Chapter 36: Hypertension Nursing Management

Hypertension develops through complex pathophysiological mechanisms involving blood pressure regulation systems, including cardiac output, systemic vascular resistance, and neurohormonal controls such as the renin-angiotensin-aldosterone system, baroreceptors, and sympathetic nervous system activity. Primary hypertension represents the majority of cases, resulting from multifactorial interactions between genetic predisposition, environmental influences, and lifestyle factors including sodium intake, obesity, insulin resistance, and endothelial dysfunction. Secondary hypertension stems from identifiable underlying conditions such as renal disease, endocrine disorders, vascular abnormalities, or medication effects. The condition often remains asymptomatic until significant target organ damage occurs, affecting cardiovascular, cerebrovascular, renal, and ocular systems through mechanisms of arterial remodeling and chronic pressure overload. Diagnostic evaluation requires systematic blood pressure measurement techniques, laboratory assessments, and screening for end-organ complications. Management strategies emphasize lifestyle modifications as foundational therapy, incorporating dietary approaches like the DASH protocol, sodium restriction, weight management, physical activity, and stress reduction techniques. Pharmacological interventions utilize multiple drug classes including thiazide diuretics, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, and beta-blockers, with treatment algorithms based on blood pressure staging and individual patient characteristics. Hypertensive emergencies require immediate intervention with careful blood pressure reduction protocols to prevent further organ damage. Special considerations for elderly patients include altered pharmacokinetics, orthostatic hypotension risks, and polypharmacy concerns, necessitating individualized treatment approaches and comprehensive nursing assessment strategies.