 Hi, welcome to Nursing School Explained and this video on hypertension. Hypertension is one of those disorders that we come across a lot in the clinical setting and in a general population because it occurs very frequently in the population. Now in order to really understand what regulates the blood pressure in our bodies, I have a separate video that's titled Mechanisms of blood pressure control that I'm going to reference here in the card section so you can go back and review that if needed But for hypertension we have to distinguish between two different types which is primary hypertension, sometimes also called essential hypertension, and then secondary hypertension. While we don't really know the causes for primary hypertension, 90 to 95 percent of cases happen or are classified as primary or essential hypertension and we know that there are several risk factors that lead to primary hypertension and some of those are age So as the arteries get stiffer and calcified over time as we age it's harder for the heart to pump and the blood vessels become less elastic therefore it takes more pressure to produce the cardiac output as well as the blood pressure. Alcohol and smoking we know are definitely not good for the vasculature and therefore can lead to hypertension. Chronic diseases such as diabetes and hyperlipidemia that are many times closely related also are risk factors for hypertension and increase in sodium or high sodium diet because we know that sodium and water go together and when there's high Sodium content that the patient consumes water will follow. If there's more water in the system it'll increase the blood pressure. Gender male patients from about middle adulthood to the early older adulthood are male patients at higher risk where right around 65 or so it switches over to where female patients are at higher risk for hypertension. A family history certainly is a risk factor as well as obesity and that kind of goes along with a sedentary lifestyle as well as diabetes and hyperlipidemia because many times those are closely related. And then ethnicity research has shown that black Americans as well as Mexican Americans have a higher risk for blood pressure, for a high blood pressure and also that certain blood pressure medications work better for certain ethnicities than for others. So this really comes into play when we're dealing with the actual medication treatment. And then socioeconomic status because we know that typically people from lower socioeconomic backgrounds have lower access to healthcare and don't really have all that well balanced diet. Many times there's stress involved, sedentary lifestyle and they're also in general not as likely to go to their regular checkups where high blood pressure could be detected. So all these risk factors here contribute to primary or essential hypertension where secondary hypertension only about 5 to 10 percent of the cases are caused by or are classified as secondary hypertension and risk factors here mean that the hypertension is caused by something else by a secondary cause in the patient's body. So cirrhosis is a big one because it also causes more water retention as the blood backs up through the liver. It causes portal hypertension and then it can lead to systemic hypertension. Cardiac defects like we many times see in the pediatric population or maybe adults that have now grown up when there are structural defects of the heart let's say a heart valve or a heart chamber there can be some structural defects that lead to hypertension. Certain drugs whether they are legal or illegal drugs and prescription medications can lead or be contributory to hypertension and those would be steroids, NSAIDs as well as illegal drugs such as cocaine or methamphetamines anything that kind of speeds up the heart rate and kind of makes the patient more kind of like causes a sympathetic nervous system response they are also known to cause secondary hypertension. Certain endocrine disorders such as pheochromocytoma or Cushing's disease as well as thyroid disease can cause secondary hypertension and the neurologic disorders so anything that disrupts the cerebral auto-regulation of the blood pressure such as in traumatic brain injury or maybe even ischemia from a stroke can definitely cause some secondary hypertension and then sleep apnea is also a big risk factor as well as renal disease and we don't really think about here as renal disease such as in maybe acute kidney or chronic kidney disease that's caused by diabetes but this is more renal disease from renal artery stenosis when the arteries that feed the kidneys are a little bit sclerosed and they don't get profused it can kind of lead to secondary hypertension as well as glomerular arthritis which is an inflammation of the glomerulus of the kidney can also lead to secondary hypertension. Now let's look at the treatment for hypertension. So because we have so many risk factors mostly for primary hypertension the treatment goal is always to reduce the risk factors and because there are so many lifestyle changes that can be done to eliminate some of these risk factors I actually made a separate video that just addresses the lifestyle changes and how it can actually benefit by how many millimeters of mercury the blood pressure can be reduced so please watch that second video I'll go ahead and I'll put the link up here in the card section again so that's always number one and then signs and symptoms hypertension many times is also classified or called the silent killer because patients many times don't have any symptoms if they don't go in for regular checkups their blood pressure might be creeping up over time over years maybe it goes into the 130s the 140s the 150s and the patient might not notice that they have any symptoms and then when it's when they have significant symptoms some of the complications have already occurred but sometimes if the patient is symptomatic some of those might include fatigue some dizziness some headache because the pressure in the head in the cerebral arteries also increases can cause a headache the patient might also feel palpitations as the heart is trying to pump harder they might have symptoms of angina chest pain with exertion because of some of those complications can occur as well as some dyspnea because of the reasons that the blood pressure or the things that the blood pressure can cause and that affect the heart so when we talk about complications we talk about target organ damage or end organ damage it's what it's sometimes called and as you can see here it affects the body in many different ways and in most of the very important organs such as the heart brain blood vessels kidneys and eyes and the reason that that is because high blood pressure is is an elevation in the pressure in all of the blood vessels all over the body and these organs are the ones that we worry about the most but again many times the patient does know that they have high blood pressure until one of these really bad things or complications occur so for the heart coronary artery disease is a complication of heart failure of hypertension mostly because of these risk factors that we discussed here earlier as the blood pressure gets higher and higher the heart has to pump harder so the heart muscle grows leading to left ventricular hypertrophy and enlarge left ventricle and then from there it doesn't take much to lead to heart failure that heart muscle will just fail over time in the brain it can cause a stroke and that would be ischemic stroke due to atherosclerosis and clogged arteries because of the risk factors of diabetes and hyperlipidemia but it can also cause a hemorrhagic stroke when those blood vessels are under so much pressure that now that blood vessel gives out and opens up and the patient has an intracranial bleed it can also lead to carotid artery stenosis clogged carotid arteries which then again is a high risk factor for developing a stroke and it's actually also led led to believe to cause complication of dementia so we see a lot of dementia in our older population now and a lot of that seems to be related to hypertension so we need to really pay attention to preventing that to pretend these long prevent these long-term complications in terms of blood vessels when there are clogged arteries it can lead to peripheral vascular disease that then can have symptoms patients can even lose limbs from that it can cause to an aortic aneurysm or an aortic dissection and that again is when the blood vessel is under so much pressure for a prolonged period of time the inner lining of the blood vessel will just kind of peel away and it will cause that outpouching and eventually it can burst leading to this aneurysm or when it bursts that means there's a dissection and I'll have different videos on that also in the kidneys it can lead to nephrosclerosis just less like it can lead to atherosclerosis so that means that the kidneys become more clogged and more prone to lead to chronic kidney disease and then in the eyes we know that diabetes is bad for the eyes causing diabetic retinopathy but also high blood pressure can cause retinal damage and then some long-term complications and even blindness from there so then really if you look at it all these bad things that can happen can possibly occur and the patient might not have any symptoms so it's very important that we correctly measure the patient's blood pressure and again because this is such an important topic and there are many steps that we need to take into consideration I made a different video about how to correctly take a blood pressure management measurement please refer to that but if we just know what the patient's blood pressure is we can treat it early with these lifestyle measures by decreasing risk factors and maybe minimizing or the patient not requiring any of these medications that we'll discuss here in a moment. Other diagnostic tests would be your analysis to check kidney function, BMP again checking kidney function and electrolytes, checking the CBC just to make sure they are not anemic and their platelet functions are okay, lipid panel because of the high risk for hyperlipidemia, an EKG on echocardiogram to check for those heart complications we discussed, liver function tests to see maybe there's something going on with the liver that could be maybe causes for secondary hypertension as here mentioned in the cirrhosis and then a thyroid panel because the thyroid gland as we know regulates the metabolic rate and if that is not working properly it can also lead to hypertension and then certainly there are a multitude of medications available different classes that treat blood pressure at different stages or through different mechanisms and I have videos on pretty much all of these medication here medication groups that go into the indications mechanism of actions common side effects as well as nursing considerations so I highly encourage you to watch those as well and I'll put a link down in the description below so you have easy reference to that but it starts with diuretics to get rid of some of that fluid volume excess the patient might be having from high sodium diet and heart failure beta blockers treat the heart itself by lowering down heart rate as well as blood pressure similarly calcium channel blockers ACE inhibitors and angiotensin receptor blockers work on the RAS that ran in angiotensin aldosterone system to kind of help with eliminating that angiotensin effect and relaxing the blood vessels renin inhibitors work also on the RAS and then adrenergic inhibitors help to decrease that adrenergic that sympathetic response that will tend to increase the blood pressure and then certainly basal dilators if we can relax the blood vessels the pressure will decrease so I highly encourage you to watch any of these videos that pertain and also I have lots of videos of all of these complications or many of these complications and if not they're currently in the making so please give me a thumbs up if you've enjoyed the video also subscribe to my channel it helps me keep going and keep making these videos also check out my instagram page where I have study tips and announcements of the latest releases thanks so much for watching nursing school explained see you soon