i. Complex interactions between the vasculature,
kidneys, sympathetic nervous system, baroreceptors,
renin-angiotensin-aldosterone system, and insulin
b. Mosaic theory
i. Genetic disposition
ii. Environmental: dietary Na+/fat intake, trace metals,
iii. Anatomical: abnormalities of vascular system
iv. Adaptive: e.g., regulation of intracellular Na+ and Ca++
by cell membrane ion pumps
v. Neural: variety of complex nerve mechanisms
vi. Endocrine: pheochromocytoma, primary aldosteronism
vii. Humoral: varied agents that constrict and dilate blood
viii. Hemodynamic: blood volume or viscosity, intrarenal
II. Classification—2003 Guidelines National Heart, Lung, and
Blood Institute (NHLBI)
a. Normal blood pressure (BP)—less than 120/80 mm Hg
b. Prehypertension—120/80 to 139/89 mm Hg
c. Hypertension—greater than 140/90 mm Hg
III. Degree of Severity
a. Stage I (mild)—140/90 to 159/99 mm Hg
b. Stage II (moderate)—160/100 mm Hg or greater
c. Stage III (severe)—systolic pressure greater than 180 and
diastolic pressure greater than 110
d. Stage IV (very severe)—systolic pressure 210 or greater
with diastolic pressure greater than 120
a. Primary (essential), which accounts for approximately 85%
to 95% of all cases, has no identifiable cause
b. Secondary, which occurs as a result of an identifiable,
sometimes correctable, pathological condition, such as
kidney disorders, adrenal gland tumors, or primary
aldosteronism, medications, drugs, or other chemicals
V. Statistics (NHLBI, 2006; Centers for Disease Control and
Prevention [CDC], CDC, 2006b; 2007a)
a. Morbidity: 72 million Americans are hypertensive (nearly
1 in 3).
i. 23% of adults aged 20 to 75 are hypertensive.
ii. 70% of adults over age 75 are hypertensive.
iii. Approximately 20% are undiagnosed.
iv. Prevalence: African Americans 32%, whites 23%,
b. Mortality: There are more than 19,000 deaths per year.
c. Cost: $47.2 billion is spent per year.
Although hypertension is usually treated in a community setting,
management of stages III and IV with symptoms of complications
or compromise may require inpatient care, especially
when target organ disease (TOD) is present. The majority
of interventions included here can be used in either setting.
Cerebrovascular accident (CVA)/stroke
Psychosocial aspects of care
Renal failure: acute
Renal failure: chronic
1. Maintain or enhance cardiovascular functioning.
2. Prevent complications.
3. Provide information about disease process, prognosis,
and treatment regimen.
4. Support active client control of condition.
1. BP within acceptable limits for individual.
2. Cardiovascular and systemic complications prevented or
3. Disease process, prognosis, and therapeutic regimen
4. Necessary lifestyle or behavioral changes initiated.
5. Plan in place to meet needs after discharge.