Hypertension

Blood pressure is the force of blood exerted on the vessel walls measured in systolic and diastolic pressures. The systolic pressure represents the ejection of the blood from the heart into the arteries. The diastolic pressure the represents the pressure of the heart at rest between beats. Blood pressure is persistently greater than 160mmHg systolic and/ or 100mmHg diastolic. Anything below 100/80 mmHg is considered hypotensive.

Signs and symptoms:

Hypertension: may be asymptomatic. Other symptoms may include headache, increased HR, chest pain, sweating.

Hypotension: may experience dizziness, weakness, fatigue, sweating or anxiety. Risk factors: overweight or obsess, increasing age, inactivity, excessive alcohol intake, family history, male, diet high in sodium, smoking, stress, excessive caffeine intake, use of oral contraceptives, adrenal gland and thyroid disorders, use of illegal drugs, certain chronic medical conditions e.g. kidney disease.

Complications: a sustained elevated blood pressure can cause organ damage, coronary artery disease, stroke, retinal damage, myocardial infarction, and renal disease if left untreated. Drug therapy:

Beta-blockers: atenolol, propranolol, metoprolol, carvedilol

MoA: a beta-1-adrenergic receptor inhibitor and some effects on beta-2 receptors. This decreases cardiac output by producing negative chronotropic and inotropic effects. Adverse effects: gastro-intestinal disturbances, bradycardia, hypotension

Important notes: avoid abrupt withdrawal especially in ischaemic heart disease, always obtain vital signs before administering, do not give if hypotensive or HR less than 60bpm. Angiotensin-converting enzyme (ACE) inhibitors: dilate blood vessels and increase blood flow.

Calcium channel blockers: dilate blood vessels.

Diuretics (loop/ thiazide): increase urine output decreasing total blood volume = decreased blood pressure.

Treatment:

Lifestyle: maintaining healthy body weight, regular exercise, quitting smoking, limiting alcohol intake, reducing salt, reducing stress.

• Benefits of exercising for the heart: Exercise id necessary for optimal physiological functioning and psychological wellbeing.

• Direct positive effect on maximal oxygen uptake, increasing cardiac output, decreasing blood lipids, decreasing BP, increasing blood flow through the coronary arteries, increasing muscle mass and flexibility, improving the psychological state, assisting in weight loss and control. Increases collateral coronary circulation.

Nursing care: patient education to have continuous monitoring of blood pressure and regular check-ups. Education to maintain low-sodium diet and regularly exercise to promote healthy lifestyle. Education on signs of hypotension and other adverse effects of medications.