors
• Atherosclerosis
• RAA system
• Vasopressin/ ADH

Fight or flight, pulling everything into those vital organs:

• SNS triggered by DECREASED O2
• Increased HR
• Increased force of contraction
• Peripheral vasoconstriction

• Control sodium and water excretion
• RAA system

• Adrenal medulla releases catecholamines = raised BP via vasoconstriction and increased CO
• Adrenal cortex releases aldosterone
• Posterior pituitary releases ADH = raise BP by increased vol

• Dependent on adequate bp
• Decreased in HTN b/c blood going through too fast to be "absorbed" into tissues
• Major organs damaged - heart, brain, kidneys, eyes

• BP in both arms - diff shouldn't be > 10 mmHg
• BP lying, sitting, standing
• Pulse
• Cap refill (tissue perfusion)
• Respirations
• I/O

Most common form of HTN in older adults

• SBP > 140
• DBP LESS THAN 90
• No symptoms
• SBP better indicator than DBP of heart disease & stroke risk

• Vague symptoms
• Exam of retina - hemorrhages and papilledema
• Progressive signs - H/A, N/V, dizziness, visual changes, nocturia, confusion

Diagnostic Tests

• Fundoscopic eye exam
• CXR - enlargement of heart
• UA (renal influence) - protein, specific gravity
• Serum electrolytes
• Serum lipids
• Serum glucose
• ECG - electrical changes caused by HTN
• Renal fxn studies
• IV pyelography - renal fxn

• Risk for Impaired Tissue Perfusion
• Risk for Decreased Cardiac Output
• Knowledge Deficit - teaching lifestyle modifications very impt (sodium, exercise, stress)

Severe and abrupt increase in BP:

• SBP > 240
• DBP > 130
• Pt may stroke out

• SEVERE H/A
• Extremely high BP
• Dizziness
• Blurred vision
• Disorientation

1. SEMI-FOWLER'S POS
2. O2
3. Meds - Nitropress, labetolol
4. V/S mon q 5 min + cardiac monitoring - chk bp in both arms
5. Observe for neurologic or CV manifestations
6. Ongoing assessment - must have good baselines

• Diuretics - loop, potassium sparing, thiazide
• Ace inhibitors
• ARBs 
• Calcium Channel Blockers
• Arterial Vasodilators
• Adrenergic Inhibitors - beta and alpha blockers
• Renin Inhibitors

• Accelerate rate of urine formation
• Remove sodium and water from body
• Decrease SVR through dilation
• Decrease ECP
• Decrease preload
• Decrease CO

• RAPID diuresis
• Decreases edema r/t CHF, liver and renal diseases
• Increases renal excretion of Ca in pt with hypercalcemia

• Electrolye loss - K
• Dehydration
• Risk of postural hypotension - woozy upon sitting, worse when standing;  fall and syncope risk
• Ototoxicity - Lasix given IV push given very slow bc of tinnitus and poss hearing loss

Loop Diuretics (Nursing Considerations):

• Mon. fluid vol status
• Mon electrolytes
• Strict I/O - prevent dehydration
• Increase K containing foods - potatoes, spinach, white beans, apricots, prune juice
• Postual hypotension precautions - rails up, assistance
• Mon glucose closely in DM pt - lasix can cause hyperglycemia

• Promote sodium and water excretion
• Retention of K - can result in increased K levels
• Weak diuresis
• Ex - Aldactone

Most common tx for HTN

• H2O, Na, Cl, and K excretion
• Decreased SVR r/t arteriole dilation
• Ex (all end in thiazide)
• Zaroxolyn - *thiazide like*

• Dizziness
• H/A
• libido
• anorexia
• N/V
• Jaundice
• Leukopenia
• Thrombocytopenia
• Photosensitivity
• Impotence
• Hypokalemia, hyponatremia
• Hyperglycemia, hypercalcemia, hyperlipidemia

• Mon fluid vol status
• Mon electrolytes
• Measure I/O
• Intake of K containing foods
• Mon glucose of DM pt
• Postural hypotension precautions

Angiotensin Converting Enzyme turns angiotensin I to angiotensin II

• End in "-PRIL"
• Decrease SVR
• Inhibit aldosterone formation = prevents Na and H2O reabsorption
• Diuresis = decreased blood vol, decreased preload, decreased cardiac workload

ACE Inhibitors (SE):

• Hypotension
• Hypoglycemia
• COUGH - nagging, only cure is to stop drug
• Hyperkalemia
• Angioedema - throat area; hoarse voice

Angiotensin Receptor Blockers

• Block tissue receptors - keep it fm triggering release of aldosterone
• "Slippery Sartans" - all meds end in "-sartan"
• Not as effective for African Americans or by themselves

• Decrease BP through vasodilation
• Ex "-dipine", verapamil, ditiazem
• Given w/ diuretics b/c cause peripheral edema

Calcium Channel Blockers (SE & Precautions):

• Hypotension
• Dizziness
• Bradycardia
• Monitor for S/S of CHF
• Do not stop abruptly - b/c of rebound HTN

• Relax vascular smooth muscle = decreased SVR
• Reserved for SEVERE HTN
• Ex - hydralazine, Loniten, Hyperstat, Nipride

• Decreased BP effects with epi/norepi
• Block either alpha, beta or both receptors
• Decrease force of contraction of the heart - decreased CO
• Dilates blood vessels - decreased afterload and SVR

• Block beta receptors to decrease HR and BP
• Slow conductivity through AV node
• Decrease contractility
• Ex - Nonselective = Inderal and Corgard; Cardioselective = Tenormin, lopressor

Beta Blockers (SE):

• Bradycardia
• Hypotension
• Heart Block
• Impotency
• GI distress
• Fatigue
• Weakness
• Wheezing

Beta Blockers (Nursing Considerations):

• Do NOT stop abruptly
• Mon DM pt
• Contraindications (non-selective) - Bronchospasms, asthma, COPD

• Prevents reuptake of norepi = decreased SVR and BP
• NOT a first line drug for HTN
• Ex - Catapress (can be given as a patch)
• Mon for sedation, syncope and impotence

• Prevents vasoconstriction = decreased SVR and CO
• Ex - Tekturna
• Minimal SE - but can cause resp distress
• Not as effective with African Americans
• Used alone or with thiazide diuretics