University of Baghdad

College of Nursing
Adult Nursing

Nursing Care for Patients with Hypertension

Assis. Instructor Shaymaa Mohammed Hussein

 The objectives of nursing care for patients with hypertension focuses on:

1. Lowering and controlling the blood pressure without adverse effects and without
undue cost.
2. To achieve these goals:
- The nurse must support and teach the patient to adhere to the treatment regimen by
implementing necessary lifestyle changes.
- Taking medications as prescribed.
- Scheduling regular follow-up appointments with the health care provider to
monitor progress or identify and treat any complications of disease or therapy.
 Hypertension is defined as a systolic blood pressure greater than 140 mm Hg
and a diastolic pressure greater than 90 mm Hg based on the average of two or more
accurate blood pressure measurements taken during two or more contacts with a
health care provider (Chobanian, Bakris, Black, et al., 2003).

Classification of Blood Pressure for Adults Age 18 and Older

BP Classification Systolic BP/ (mmHg) Diastolic BP/ (mm Hg)

Normal 120 80

Prehypertension 120 – 139 80 – 89

Stage 1 hypertension 140 – 159 90 – 99

Stage 2 hypertension 160 100

 In the total U.S. population of persons with hypertension, 90% to 95% have
primary hypertension, high blood pressure from an unidentified cause (Oparil, Zaman
& Calhoun, 2003). The remaining 5% to 10% of this group have secondary
hypertension, high blood pressure related to identified causes. These causes include
narrowing of the renal arteries, renal parenchymal disease, hyperaldosteronism
(mineralocorticoid hypertension), certain medications, pregnancy, and coarctation of
the aorta (Chiong, Aronow, Khan, et al., 2008).

Hypertension is sometimes called the “silent killer” because people who have
it are often symptom free (Ong, Cheung, Man, et al., 2007).
 Hypertension often accompanies other risk factors for atherosclerotic heart
disease, such as dyslipidemia (abnormal blood fat levels), obesity, diabetes mellitus,
metabolic syndrome, and a sedentary lifestyle. The prevalence is also higher in persons
who have other cardiovascular conditions including heart failure, coronary artery
disease, and a history of having had a stroke (Ong, et al., 2007). Cigarette smoking
does not cause high blood pressure; however, if a person with hypertension smokes, his
or her risk of dying from heart disease or related disorders increases significantly
(Baliunas, Patra, Rehm, et al., 2007).
 High blood pressure can be viewed in three ways: as a sign, a risk factor for
atherosclerotic cardiovascular disease, or a disease. As a sign, nurses and other health care
professionals use blood pressure to monitor a patient’s clinical status. Elevated pressure
may indicate an excessive dose of vasoconstrictive medication or other problems. As a risk
factor, hypertension contributes to the rate at which atherosclerotic plaque accumulates
within arterial walls. As a disease, hypertension is a major contributor to death from
cardiac, cerebrovascular, renal, and peripheral vascular disease.

Hypertension = cardiac output (CO) x peripheral resistance (PR) (Lieberman, E. &

Neal, W. (2006). Kaplan’s clinical hypertension (9th ed.). Philadelphia: Lippincott
Autoregulation Williams & Wilkins).
Major Risk Factors
• Smoking
• Dyslipidemia (elevated LDL [or total] cholesterol and/or low HDL cholesterol)
• Diabetes mellitus
• Impaired renal function (GFR) (60 mL/min and/or micro albuminuria)
• Obesity (BMI 30 kg/ m2)
• Physical inactivity
• Age (older than 55 years for men, 65 years for women)
• Family history of cardiovascular disease (in female relative younger than 65 years or male relative younger than
55 years)
• Target Organ Damage or Clinical Cardiovascular Disease
• Heart disease (left ventricular hypertrophy, angina or previous myocardial infarction, previous coronary
revascularization, heart failure)
• Stroke (cerebrovascular accident, brain attack) or TIA
• Chronic kidney disease
• Peripheral arterial disease
• Retinopathy
Clinical Manifestations
By physical examination may reveal:
 Elevated blood pressure.
 Occasionally, retinal changes such as hemorrhages, exudates (fluid accumulation).
 Arteriolar narrowing, and cotton-wool spots (small infarctions) occur.
 In severe hypertension, papilledema (swelling of the optic disk) may be seen.
 Coronary artery disease with angina and myocardial infarction are common consequences of hypertension.
 Left ventricular hypertrophy occurs in response to the increased workload placed on the ventricle as it contracts
against higher systemic pressure.
 When heart damage is extensive, heart failure follows.
 Pathologic changes in the kidneys (indicated by increased blood urea nitrogen [BUN] and serum creatinine levels)
may manifest as nocturia.
 Cerebrovascular involvement may lead to a stroke or transient ischemic attack (TIA), manifested by alterations in
vision or speech, dizziness, weakness, a sudden fall, or transient or permanent paralysis on one side (hemiplegia).
 Cerebral infarctions account for most of the strokes and TIAs in patients with hypertension.
Assessment and Diagnostic Findings

A thorough health history and physical examination are necessary. The retinas are examined and
laboratory studies are performed to assess possible target organ damage. Routine laboratory tests include:
- Urinalysis.
- Blood chemistry (ie, analysis of sodium, potassium, creatinine, fasting glucose, and total and high-
density lipoprotein [HDL] cholesterol levels).
- A 12-lead electrocardiogram (ECG).
- Left ventricular hypertrophy can be assessed by echocardiography.
Renal damage may be suggested by elevations in BUN and creatinine levels or by
microalbuminuria or macroalbumin uria.
Additional studies, such as creatinine clearance, renin level, urine tests, and 24-hour urine protein,
may be performed.
 Nursing Interventions
 Increasing knowledge through:
 The patient needs to understand the disease process and how lifestyle changes and medications can control
hypertension.
 The nurse needs to emphasize the concept of controlling hypertension rather than curing it.
 The nurse can encourage the patient to consult a dietitian to help develop a plan for improving nutrient intake
or for weight loss.
 The program usually consists of restricting sodium and fat intake, increasing intake of fruits and vegetables,
and implementing regular physical activity.
 Explaining that it takes 2 to 3 months for the taste buds to adapt to changes in salt intake may help the patient
adjust to reduced salt intake.
 The patient should be advised to limit alcohol intake, and tobacco should be avoided because anyone with
high blood pressure is already at increased risk for heart disease, and smoking amplifies this risk.
 Support groups for weight control, smoking cessation, and stress reduction may be beneficial for some
patients; others can benefit from the support of family and friends.
 Allowed to teach each person screened what the blood pressure numbers mean. Each person should be
given a written record of his or her blood pressure at the screening.
 The patients should be advised to have an adequate supply of medication. If they are traveling by
airplane, they should pack the medication in their carry-on luggage.
 Both female and male patients should be informed that some medications, such as beta-blockers, may
cause sexual dysfunction.
 The nurse can encourage and teach patients to measure their blood pressure at home. This practice
involves patients in their own care and emphasizes that failing to take medications may result in an
identifiable rise in blood pressure.
 Patients need to know that blood pressure varies continuously and that the range within which their
pressure varies should be monitored.
 The nurse assists the patient to develop and adhere to an appropriate exercise regimen, because regular
activity is a significant factor in weight reduction and a blood pressure–reducing intervention in the
absence of any loss in weight (Chobanian, et al., 2003).
Monitoring and Managing Potential Complications
The hypertension is progressing to the extent that target organ damage is
occurring must be detected early so that appropriate treatment can be initiated.
When the patient returns for follow-up care, all body systems must be assessed to
detect any evidence of vascular damage.
An eye examination with an ophthalmoscope is particularly important because
retinal blood vessel damage indicates similar damage elsewhere in the vascular system.
The patient is questioned about blurred vision, spots in front of the eyes, and diminished
visual acuity.
The heart, nervous system, and kidneys are also carefully assessed. Any
significant finding are promptly reported to determine whether additional diagnostic
studies are required. Based on the findings, medications may be changed to improve
blood pressure control.
References
- Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)
- Oparil, S., Zaman, M. A. & Calhoun, D. A. (2003). Pathogenesis of hypertension. Annals of Internal Medicine, 139(9), 761–776.
- Chiong, J. R., Aronow, W. S., Khan, I. A., et al. (2008). Secondary hypertension: Current diagnosis and treatment. International Journal of
Cardiology,
124(1), 6–21.
- Baliunas, D., Patra, J., Rehm, J., et al. (2007). Smoking-attributable mortality and expected years of life lost in Canada 2002: Conclusions
for prevention and policy. Chronic Disease in Canada, 27(4), 154–162.
- Kaplan’s clinical hypertension (9th ed.). Philadelphia: Lippincott Auto regulation Williams & Wilkins.
- Chobanian, A. V., Bakris, G. L., Black, H. R., et al. (2003). The Seventh Report of the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report (erratum in: Journal of the American Medical Association,
2003; 290(2), 197). Journal of the American Medical Association, 289(19), 2560–2572.
- Ong, K. L., Cheung, B. M., Man, Y. B., et al. (2007). Prevalence, awareness, treatment, and control of hypertension among United States
adults 1999–2004. Hypertension, 49(1), 69–75.
- Pickering, T. G., Hall, J. E., Appel, L. J., et al. (2005). Recommendations for blood pressure measurement in humans and experimental
animals: Part 1: Blood pressure measurement in humans: A statement for professionals from the Subcommittee of Professional and
Public Education of the American Heart Association Council on High Blood Pressure Research. Hypertension, 45(1), 142–161.