Hypertension:
•	Prehypertension: 139/80- 89 mm Hg
•	Hypertension:  140/ 90 mm Hg 
•	Hypertension can be further classified into as stage 1 or stage 2
o	Stage 1:  140-159/ 90- 99 mm Hg
o	Stage 2: 160/ 100 mm Hg or greater
o	Diagnosis is determined by two or more reading measurements taken  during two or more different times
Pathophysiology 
•	For hypertension to develop there must be a change in one or more factors affecting peripheral vascular resistance (PVR) or cardiac output 
o	Peripheral vascular resistance:  r/t the diameter of the blood vessels and the viscosity of the blood
•	thicker blood or smaller radius of  blood vessels = higher resistance
•	larger diameter of blood vessels or thinner blood = lower PVR
o	Cardiac output: vol. of blood being pumped by the heart per min. 
Diff b/n primary/ secondary
•	Primary Hypertension:  high BP from an unidentified cause 
o	Also given the names: essential or idiopathic hypertension
o	More common than secondary hypertension in 2009 95% of pts. diagnosed w/ hypertension was is in the form of primary hypertension
•	Secondary Hypertension: high BP to secondary to an identified cause 
o	Possible causes narrowing of renal arteries or renal stenosis, renal disease, medications, and pregnancy 
Risk Factors/ general info
•	Hypertension increases w/ age
o	Aging causes structural changes and functional changes in the heart and blood vessels ( atherosclerosis and decreased elasticity of major blood vessels, increased wall stiffness)
•	Systolic hypertension is the  most common form of hypertension
•	Hypertension is more common in men than women, until  menopause
•	Obesity common risk factor 
o	BMI > 30 
•	Hypertension is a risk factor for the development of atherosclerotic heart disease, often coexists w/ dyslipidemia and diabetes mellitus
o	Dyslipidemia: elevated LDL  cholesterol or low HDL cholesterol or a total elevated total cholesterol 
•	Oral contraceptives can cause a small increase in systolic and diastolic BP
•	Smoking does NOT cause high BP but if they have hypertension and smoke it increases their risk of dying from heart disease or related disorders 
Signs/ symptoms
•	SOB
•	Alteration in speech 
•	Vision 
•	Angina pain
•	Impaired balance
•	Epistaxis ( nosebleeds)
•	Headache 
•	Dizziness
•	Nocturia
Assessment  
•	Typically no symptoms, physical examination may only reveal an elevated BP
•	The nurse should assess for signs and symptoms of target organ damage 
•	The nurse should also ask about personal, social, or financial  factors and about medication usage  
Best practice for taking BP
•	*Inflate the cuff to palpate the brachial artery until the pulse is obliterated, deflate the cuff, add 30 mm Hg to the  palpated pressure, and then measure the BP*
•	Instruct the pt to avoid smoking or drinking caffeine 30 min. prior 
•	Make sure the cuff size is correct
o	Too small of a cuff=  too high of a reading
o	Too large of a cuff = too low of a reading
•	Position the pts. arm at level of the heart
•	Palpate the systolic pressure before auscultating
•	Ask the pt to sit quietly
•	When releasing the pressure let out about 2 mm Hg per sec.
•	Make sure to document the location of the site it taken at
o	Especially important when assessing for orthostatic changes
•	 Inform the pt of the BP value and what it means, emphasize the need for periodic reassessment, and encourage the pts. who measure BP at home to keep a written log
o	This engages the pt in the teaching process and correlation of diet, medication adherence w/ BP 
Treatment 
•	Net goal is a BP < 140/90 mm Hg and > 130/ 80 mm Hg for those w/ diabetes or chronic kidney disease  
•	Self-management should be encourage which includes self BP monitoring, pt should be given information on healthy lifestyle changes 
•	Life style changes include: weight reduction, DASH diet, reduction of Na, physical activity, moderation of alcohol consumption
•	Educate the pt it takes 2 to 3 months for taste buds to adapt to changes in salt intake
•	Teach pt how to read food labels and to look for foods that contain less 400 mg of Na per serving 
•	It is important to assess the pts. beliefs about hypertension  
•	Prehypertension
o	Want to prevent or delay the onset of hypertension
o	Lifestyle modification: dietary changes and exercise
•	Stage 1 
o	Pharmacologic therapy and lifestyle changes
o	Should be monitored every month until their BP goal is met, and every 3 months to 6 months thereafter
•	Stage 2  hypertension w/ other complicating conditions
o	They need to be seen more frequently 
Drug interaction/ Herbals
•	Herbals or Over the counter (OTC) meds. that may increase BP
o	Caffeine
o	Ephedra
o	Oral contraceptives
o	Acetaminophen
o	NSAIDs
Medicine/ non pharmacologic
•	The most effective therapy is only effective if the pt. adheres to it and adherence is dependent on the pts. motivation 
•	Motivation improves if pt has a positive experience and if trust is built, empathy builds trust and is a positive motivator 
•	Thiazide diuretic are given to those w/ uncomplicated hypertension
o	Useful in elderly w/ osteoporosis because they decrease bone breakdown
•	Medications can be added or the dose may be increased 
o	Advantage of adding a new med. instead of increasing the dose is that the occurrence of side effect may be avoided 
o	Most pts. need two or more drugs because hypertension is caused by multiple factors
•	For those w/ diabetes, heart failure , or cardiovascular disease an ACE inhibitor or ARB is recommended
o	These drugs protect and preserve renal function and protect the vascular endothelium 
•	Statins are given to lower cholesterol 
•	Low-dose-aspirin  therapy is indicated once BP is controlled to limit cardiovascular complications

Nursing alerts
	“Pulse pressure is the diff. b/n the systolic and diastolic pressure; normally it is 40 mm Hg i.e. 120/80 mm Hg. A widened pulse pressure, over 50 mm Hg is associated w/ increased intracranial pressure, atherosclerosis, aortic insufficiency, and fever.”
	“Normally, the BP should vary by no more than 5mm Hg b/n arms. A diff. greater than 10 mm Hg or greater may indicate an arterial obstruction on the side w/ the lower value.”	
	“Reducing table salt to about 1 teaspoon per day, or 2.4 g of Na, can reduce systolic BP by 2 to 8 mm Hg.”

Peripheral Arterial Disease:
Arthrosclerosis
Signs/ symptoms
Interventions/care
Abdominal Aortic Aneurysm (AAA)
Signs/ symptoms
Risk factors
Preop/Postop care