• tension or pressure exerted by blood against ARTERIAL walls. 
• It is the product of cardiac output multiplied by peripheral resistance or systemic vascular resistance (SVR)

• Decreasing Systemic Vascular Resistance
• Decreasing Blood Volume
• Decreasing the strength and rate of myocardial contractions.

It increases the workload of the left ventricle which must pump hard to eject blood into the arteries which eventually causes hypertrophy and HF.

BP 

Systolic 120-139 or Diastolic 80-89    

BP

Systolic 140-149 or Diastolic 90-99

BP

Systolic > 160 or Diastolic > 100

Don't know what is causing it.

90-95%

• Due to a discernable cause such as:
• identified cause, renal artery stenosis (narrowed artery causing increased pressure and less excretion of wastes.)
• Hyperaldosteronism
• Meds such as Aderol and Cocaine, ADD meds and cold meds
• Pregnancy
• Coarctation of the Aorta (transposed circulation of blood)

Smoking                Obesity

Menopause           Family History

Male                       DM

>60                     Activity

1. The volume of blood transported.
2. Commonly expressed as liters or mL per minute or cubic centimeters per second.

• The opposing forces or impedance to blood.
• Determined by blood viscosity, length of vessel, and diameter of vessel.

Causes vasodilation of arterioles, lowering BP

***Anything that stimulates PNS will lower BP***

• Sympathetic nervous system overactivity
• Renin-angiotensin-aldosterone sys overactivity
• Chemical mediator of vasomotor tone (atrial natriuretic peptides)
• Interaction between insulin resistance and endothelial function.

• Accelerates rate of atherosclerosis increasing risk of CHD and stroke, PVD, and aneurysms
• Workload of left ventricle increases leading to left ventricle hypertrophy and increasing the risk of CHS, dysrhythmias, and HF
• Leads to nephrosclerosis (stiff) and renal insufficiency.

Cold causes vasoconstriction which increase BP

Heat causes vasodilation which decreases BP

Influence blood pressure by affecting cardiac output and / or peripheral vascular resistance.

• Headache near back of head and neck occurs when awakened and subsides during day.
• May develop s/s if other organs involved such as confusion, nausea, vomiting, visual disturbances (such as halos or stars)
• Eye exam will show narrowed arterioles, hemorrhages, an papilledema

Lifestyle modifications

Pharmacologic Treatment

Prevention of complications

No-cure control

No Dx tests for essential HTN except BP measure

• The reduction of cardiovascular and renal morbidity and mortality as it relates to HTN
• Treating SBP and DBP to targets of <140/90 is associated with decreased CVD
• Patients with diabetes or renal disease the goal is <130/80 mmHg

• Weight reduction
• Physical activity (mainly cardio)
• Moderation of alcohol consumption
• Diet rich in potassium and calcium and low in sodium (DASH, Dietary approaches to stop HTN)
• Increase lagunes, beans, fiber and decrease in all fast food type food.

• ACE inhibitors
• ARB's: ACE's and ARBS lower BP by causing dilation of vessels.
• Beta Blockers
• CCB's
• Thiazide-type diuretics

Diuretics

1. They enhance antuhypertensive efficacy of multidrug regimens
2. They are affordable
3. You can use them in combination with other drugs.

• Watch Potassium, sodium, and calcium :(lasix lowers electrolytes and aldactone is potassium sparing.
• Monitor for s/s of hypokalemia which are dysrhythmia, constipation, fatigue/muscle weakness, spasms or paralysis which can include lungs.
• Give early in the day to keep from nocturia.

ACE INHIBITORS

End in prils

• Renoprotective
• Cause peripheral blood vessel dilation
• Used commonly in patients with ischemic heart disease, HF, diabetic HTN
• Watch for cough
• Avoid in women of childbearing age (Teratogenic)
• watch for hx of angioedema
• Can also cause elevated potassium level

Angiotensin II Antagonists

(Don't raise potassium as much)

Meds end in Sartan

• Blocks the binding of Angiotensin II on its receptors resulting in decreased Aldosterone (controls reabsorption of sodium and chloride and secretion of potassium and hydrogen.
• Reduces left ventricular hypertrophy
• Common side effect is cough.

Calcium Channel Blockers

End in "Pine", Verapamil; Diltiazem

Dilate peripheral arterioles and reducing peripheral resistance.

Used for cardiovascular resistance

Avoid in HF and post MI

***Good results with African American and patients  with breathing problems***

Beta Adrenergic Blockers

"lol"

Reduce CO by producing beta adrenergic blockage

Most commonly used with diuretics

Avoid with pulmonary patients, diabetic patients

Used with ischemic heart disease.

Slows HR (must be >60 to administer)

Bradycardia              Headache

Palpitations            Hypoglycemia

Cough w/ ACE's and ARBS

Dizziness                  Fatigue

Erectile dysfunction         decreased libido

Postural hypotension and hypotension

Elevated bp from identifiable underlying condition (5-10%)

Kidney disease

Coarction of aorta

Target Organ Damage such as MI, dissecting aortic aneurysm, Intracranial pressure.

Use vasodilators such as : Nitropress, Vasotec, Nitro Bid stat IV

• Diuretics: Hydrochlorathiazide, Lasix, Aldactone
• Beta Blockers: Tenormin, Lopressor, Inderal
• Calcium Channel Blockers: Norvasc, Calan
• ACE Inhibitors: Capoten, Vasotec
• ARBS: Altacand, Cozaar