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Hypertension is a common disorder characterized by a sustained elevation of systolic arterial pressure (top number) of 140 mm Hg or higher, or a diastolic arterial pressure (bottom number) of 90 mm Hg or greater, or both. Hypertension is divided into two categories: essential (or primary) hypertension and secondary hypertension. Etiology: Research has shown that hypernatremia (elevated serum sodium) increases the volume of blood, which raises blood pressure. Primary hypertension may also develop from alterations in other bosy chemicals. For some clients who respond to stress at a higher degree, hypertension may be related to a higher degree, hypertension may be related to a higher release of catecholamines, such as epinephrine and norepinephrine, which elevates blood pressure. Others feel that hypertension may be caused by a deficiency of natriuretic factor (a hormone produced by the heart) causing arteries to remain in a state of sustained vasoconstriction. Other causes may include: - Adrenal tumors - Acute pain or stress - Alcohol withdrawal - Amphetamines - Birth Control pills - Cardiovascular disease - Cushing's disease - Genetic factors - Hyperthyroidism - Kidney failure Pathophysiology: Regardless of whether a person has primary or secondary hypertension, the same types of organ damage and complications occur. Hypertension causes the heart to pump against greater resistance, increasing its workload. The size of the heart muscle increases from the outer layer of the epicardium to the inner layer of the endocardium. Besides the direct effects on the heart, high blood pressure accelerates atherosclerosis and can cause other serious complications. Damage to many organs of the body can also occur, such as to the eyes, heart, brain, and kidneys. Blood vessels may rupture under the strain of high pressure. Tiny arteries in the retina may hemorrhage, possibly resulting in blindness. A blood vessel may hemorrhage in the brain causing cerebrovascular problems. Renal failure may also result from decreased circulation to the kidneys. Signs & Symptoms: Clients may not have symptoms since the onset of hypertension, often called the silent killer, is gradual. In some cases, hypertension is not diagnosed until the person experiences a major complication. Some minor symptoms may include: - Consistent Bp readings of 140/90 or higher - Headache - Flushed face - Pulsing sensation in the head - Dizziness - Fatigue - Insomnia - Nervousness The most obvious finding during a physical assessment is a sustained elevation of one or both blood pressure measurements. The pulse may feel bounding from the force of ventricular contraction. Hypertensive patients may be overweight and may possibly have peripheral edema. An opthalmic examination may reveal vascular changes in the eyes, retinal hemorrhages, or a bulging optic disk. Diagnosis: A patient may be experiencing hypertension when the blood pressure is consistently, but not always, higher than normal. The blood pressure should be checked at different times and different days to confirm that the readings are consistent. In addition to repeating the blood pressure measurements, an evaluation for hypertension by a medical doctor may include: - a physical examination, including an accurate medical history - lab blood work (may include kidney profile, thyroid profile, and adrenal gland function) - urinalysis - electrocardiogram - chest x-ray Medical Treatment: Currently there is no cure for hypertension that is not secondary to another disease or condition. However, there are successful treatments that do control the effects of the hypertension. Initial management of hypertension depends on the degree of pressure elevation. Mild elevation may be treatable with nonpharmacologic therapy, which may include rest, reduction of stress, counseling, weight loss, reduction of sodium in the diet, limiting the drinking of alcohol and the elimination of smoking tobacco products. If cholesterol and triglyceride levels are increased, a diet low in saturated fats may be recommended. Depending on the clients response to nonpharmacologic therapy, one of several antihypertensive drugs may be prescribed. There are many different types of drugs with proven track records in the control of hypertension, such as Apresoline and Brodipine. Choice of treatment depends upon the patient's age, race, and medical history. Prognosis: If untreated, hypertension places a patient at high risk for the development of a disabling or fatal disease. Thorough evaluation by a medical doctor will start a patient on a successful treatment program that will include patient education for a healthier lifestyle. Following the recommended treatment program will enable the patient to enjoy a more active life. Word Count: 726

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