Wondering how hypertension occurs and why it is also called a “silent killer”? Look no further because this article covers the disease process (pathophysiology) and management of hypertension.
As of March 31, 2022, the Philippine Statistics Authority reported that, with 2,565 cases, hypertension ranked as the nation’s fifth leading cause of death.
Hypertension is the medical term for high blood pressure, defined as a chronic medical condition characterized by persistently elevated pressure in the arteries. It is a major risk factor for serious health problems such as heart disease, stroke, kidney failure, and vision loss. Hypertension is often referred to as the “silent killer” because it typically does not present noticeable symptoms, especially in its early stages. Many individuals are unaware they have high blood pressure, as it can go undetected for years until it leads to serious issues like heart attacks or strokes.
By reading this article, nurses and nursing students will learn how to provide effective patient education, promote early detection, and implement appropriate management strategies. Given that hypertension is common and often asymptomatic, nurses equipped with knowledge about its causes, risk factors, and complications can better educate patients on lifestyle changes and medication adherence, leading to improved outcomes. Moreover, this understanding enables nurses to develop comprehensive care plans and collaborate effectively with healthcare teams, improving overall patient care.
What is Hypertension?
High blood pressure, or hypertension, is a prevalent condition affecting the body’s arteries. When blood pressure is high, the force exerted by the blood against the artery walls is consistently elevated, making the heart work harder to circulate blood.
Blood pressure is measured in millimeters of mercury (mm Hg), and hypertension is defined as a reading of 130/80 mm Hg or higher. A sphygmomanometer is used to measure both systolic and diastolic pressures.
The American College of Cardiology and the American Heart Association classify blood pressure into four main categories:
- Normal blood pressure: Less than 120/80 mm Hg.
- Elevated blood pressure: Systolic between 120-129 mm Hg and diastolic less than 80 mm Hg.
- Stage 1 hypertension: Systolic between 130-139 mm Hg or diastolic between 80-89 mm Hg.
- Stage 2 hypertension: Systolic 140 mm Hg or higher or diastolic 90 mm Hg or higher.
A blood pressure reading above 180/120 mm Hg is classified as a hypertensive crisis, requiring immediate medical attention.
Types of Hypertension
There are two types of hypertension: primary (essential) and secondary. Primary hypertension is the most common type, developing gradually due to genetic, lifestyle, and environmental factors. Secondary hypertension is less common and caused by an underlying medical condition, such as kidney disease, thyroid problems, or certain medications.
Causes and Risk Factors
Hypertension is influenced by a variety of non-modifiable and modifiable risk factors.
Non-Modifiable Risk Factors:
- Age: The risk of hypertension increases with age. Men are generally more affected until their 60s, after which women are at a higher risk.
- Family History: Genetics plays a significant role, and individuals with a family history of hypertension are more likely to develop it.
- Race: Certain racial and ethnic groups, particularly Black individuals, are at greater risk, often developing hypertension at an earlier age.
Modifiable Risk Factors
- Obesity: Excess body weight increases the volume of blood needed to supply oxygen and nutrients, raising blood pressure.
- Diet: High sodium intake can cause fluid retention, raising blood pressure. Low potassium levels can exacerbate hypertension since potassium helps balance sodium levels.
- Physical Inactivity: Lack of exercise contributes to weight gain and higher heart rates, both of which can raise blood pressure.
- Alcohol Consumption: Drinking more than the recommended amounts (one drink per day for women, two for men) can increase blood pressure.
- Tobacco Use: Smoking narrows blood vessels, leading to temporary spikes in blood pressure and long-term damage to the blood vessels.
- Stress: Chronic stress can cause sustained increases in blood pressure due to continuous activation of the sympathetic nervous system.
- Chronic Conditions: Conditions like diabetes and kidney disease can impair the body’s ability to regulate blood pressure.
- Medications: Certain drugs, such as NSAIDs and decongestants, can raise blood pressure by constricting blood vessels or affecting kidney function.
- Hormonal Factors: Hormonal disorders, such as adrenal and thyroid issues, can also lead to secondary hypertension.
Hypertension Disease Process (Diagram)
Management Strategies
The primary goal in managing hypertension is to lower blood pressure and minimize the risk of associated health problems. Treatment usually involves a combination of lifestyle modifications and medications. Patients should consult a physician and follow their prescribed regimen, including regular BP monitoring.
Lifestyle Changes: Nurses should educate patients on the following strategies to control blood pressure:
- Eat a healthy diet low in sodium, saturated fat, and added sugars (see the DASH diet below).
- Maintain a healthy weight or lose excess pounds.
- Engage in regular physical activity.
- Limit alcohol consumption.
- Quit smoking and avoid secondhand smoke.
- Manage stress through relaxation techniques.
Pharmacologic Therapy: If lifestyle changes are insufficient, healthcare providers may prescribe antihypertensive medications. Common drug classes include:
- Diuretics
- Angiotensin-converting enzyme (ACE) inhibitors
- Angiotensin II receptor blockers (ARBs)
- Calcium channel blockers
- Beta-blockers
The choice of medication depends on factors like the patient’s age, race, comorbidities, and previous treatments.
The DASH Diet
The DASH diet (Dietary Approaches to Stop Hypertension) is a heart-healthy eating plan designed to help prevent and treat hypertension. It emphasizes vegetables, fruits, whole grains, lean proteins, and low-fat dairy products while limiting sodium added sugars, and saturated fats. The standard DASH diet limits sodium to 2,300 mg per day, while a lower sodium version restricts it to 1,500 mg per day.
Benefits of the DASH Diet:
- Helps lower blood pressure and cholesterol levels.
- Reduces the risk of heart disease and stroke.
- Provides a balanced eating plan that is easy to follow for life.
Key Components of the DASH Diet:
- Vegetables: 4-5 servings per day
- Fruits: 4-5 servings per day
- Whole grains: 7-8 servings per day
- Low-fat or fat-free dairy: 2-3 servings per day
- Lean meats, poultry, fish: 6 or fewer servings per day
- Nuts, seeds, legumes: 4-5 servings per week
- Fats and oils: 2-3 servings per day
- Sweets: 5 or fewer servings per week
Tips for Following the DASH Diet:
- Choose low-sodium options when possible.
- Limit processed, canned, and fast foods.
- Read nutrition labels and select lower-sodium items.
- Use herbs, spices, and salt-free seasonings.
- Gradually reduce sodium intake to allow taste buds to adjust.
Conclusion
Effective management of hypertension requires a comprehensive approach that addresses both modifiable and non-modifiable risk factors. By working closely with healthcare teams and empowering patients to take an active role in their care, nurses can help reduce the burden of hypertension and its associated complications. Early detection, prompt management, and healthy lifestyle practices are important for controlling high blood pressure and promoting long-term cardiovascular health.
References
- Hinkle, J. L., & Cheever, K. H. (2014). Brunner & Suddarth’s textbook of medical-surgical nursing (Edition 13.). Wolters Kluwer Health/Lippincott Williams & Wilkins.
- Causes and risk factors. Retrieved September 1, 2024, from NHLBI, NIH website: https://www.nhlbi.nih.gov/health/high-blood-pressure/causes
- Chen, R., Dharmarajan, K., Kulkarni, V. T., Punnanithinont, N., Gupta, A., Bikdeli, B., … Ranasinghe, I. (2013). Most important outcomes research papers on hypertension. Circulation. Cardiovascular Quality and Outcomes, 6(4). doi:10.1161/circoutcomes.113.000424
- DASH eating plan. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/education/dash-eating-plan. Accessed September 02, 2024.
- Dela Rosa, J. G. L., Catral, C. D. M., Reyes, N. A., Opiso, D. M. S., Ong, E. P., Ornos, E. D. B., Tantengco, O. A. G. (2024). Current status of hypertension care and management in the Philippines. Diabetes & Metabolic Syndrome, 18(4), 103008. doi:10.1016/j.dsx.2024.103008
