Introduction: Hello, Professor and Class. My name is Sonia Robinson, and today I will present a Clinical Practice Guideline on Hypertension. Hypertension, commonly referred to as high blood pressure, is a significant health concern in the United States, with far-reaching implications for public health. Disease and Background: Hypertension (HTN) is a prevalent chronic condition, affecting approximately 1 in 3 Americans, which translates to roughly 34% of the population. This prevalence increases with age and disproportionately impacts African American men and women more than European Americans and Latinos. Despite the widespread nature of this condition, no specific incidence data for HTN is available in the Clinical Practice Guidelines (CPG), textbooks, or on the CDC website. Pathogenesis of Essential Hypertension: Essential hypertension, which is high blood pressure without an identifiable cause, is the most common form of HTN. The pathogenesis of essential hypertension is multifactorial, involving several contributing factors. However, arterial endothelial dysfunction is believed to play a pivotal role. This dysfunction impacts vascular structure and tone, inflammation, and clotting abilities, which collectively contribute to elevated blood pressure. Additional factors influencing the development of essential hypertension include:
  • Diet: High sodium intake, low potassium levels, and poor nutritional habits contribute to increased blood pressure.
  • Lifestyle Practices: Sedentary behavior, excessive alcohol consumption, and smoking are significant risk factors.
  • Genetics: A family history of hypertension increases the likelihood of developing the condition.
  • Environmental Factors: Stress and exposure to certain environmental triggers can elevate blood pressure.
  • Vasoactive Substance Imbalance: Imbalances in hormones and other substances that regulate vascular tone may also play a role.
Clinical Presentation: Hypertension is often referred to as the “silent killer” because many individuals with HTN are asymptomatic. When symptoms do occur, they are typically associated with extremely high blood pressure levels. A common symptom is a headache, particularly in the occipital region, that tends to be present upon waking. In cases of a hypertensive crisis, which is a medical emergency, the presentation may include more severe symptoms such as:
  • Blurred Vision: Caused by increased pressure on the optic nerves.
  • Decreased Mental Status: Resulting from reduced cerebral perfusion.
  • Chest Pain: Indicative of myocardial strain or impending cardiovascular events.
  • Bounding Pulses: Reflecting the intense pressure within the vascular system.
Objective Measures: The objective diagnosis of hypertension is made based on blood pressure readings. According to the current guidelines, hypertension is defined as:
  • Systolic Blood Pressure (SBP): Greater than 130 mm Hg
  • Diastolic Blood Pressure (DBP): Greater than 80 mm Hg
These readings must be confirmed on at least two separate occasions to establish a diagnosis of HTN. Conclusion: Hypertension is a pervasive and potentially life-threatening condition that requires diligent management and lifestyle modification. Understanding the pathogenesis, recognizing the clinical presentation, and adhering to evidence-based guidelines are critical in managing this condition effectively. The guidelines, as outlined in the JNC8 report published in the Journal of the American Medical Association, provide a framework for clinicians to diagnose and treat hypertension, thereby reducing the risk of complications and improving patient outcomes. References: James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfard, C., Handler, J., … Ortiz, E. (2014). Evidence-based guideline for the management of high blood pressure in adults: (JNC8). Journal of the American Medical Association, 311(5), 507-20. Retrieved from https://jamanetwork.com/journals/jama/fullarticle/1791497 Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2019). Primary Care: The Art and Science of Advanced Practice Nursing (5th ed.). F.A. Davis Company.