GENERAL OBJECTIVES:

AFTER 1 HOUR OF VARIED LECTURE-TEACHING, THE X FAMILY WILL BE ABLE TO ACQUIRE BASIC KNOWLEDGE, DEVELOP SKILLS AND
POSITIVE ATTITUDE IN THE CONCEPT OF HYPERTENSION.

SPECIFIC OBJECTIVES CONTENT TIME ALLOTMENT METHODOLOGY RESOURCES EVALUATION

Specifically, the
students will be able to:

1. Define hypertension Hypertension, also referred to as high blood pressure, 3 mins Lecture- Human
HTN or HPN, is a medical condition in which the blood Discussion resources:
pressure is chronically elevated. Hypertension is defined as a
sustained elevation in the mean arterial pressure. It is often Time and
an asymptomatic disorder characterized by persistent effort of the
elevation of blood pressure associated with the thickening nurse and
and loss of elasticity in the arterial walls. family
members

2. Enumerate the Hypertension can be classified either primary 3 mins

classifications of or secondary. Primary hypertension indicates that no specific Material
hypertension medical cause can be found to explain a patient's condition. It resources:
is also called essential hypertension or idiopathic
hypertension. About 90 % of all hypertensive have primary Visual aids;
hypertension. Secondary hypertension indicates that the high special
blood pressure is a result of (i.e., secondary to) another papers, low
condition, such as kidney disease or tumours. cost supplies

3. Identify the Expenses for

Normal is classified with a blood pressure of <120
classification of BP 5 mins teaching aids
mmHg systolic and <80 mmHg diastolic. Pre-hypertension is
and categories of
classified with a blood pressure of 102-139 mmHg systolic
hypertension for
and 80-89 mmHg diastolic. Stage 1 hypertension is classified
adults 18 and older
with a blood pressure of 140-159 mmHg systolic and 90-
99mmHg diastolic.
4. Contributing factors
of factors The risk of hypertension is 5 times higher in the obese as 20 mins
compared to those of normal weight and up to two-thirds of
cases can be attributed to excess weight. More than 85% of
cases occur in those with a BMI>25.

 Sodium sensitivity

Sodium is an environmental factor that has

received the greatest attention. Approximately one third of
the essential hypertensive population is responsive to sodium
intake. This is due to the fact that increasing amounts of salt
in a person's bloodstream causes cells to release water (due
to osmotic pressure) to equilibrate concentration gradient of
salt between the cells and the bloodstream; increasing the
pressure on the blood vessel walls.

 Role of renin

Renin is an enzyme secreted by the

juxtaglomerular apparatus of the kidney and linked with
aldosterone in a negative feedback loop. The range of renin
activity observed in hypertensive subjects tends to be
broader than in normotensive individuals. In consequence,
some hypertensive patients have been defined as having low-
renin and others as having essential hypertension. Low-renin
hypertension is more common in African Americans than
white Americans, and may explain why African Americans
tend to respond better to diuretic therapy than drugs that
interfere with the renin-angiotensin system. High Renin levels
predispose to Hypertension: Increased Renin → Increased
Angiotensin II → Increased Vasoconstriction, Thirst/ADH and
Aldosterone → Increased Sodium Resorption in the Kidneys
(DCT and CD) → Increased Blood Pressure. Some authorities
claim that potassium might both prevent and treat
hypertension.
  Insulin resistance

Insulin is a polypeptide hormone secreted by cells in

the islets of langerhans, which are contained throughout the
pancreas. Its main purpose is to regulate the levels of glucose
in the body antagonistically with glucagon through negative
feedback loops. Insulin also exhibits vasodilatory properties.
In normotensive individuals, insulin may stimulate
sympathetic activity without elevating mean arterial pressure.
However, in more extreme conditions such as that of the
metabolic syndrome, the increased sympathetic neural
activity may over-ride the vasodilatory effects of insulin.
Insulin resistance and/or hyperinsulinemia have been
suggested as being responsible for the increased arterial
pressure in some patients with hypertension. This feature is
now widely recognized as part of syndrome X, or the
metabolic syndrome.

 Genetics

Hypertension is one of the most common complex

disorders, with genetic heritability averaging 30. Data
supporting this view emerge from animal studies as well as in
population studies in humans. Most of these studies support
the concept that the inheritance is probably multifactorial or
that a number of different genetic defects each have an
elevated blood pressure as one of their phenotypic
expressions.

 Age

Over time, the number of collagen fibers in artery and

arteriole walls increases, making blood vessels stiffer. With
the reduced elasticity comes a smaller cross-sectional area in
systole, and so a raised mean arterial blood pressure.
  Liquorice

Consumption of liquorice (which can be of potent

strength in liquorice candy) can lead to a surge in blood
pressure. People with hypertension or history of cardio-
5. Identify the signs and vascular disease should avoid liquorice raising their blood 5 mins
symptoms of pressure to risky levels. Frequently, if liquorice is the cause of
hypertension the high blood pressure, a low blood level of potassium will
also be present.

Hypertension is usually found incidentally by

healthcare professionals measuring blood pressure during a
routine checkup. In isolation, it usually produces no
symptoms although some people report headaches, fatigue,
dizziness, blurred vision, facial flushing, transient insomnia or
difficulty sleeping due to feeling hot or flushed, and tinnitus
during beginning onset or before hypertension diagnosis.

Hypertension is often confused with mental

tension, stress and anxiety. While chronic anxiety and/or
irritability is associated with poor outcomes in people with
hypertension, it alone does not cause it. Accelerated 3 mins
6. Enumerate the ways hypertension is associated with somnolence, confusion, visual
on how hypertension disturbances, and nausea and vomiting (hypertensive
can be diagnosed encephalopathy).

Diagnosis in adults as made when an average of

two or more diastolic readings on at least two subsequent
visits is between 80-90 mmHg or when the average on
multiple systolic BP on two or more subsequent visits is
between 120-139 mmHg. Tests are undertaken to identify
possible causes of secondary hypertension, and seek
evidence for end-organ damage to the heart itself or the eyes
(retina) and kidneys. Diabetes and raised cholesterol levels
being additional risk factors for the development of
 cardiovascular disease are also tested for as they will also
require management.

Blood tests commonly performed include:

 Creatinine (renal function) - to identify both underlying

renal disease as a cause of hypertension and
conversely hypertension causing onset of kidney
damage. Also a baseline for later monitoring the
possible side-effects of certain antihypertensive drugs.
 Electrolytes (sodium, potassium)
7. List the non-  Glucose - to identify diabetes mellitus 21 mins
pharmacological and  Cholesterol
non-pharmacological
management for
hypertension
Lifestyle modification (nonpharmacologic treatment)

 Weight reduction and regular aerobic exercise (e.g.,

jogging) are recommended as the first steps in treating
mild to moderate hypertension. Regular mild exercise
improves blood flow and helps to reduce resting heart rate
and blood pressure. These steps are highly effective in
reducing blood pressure, although drug therapy is still
necessary for many patients with moderate or severe
hypertension to bring their blood pressure down to a safe
level.
 Reducing dietary sugar intake
 Reducing sodium (salt) in the diet is proven very
effective: it decreases blood pressure in about 60 percent
 of people (see above). Many people choose to use a salt
substitute to reduce their salt intake.
 Additional dietary changes beneficial to reducing blood
pressure includes the DASH diet (dietaryapproaches
to stop hypertension), which is rich in fruits and
vegetables and low fat or fat-free dairy foods. This diet is
shown effective based on research sponsored by the US
National Institutes of Health. [citation needed]
 In addition, an
increase in daily calcium intake has the benefit of
increasing dietary potassium, which theoretically can
offset the effect of sodium and act on the kidney to
decrease blood pressure. This has also been shown to be
highly effective in reducing blood pressure.
 Discontinuing tobacco use and alcohol consumption has
been shown to lower blood pressure. The exact
mechanisms are not fully understood, but blood pressure
(especially systolic) always transiently increases following
alcohol and/or nicotine consumption. Besides, abstention
from cigarette smoking is important for people with
hypertension because it reduces the risk of many
dangerous outcomes of hypertension, such as stroke and
heart attack. Note that coffee drinking (caffeine ingestion)
also increases blood pressure transiently, but
does not produce chronic hypertension.
 Reducing stress, for example with relaxation therapy,
such as meditation and other mindbody relaxation
techniques, by reducing environmental stress such as high
sound levels and over-illumination can be an additional
 method of ameliorating hypertension. Jacobson's
Progressive Muscle Relaxation and biofeedback are also
used, particularly, device-guided paced breathing,
although meta-analysis suggests it is not effective unless
combined with other relaxation techniques.

Medications

Unless hypertension is severe, lifestyle changes such

as those discussed in the preceding section are strongly
recommended before initiation of drug therapy. Adoption of
the DASH diet is one example of lifestyle change repeatedly
shown to effectively lower mildly-elevated blood pressure. If
hypertension is high enough to justify immediate use of
medications, lifestyle changes are initiated concomitantly.

There are many classes of medications for treating

hypertension, together called antihypertensives, which — by
varying means — act by lowering blood pressure. Evidence
suggests that reduction of the blood pressure by 5-6 mmHg
can decrease the risk of stroke by 40%, of coronary heart
disease by 15-20%, and reduces the likelihood of dementia,
heart failure, and mortality from vascular disease.

The aim of treatment should be blood pressure

control to <140/90 mmHg for most patients, and lower in
certain contexts such as diabetes or kidney disease (some
medical professionals recommend keeping levels below
120/80 mmHg). Each added drug may reduce the systolic
blood pressure by 5-10 mmHg, so often multiple drugs are
necessary to achieve blood pressure control.

Commonly used drugs include:

 ACE inhibitors such as creatine captopril, enalapril,

 fosinopril (Monopril), lisinopril (Zestril), quinapril, ramipril
(Altace)
 Angiotensin II receptor antagonists: eg, telmisartan
(Micardis, Pritor), irbesartan (Avapro), losartan (Cozaar),
valsartan (Diovan), candesartan (Amias)
 Alpha blockers such as prazosin, or terazosin. Doxazosin
has been shown to increase risk of heart failure, and to be
less effective than a simple diuretic, so is not
recommended.
 Beta blockers such as atenolol, labetalol, metoprolol
(Lopressor, Toprol-XL), propranolol.
 Calcium channel blockers such as nifedipine (Adalat)
amlodipine (Norvasc), diltiazem, verapamil
 Direct renin inhibitors such as aliskiren (Tekturna)
 Diuretics: eg, bendroflumethiazide, chlortalidone,
hydrochlorothiazide (also called HCTZ)
 Combination products (which usually contain HCTZ and
one other drug)
BIBLIOGRAPHY:

Books:

 Black, et.al. MEDICAL –SURGICAL NURSING. 8TH edition. Elsevier Pte Ltd. Singapore, 2008

 Cuevas.et al. PUBLIC HEALTH NURSING IN THE PHILIPPINES. 10th edition. National League of Philippine Government Nurses,
Incorporated. Philippines, 2007

Internet:

 http://www.health-diseases-tips.com/hypertension-267809.html