Bad Request (Invalid Hostname)

	More NurseWeek Features   Smoke-Free Zone   Nurses and patients tackle nicotine addiction   Bloodless Survival     Surgical techniques to use when transfusion drops out of the equation
Caffeine has been shown to raise aortic stiffness and place hypertensive individuals at greater risk for cardiovascular events.

When taking on a formidable opponent, a strong offense is often the best defense. This kind of strategy might well serve nurses caring for patients with hypertension. Much in the same way a team “sizes up” a new opponent and develops a game plan, the uniqueness of each person’s hypertension must be scrutinized before the right treatment components can be selected.

While hypertension is simply an elevation of blood pressure (BP), all hypertension is not, and should not be, treated with the same approach.

You can get in the game — and stay in it — by learning the latest information about hypertension and its treatment.

It’s well known that obesity, genetics, and other disease processes (such as diabetes, renal disorders, adrenal tumors, and hyperthyroidism) all contribute to the incidence of hypertension.

Circadian rhythms regulate the rise and fall of BP and heart rate. Both BP and heart rate drop during the night (a phenomenon known as “ dipping”) and rise in the early morning hours upon awakening. Some individuals, however, do not “dip”— they still experience morning elevation in BP and heart rate, a phenomenon common among African Americans.¹

Look who’s hypertensive now

BP classifications have been simplified by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7).² More individuals now satisfy the diagnostic criteria of hypertension, and even more people fall into a new classification that bears close watch — prehypertension.

To have a “normal” BP, both an individual’s systolic and diastolic pressures must fall into parameters below 120/80. Isolated systolic or diastolic pressures above these parameters classify an individual as prehypertensive or hypertensive.

Classification is based upon inclusion rather than exclusion — individuals fall into the classification matching their highest reading. For example, consider the chart which details the new classification system. An individual with a pressure of 118/92 would be classified as having stage 1 hypertension, even though the systolic reading falls within the “normal” range.

New rules, new strategies

For years, practitioners have shared concerns over the accuracy of BP readings taken in a health care setting. The so-called “white coat hypertension” phenomenon, or the elevation of BP in a clinical environment despite normal pressures elsewhere, has caused diagnostic and management dilemmas.

Evaluating patients treated for hypertension for effectiveness in reducing poor outcomes is also changing. The “rule book” for hypertension diagnosis and management has expanded with a more reliable and long-term option.

Recent research has revealed ambulatory blood pressure monitoring involving patients tracking their own blood pressure readings twice daily either at home or at work for a week makes for a better predictor of stroke and myocardial infarction than the traditional office BP measurement.³

Beyond known risk factors

Hypertension is unequivocally equated with a high-sodium diet. For most nurses, the thought of hypertension conjures up images of an overweight middle-aged individual with a high-stress job and a sedentary lifestyle who probably reports a family member with hypertension. This stereotypical image may minimize the cautious eye they cast others at equal or greater risk for hypertension at much earlier ages.

Nurses should consider these additional hypertensive-predisposing risk factors:^1,2,4

• Low birth weight
• Smoking
• High-fat diet
• Excessive alcohol intake
• Geographical location (whites from the Northeast, African Americans from the South)
• Lower dietary intake of magnesium
• Lower dietary intake of calcium

Nurses warn patients about sodium, which remains the primary culprit behind hypertension. But research indicates a word of caution is also needed regarding caffeine consumption — even when BP is well-controlled. Caffeine has been shown to raise aortic stiffness and place hypertensive individuals at greater risk for cardiovascular events.⁵

A black-and-white issue

The onset of hypertension among African Americans occurs earlier than among whites — a measurable difference exists even before age 10 among African Americans and is especially pronounced for African-American girls.⁶ With that taken into account, nurses caring for children have yet another reason to stress physical exercise, a balanced diet, and appropriate health screenings.

As a nation rich with caregivers, we simply aren’t meeting the mark when it comes to reducing hypertension among African Americans. Despite raised public awareness and educational efforts, analysis of recent National Health and Nutrition Examination Survey (NHANES) data reveal that the prevalence of hypertension among non-Hispanic blacks rose 33.5% between 1988 and 2000.⁷

Expanded game plan

Beyond lifestyle recommendations, adequately controlling hypertension often involves the careful prescription of medications selected on the basis of both an individual’s pattern of hypertension and other disorders present. Some antihypertensive drugs are selected based not only on their ability to combat hypertension, but also the positive impact these medications have on other disorders. One such example would be the use of ACE inhibitors when diabetes is present along with hypertension.

Diuretics and calcium channel blockers provide a controlled response during the day, and extended-release calcium channel blockers offer 24-hour control.⁸ Drugs also have been developed that selectively block the different systems responsible for BP control, namely those involved in the renin angiotensin system.