Hypertension Hypertensive cardiomyopathy (heart failure
However, the
Hypertension or high blood pressure is
defined as a sustain elevation in mean arterial
pressure. It is not a single disease state but a
disorder with many causes, a variety of symptoms
and a range of responses to therapy. Hypertension
is also a major risk factor for the development of
other cardiovascular diseases like coronary heart
disease and stroke.
Etiology or Cause
In terms of etiology, hypertension is
classified into primary (essential) and secondary
hypertension. Essential hypertension indicates that
no specific medical cause can be found to explain
a patient's condition. Secondary hypertension
indicates that the high blood pressure is a result of
(i.e., secondary to) another condition, such as
kidney disease or tumors (pheochromocytoma and
paraganglioma). Persistent hypertension is one of
the risk factors for strokes, heart attacks, heart
failure and arterial aneurysm, and is a leading
cause of chronic renal failure. Even moderate
elevation of arterial blood pressure leads to
shortened life expectancy. At severely high
pressures, defined as mean arterial pressures 50%
or more above average, a person can expect to
live no more than a few years unless appropriately
treated.
Complications
While elevated blood pressure alone is not
an illness, it often requires treatment due to its
short- and long-term effects on many organs. The
risk is increased for:
Cerebrovascular accident (CVAs or strokes)
Myocardial infarction (heart attack)
therefore, not treated.
due to chronically high blood pressure) Framingham study showed that there was
Hypertensive retinopathy - damage to the two to five times increase in death from
CVD associated with isolated systolic
retina
hypertension. It is therefore recommended
Hypertensive nephropathy - chronic renal
that BP values in the elderly should be
failure due to chronically high blood
similar to those of the rest of the
pressure
population.
Hypertensive encephalopathy - confusion,
High salt intake – Remember that excessive
headache, convulsion due to vasogenic
edema in brain due to high blood pressure. salt intake does not cause hypertension in
all people, nor does reducing salt intake
Risk factors reduce BP in all hypertensive’s. Some
people are more susceptible than others to
There is no single cause of primary
effects of increased salt intake. How salt
hypertension but several risk factors have been
intake contributes to hypertension is still
implicated in its development. Risk factors include
not clear. Salt may cause in elevation of
family history, advancing age, race and high salt
blood volume, increase the sensitivity of
intake. Other lifestyle factors interact with these
cardiovascular or renal mechanisms such
risk factors and contribute to the development of
as the renin-angiotensin-aldosterone
hypertension such as obesity, excess alcohol
mechanism.
consumption, intake of potassium (diet high in
Obesity – Risk for hypertension is two times
sodium is generally low in potassium; increasing
greater among overweight/obese persons
potassium in diet increases elimination of sodium),
compared to people of normal weight and
calcium and magnesium, stress and use of
three times more than that of underweight
contraceptive drugs.
persons. Fat distribution is more than risk
Family history – People with positive family
factor than actual weight as measured by
history of hypertension are twice at risk
waist-to-hip ratio. Increased waist-to-hip
than those with no history. It is not known
ratio is more associated with hypertension.
whether a single gene or multiple genes are
The exact mechanism of how obesity
involved.
contributes to the development of
Age – Older persons are at greater risk for
hypertension is unknown. Whatever the
hypertension than younger persons. The cause, weight loss is effective in reducing
aging process that increase BP (Blood BP in obese hypertensive patients.
Pressure) includes stiffening of the arteries, Excessive alcohol intake – As much as 10 %
decreased baroreceptor sensitivity,
of hypertension cases could be related to
increased peripheral resistance and
alcohol consumption. Regular consumption
decreased renal blood flow. For years,
of 3 or more drinks per day increased risk
systolic hypertension is common in older
of hypertension.
persons was considered benign and,
Key Areas for Prevention of Hypertension

Encourage proper nutrition – reduce salt

and fat intake.
Prevent becoming overweight or obese –
weight reduction through proper nutrition
and exercise.
Smoking cessation – tobacco use promotes
atherosclerosis that may contribute to
hypertension; quitting smoking anytime is
beneficial; this refers to both active and
passive smokers.
Identify people with risk factors and
encourage regular check-ups for possible
hypertension and modification of risk
factors.

BSN – II (SY 2008-2009)

Health Care 2