18.1: Hypertension and Angina
By the end of this section, you should be able to:
- 18.1.1 Describe the pathophysiology of hypertension and angina.
- 18.1.2 Explain the blood pressure guidelines for determining hypertension.
- 18.1.3 Identify clinical manifestations related to hypertension and angina.
- 18.1.4 Identify etiology and diagnostic studies related to hypertension and angina.
Hypertension
The cardiovascular system transports blood and oxygen throughout the body. Blood flows from a system of higher resistance to one of lower resistance—from arteries to capillaries to veins. Blood pressure (see Figure 18.2) represents the force that blood flow exerts on arterial walls.
Diagnostics
A physical examination by a health care provider with a sphygmomanometer (blood pressure cuff or device) will identify an elevated blood pressure, and a 12-lead electrocardiogram (ECG, EKG) can assist in determining if the heart has a normal or abnormal rhythm. The health care provider also obtains blood work to determine factors that contribute to the client’s hypertension as well as how the body is reacting to elevated blood pressure. These laboratory tests include a complete blood cell count (CBC), basic electrolyte panel, cholesterol panel, and renal function. An echocardiogram—an ultrasound of the heart—is not typically included in diagnostic procedures to determine hypertension; however, the health care provider may add this diagnostic study to visualize the heart’s chambers, valves, and pumping action to determine the effect of hypertension on the heart, which may cause other disorders such as hypertrophy of the heart. The health care provider bases the diagnosis for hypertension on the findings of the physical examination and the diagnostic study results.
Clinical Manifestations
Symptoms of hypertension may not occur for years, and most of the time, the symptoms can be silent. Symptoms typically associated with hypertension include elevated blood pressure readings, headaches, dizziness, nausea, vomiting, visual disturbances, and neurological disturbances such as disorientation or a decreased level of consciousness. Over time, uncontrolled hypertension can lead to organ damage. Clients can experience symptoms related to the specific organ that is damaged; for example, if hypertension is left untreated, it may cause renal insufficiency, which may then continue to deteriorate, causing kidney damage and leading to end-stage renal disease that requires dialysis.
Nonpharmacologic Treatment for Hypertension
Nonpharmacologic measures used to treat hypertension center around lifestyle changes. Lifestyle changes focus on the client’s personal, social, and cultural influences. These changes may include diet modification, increased physical activity and exercise, smoking cessation, alcohol consumption reduction, relaxation techniques, and self-monitoring.
Trending Today
Gender and Racial Bias in Cardiovascular Disease Treatment
The AHA conducted a critical assessment of research and clinical knowledge on cardiovascular disease across the United States specifically addressing women’s health . In its report to the president , gaps were identified and actions outlined to optimize cardiovascular health in women across their lifespans, with the goal of reaching health equity in health care (Wenger et al., 2022). The AHA has deployed awareness campaigns that are culturally sensitive and focus on the optimization of preventive and clinical care. Community engagement and advocacy in policy change at the legislative level have been encouraged.
In a fireside video chat, The Heart of the Matter: Racial and Gender Bias in Cardiovascular Care , presented by Abbott Cardiovascular, an expert panel of health care providers and representatives discusses cardiovascular care. The panel identifies gender and racial bias as negatively impacting the client experience for persons with coronary and peripheral artery disease. The chat covers not only cardiovascular health but also technologies that may be utilized to bridge the critical gaps identified.
Dietary Modification
Clients with hypertension should eat a low-sodium diet consisting of whole grains, vegetables, and fruits. Other recommendations include low-fat dairy products and limiting meat intake to about two servings daily of lean meat, such as fish and poultry (Challa & Ameer, 2023). Reducing sweets and red meat is also important. The AHA (n.d.-b) recommends 1500 mg to no more than 2300 mg of sodium intake daily. Dietary patterns and nutritional therapy should focus on food preferences, social and cultural influences, and appropriate caloric intake.
Physical Activity and Exercise
The AHA (n.d.-d) recommends 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous aerobic activity weekly. Average time for exercise should be at least 30–40 minutes per session to assist in decreasing blood pressure. If the client cannot do 30–40 minutes of moderate exercise four times a week, the nurse should suggest an alternate exercise plan, emphasizing that some physical activity is better than no physical activity. Physical activity and exercise enhance weight reduction and promote a healthy lifestyle.
Smoking Cessation and Reducing Alcohol Consumption
Tobacco use is the leading preventable cause of coronary artery disease. Smoking increases sympathetic nervous system activity, which causes vasoconstriction and, therefore, increases blood pressure, heart rate, and myocardial contractility. Although smoking has been established as a known risk factor for cardiovascular disease, its relationship to high blood pressure is still being investigated. Nevertheless, smoking and exposure to secondhand smoke contribute to increased accumulation of fatty deposits within the arteries, which high blood pressure is known to accelerate (AHA, n.d.-c).
Alcohol consumption increases blood pressure by increasing the level of the hormone renin in the blood. Renin decreases fluid elimination, causing higher fluid volume in the body and arterial vasoconstriction that results in an increase in blood pressure. Reducing alcohol consumption has been shown to decrease systolic and/or diastolic blood pressure by 5–12 mm Hg (Wake, 2021).
Relaxation Techniques
According to Harvard Health Publishing (2022), meditation has been associated with reducing blood pressure. Herawati et al. (2023) adds that slow breathing can be used as a nonpharmacological treatment to lower blood pressure. The National Center for Complementary and Integrative Health (2021) reviewed research on relaxation and blood pressure control that showed relaxation techniques resulted in small reductions in blood pressure and demonstrated yoga may be used as an adjunct intervention for the management of hypertension.
Clinical Tip
Assessing Client Lifestyle Modifications
The nurse should work closely with the client to promote lifestyle changes—such as diet modifications and weight loss, increase in exercise, smoking cessation, and use of relaxation techniques—that will improve baseline blood pressure readings.
Self-Monitoring of Hypertension
Home blood pressure monitoring (Figure 18.4) contributes to the comprehension of hypertension and facilitates the awareness of the importance of blood pressure management. Clients are now able to monitor their blood pressure with electronic blood pressure devices. Home blood pressure monitoring leads to awareness of one’s blood pressure, better blood pressure control, and adherence to lifestyle changes and drug therapies (Verma et al., 2021).
Based on the assessment, what diagnosis should the nurse anticipate from the health care provider?
- Answer
-
Hypertension stage 2
Which of the following diagnostic tests would the nurse expect the health care provider to order for Hahn?
- Answer
-
Renal function panel