PRIMARY HYPERTENSION AND SECONDARY HYPERTENSION: HYPERTENSION SYMPTOMS HYPERTENSION TREATMENT
Hypertension (Primary hypertension and secondary hypertension) is the persistent, intermittent or sustained elevation of the blood pressure, usually above 140/90mmhg. Blood pressure is the pressure exerted on the walls of the blood vessels by the blood they contain (blood pressure is = cardiac output multiplied by peripheral resistance). Cardiac output = Heart rate multiplied by stroke volume.
Hypertension can result from a change in cardiac output, a change in peripheral resistance or both. The normal blood pressure is 100/60 140/90mmHg. However, irrespective of the Hypertension symptoms, with focused hypertension treatment these conditions can be checkmated.
TYPES OF HYPERTENSION
PRIMARY HYPERTENSION ( or Idiopathic Hypertension)
It has no identifiable cause but there are some risk/predisposing factors which includes the following
- Race (common among blacks)
- Gender (common in men than women)
- Family history
- Sedentary lifestyle
- Hormonal contraceptive use
- High dietary intake of sodium or saturated fats
- Excessive caffeine, alcohol or tobacco use
It is the most common type of hypertension (90 - 95% of all cases). It is the type cause by disease conditions of the organs of various systems in the body. Some of the causes of various systems in the body. Some of the causes includes the following:
- Renal Disease
- Cushing syndrome
- Thyroid, Parathyroid or pituitary dysfunction
- Pregnancy induced hypertension
- Coarctation of the aorta
- Diabetes mellitus
- Head trauma that will lead to increased intracranial pressure
PATHOPHYSIOLOGY OF HYPERTENSION
In hypertension, the various causes stimulates the vasomotor centre in the medullar of the brain. This will lead to the release of acetylcholine, epinephrine and nor-epinephrine resulting in the constriction of blood vessels and vasoconstrictions of peripheral vessels. This will result in increased peripheral resistance leading to elevated blood pressure continuous peripheral resistance results in compensatory mechanism of the heart thereby increasing heart rate.
CLINICAL MANIFESTATION (HYPERTENSION SYMPTOMS)
Common Hypertension symptoms includes the following:
- Headache (Occipital)
- Flushed face
- Elevated blood pressure
- Insomnia (Sleeplessness)
- Chest pain (Angina)
- Impaired vision and speech
- Serial blood pressure reading, that is above 140/90mmHg in persons younger than age, 60 and 160/mmHg in persons older than age 60 in a minimum of three readings on separate occasions is diagnostic
- Chest radiograph shows left ventricular hypertrophy
- Electrocardiogram will show altered waves
- Blood urea nitrogen and creatinine levels are increased because of renal involvement
HYPERTENSION TREATMENT (MANAGEMENT)
The aim of management is to reduce the blood pressure in order to prevent complications such as cerebrovascular accident, retina damage and renal insufficiency. The management of hypertension cuts across the use of various groups of drugs and modification of lifestyle such as limitation of alcohol intake, avoidance of tobacco use, regular physical activity and dietary changes.
Pharmacology (Drug Therapy)
This is the major treatment of primary hypertension. The drugs include the following:
- Diuretics: These drugs help in decreasing blood volume by promoting micturition thereby decreasing heart workload. Examples are chlorothiazide, furosemide(lasix) and spironolactone (Aldacton).
- Adrenergic Inhibitors: These drugs impair the synthesis and re-uptake of nor-epinephrine thereby causing vasodilation. Examples are reserpine (peripherals agents) guanethidine, methyldopa (aldomet), propranololmetropolo and nadolol (Beta blocker), prazosin hydrochloride (alpa blocker) and labetalol hydrochloride (combined Alpha and Beta blocker)
- Vasodilators: These drugs act on the smooth musces of blood to cause vasodilation and decreasing peripheral resistance. Examples are hydralazine hydrochloride (Aspresoline), nitroglycerine, minoxidil and diazoxide
- Angiotension: Conversion enzyme inhibitors: These drugs inhibit the converts of Angiotension I to Angiotension II thereby lowering total peripheral resistance. Examples are catopril (capoteno, enalapril (vasotec), lisonopril, ramipril and tradolapril and benazepril.
- Angiotensis II Receptor Blockers: These drugs block the effects of angiotensin II at the receptor thereby reducing peripheral resistance and reducing blood Examples are losartan , valsantan, candisartan, tasosarten and irbesartan.
- Calcium Channel blockers: These drugs inhibits calcium ion influx thereby reducing cardium impulse and reducing cardiac workload causing vasodilation of coronary and peripheral arteriole examples are verapami, Amlodipine, Felodipin, Nifedipine, Istadipine and Verapanil
Nursing Management (for Primary Hypertension and Secondary Hypertension)
To facilitate Hypertension Treatment the following nursing management strategies should be taken by the nurse or medical personnel:
- Admission: Patients should be admitted in a comfortable and noiseless environment. Adequate rest with relaxation techniques should be provided to reduce stimulation of sympathetic nervous system workload and to conserve energy1
- Observation: Vital signs especially blood pressure should be monitored regularly to know the effects of medications and to confirm if there is improvement
- Nutrition: prevent over weight by reducing calorie intake and restrict sodium intake to reduce heart overload. Avoid constipation bytaking high fibre diet
- Physical care: Assist in activities of daily living, self care, passive and active exercise. Apply ice pack if there is epistaxis, but if bleeding is much the nose is packed
- Monitor side effect and adverse effects of drug so that changes can be made on report, explain orthostatic hypotension and how to manage it e.g by rising from bed slowly
- Client/patient's family education or teaching
- Patient should be advised to reduce weight by restricting caloric intake
- Patient should also be instructed to restrict sodium, alcohol and caffeine intake
- Patient should be urged to stop smoking
- Patient should be encouraged to conduct a regular physical activity and exercise programme since exercise enhance the sense of wellbeing
- Discus the importance of regular blood pressure monitoring with the patient. Teach patient how to take blood pressure monitoring and keep a record of the readings
- Discuss the importance of lifelong medical follow-up with patient
- Teach the patient and family about process, factors contributing to symptoms and risks and the importance of effective management
- Intervene in a hypertensive crisis, blood pressure need to be lowered immediately iv antihypertensive agents are used and blood pressure monitored every 5-15minuites because in hypertensive crisis the BP is usually very high (250/150mmHg and above)
- Impaired breathing pattern related to angina (chest pain) evidence by dyspnea
- Pain (occipital headache) related to cerebral arteries constriction/disease process evidence by patient's complain
- Impaired sleep pattern (insomnia) related to disease process evidence by fatigue
- Knowledge deficit regarding the relation between the treatment regimen and control of the disease process evidence by non compliance with therapeutic regimen
Below are medical conditions that may result if Hypertension (Primary and Secondary) are not well managed
- Myocardial infaction
- Retinal haemorrhage
- Renal insufficiency
- Cerebro vascular accident (stroke)
- Heart failure
DIETARY MANAGEMENT FOR HYPERTENSION (PRIMARY AND SECONDARY HYPERTENSION)
The best diet for a hypertensive patient is meals that are low in trans fat, cholesterol, saturated fat, salt (sodium), and added sugars.
Generally it is the best dietary advice for every adult regardless of blood pressure. The main thing a hypertensive patient should checkmate is salt intake. Too much of salt or sodium causes the body to retain fluid and this increases blood pressure.
In hypertension treatment plan the most important aspect is to maintain a healthy diet, which includes limiting sodium intake. Optimally a healthy person should consume less than 2,300mg of sodium per day, hypertensive patients should restrict salt(sodium) intake even more. Adults hypertensive patients should not consume more than 1,500 mg of salt per day.
Thus to stay on track in treating hypertension symptoms, the adult should choose low-sodium and no-added-salt foods and seasonings, nutrition facts labels of food should be examined/read carefully before consumption of the food, so as to determine the amount of salt (sodium) added to package and processed foods.
Heart-Healthy (DASH diets-Dietary Approaches to Stop Hypertension) is recommended by Dieticians or doctors because it focuses on dietary heart-healthy foods that are low in fat, cholesterol and sodium(salt), but rich in nutrients, protein and fibre.
These foods includes, vegetables, whole grains, fish, nuts, poultry products, fat-free or low-fat dairy products
Dash Diets (Dietary heart-healthy foods that are low in fat, cholesterol, and sodium, and rich in nutrients, protein, and fiber