Pathologic Conditions
- Definition:
- For adults:
- 120–139 systolic or 80–89 diastolic = Prehypertension
- 140–159 systolic or 90–99 diastolic = Stage 1 HTN
- >160 systolic or >100 diastolic = Stage 2 HTN
- For children:
- Whichever reading is higher (systolic or diastolic) is used to classify blood pressure.
- Pathophysiology and Etiology: Usually unknown (essential, primary, or idiopathic HTN). Excess renin may increase the production of angiotensin II, which raises blood pressure. HTN may be caused by insulin resistance, structural cardiac or vascular defects or disease, pregnancy, obesity, cocaine (most common cause of young adult HTN presentation to ER), sleep apnea, thyroid or parathyroid disease, kidney disease, pheochromocytoma, oral contraceptives, amphetamines, excess alcohol, steroids, erythropoietin, and other pathologies. The term secondary HTN is used when cause is known.
- Manifestations: Initially, essential HTN is usually asymptomatic except for elevation of blood pressure. Occasionally headache. Late complications of uncontrolled HTN include manifestations of damage to eyes (retinopathy), kidneys, heart, or brain.
- Med Tx: Lifestyle changes that include prevention or treatment of obesity and hyperlipidemia by increasing exercise and decreasing dietary calories, fat, and sodium (DASH diet). Smoking cessation and moderation of alcohol consumption. Antihypertensive meds—usually more than one med is needed.
- Nsg Dx: Risk for decreased cardiac output (vasoconstriction), risk for sexual dysfunction (atherosclerosis or side effect of meds), pain (headache), knowledge deficit, impaired adjustment.
- Nsg Care: Check B/P at every office visit or at least once per shift when hospitalized. Teach regarding healthy weight, exercise diet, smoking cessation, and alcohol moderation.
- Prognosis: Excellent with B/P controlled below <140/90 or <130/80 for those with diabetes or kidney failure. Uncontrolled HTN may result in damage to eyes, kidneys, heart, or brain. These complications are called end-organ damage. Heart failure and death are possible.