Sheryl LaCoursiere, PhD, RN-BC
Cynthia Patton,  RN, MSN                           

 

      HYPERTENSION

Blood flowing through blood vessels

 

 

HYPERTENSION PRESENTATION

• Hypertension.ppt - Hypertension powerpoint presentation- has clickable links to web sites

• HypertensionColor.pdf -  Presentation slides in color

• HypertensionBW.pdf- Presentation slides in black & white
   

• Hypertension.doc- Speaker's notes for pathophysiology section of the presentation

 

JNC GUIDELINES

 The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)

 On the JNC home page, there are a number of important resources for clinicians as well as patient resources, including:

• JNC 7 Complete Report: The Science Behind the New Guidelines  (86 pages)

• JNC 7 Express Highlights "Must Know" Clinical Practice Updates (34 pages)

• JNC 7 Reference Card (2 pages)- A great summary of Evaluation, Treatment,

• JNC 7 Guidelines Electronic Version- for Palm or Pocket PC devices

 

EVALUATION OF HYPERTENSION

Hypertension is evaluated by a four-step process:

• 1.  Blood pressure is classified

• 2.  A diagnostic workup is performed

The patient is then assessed for:

• 3.  Major cardiovascular disease (CVD) risk factors; and

• 4.  Identifiable causes of hypertension

 

 

                                                                                                                               Evaluation of Hypertension

                                                                                                                                                                               From the JNC Reference Card

 

TREATMENT OF HYPERTENSION

• Treatment begins with a patient who has a blood pressure of greater than 140/90, and in patients with diabetes or renal failure, greater than 130/80. The clinician then follows the algorithm based on the patient's stage of hypertension.

                                                                                                                            Treatment of Hypertension             

                                                                                                                                                                                            From the JNC Reference Card

 

    

 LIFESTYLE MODIFICATIONS, and the DIETARY APPROACHES TO STOP HYPERTENSION (DASH) DIET

• Lifestyle modifications are the first line of treatment in hypertension. According to the JNC, lifestyle modifications can reduce systolic blood pressure from a low of 2-8 mm Hg for dietary sodium restriction, to a high of 5-20 mm Hg for weight reduction.

 

Lifestyle Modification Recommendations

                                                                                    From the JNC Reference Card

 

• DASH Eating Plan (56 pages)- The DASH eating plan has sodium reduction at the core of its recommendations

 

     MEDICATIONS

• If the patient does not respond to lifestyle modification, medications are initiated (refer to the treatment diagram above).

• Various classes of medications are used, including

1. Thiazide Diuretics (THIAZ)

2. Beta-blockers (BB)

3. Angiotensin Converting Enzyme Inhibitors (ACEI)

4. Angiotensin Release Blockers (ARB)

5. Aldosterone antagonists (ALDO ANT)

6. Calcium Channel blockers (CCB)

Examples of medications for each class are shown below

Oral Antihypertensive Medications

                                                                                                                                                                                    From the JNC Complete Report, pp. 27-28

 

• The JNC has specific guidelines for patients with certain conditions and risk factors, termed Compelling Indications, including:

1. Heart failure

2. Post myocardial infarction

3. High cardiovascular disease (CVD) risk

4. Diabetes

5. Chronic kidney disease; and

6. Recurrent stroke prevention

Compelling Indications for Individual Drug Classes

                                                                                 From the JNC Reference Card

 

 

• This diagram illustrates the mechanism of action of two important hypertension medications, the Angiotensin Converting Enzyme (ACE) Inhibitors, and Angiotensin Release Blockers (ARBs).

• The majority  of patients will require two medications to reach their blood pressure goal!
   

Modified April 18, 2007
Questions?