Clinical management of different types of hypertension.

Clinical management of different types of hypertension.

Clinical management of different types of hypertension.

High Blood Pressure (HBP) or hypertension is a persistent abnormal elevation of the pressure within the arteries which deliver blood to the entire body. An adult’s blood pressure is calculated by using two numbers. The heart’s rhythmic pumping action creates the upper systolic pressure (normal is 120 mm. Hg. or lower) and its resting pressure between heart beats is the lower diastolic pressure (normal is 80 mm. Hg. or lower) (Oliveira, Duarte, & Zanetta, 2019). There are four stages of high blood pressure or hypertension:



  • STAGE 1 or Prehypertension is 120/80 to 139/89
  • STAGE 2 or Mild Hypertension is 140/90 to 159/99
  • STAGE 3 or Moderate Hypertension is 160/100 to 179/109
  • STAGE 4 or Severe Hypertension is 180/110 or higher

If the patients’ blood pressure is in the prehypertension range, it is likely that you will end up with high blood pressure unless they take action to prevent it. High blood pressure needs to be treated because it can lead to kidney failure, heart attacks, heart failure, stroke, and blindness. High blood pressure affects more than 50 million Americans 60 years of age and older (Oliveira, Duarte, & Zanetta, 2019). One in three adults has high blood pressure. Approximately half of all these patients use medications to lower their blood pressure, but only half of these have their blood pressure under control. They can lower their risk of high blood pressure with a healthy lifestyle, including:

  • Maintaining a healthy weight
  • Increasing physical activity
  • Eliminating tobacco use
  • Limiting alcohol consumption to no more than three ounces per day for men and one and a half ounces for women
  • Building relaxation into your workday
  • Developing healthy eating habits, which include selecting a variety of foods, partially whole grains, fruits and green vegetables, and limiting the intake of salt and saturated fats

They can also work with their doctor to achieve good blood pressure control by:

  • Knowing their blood pressure. If either the upper level (systolic pressure) or lower level (diastolic pressure) goes persistently beyond the normal limit of 140/90, consult with their physician.
  • Monitor their blood pressure regularly, and keep a written record to share with their doctor.
  • Take medications as instructed.
  • If blood pressure readings remain high, ask their doctor if tests to detect secondary hypertension should be conducted. Depending on the findings, treatment may be modified to achieve blood pressure control.

Identify the risk factors for the development of CAD and atrial fibrillation in the older adult.

Any person, ranging from children to adults, can develop atrial fibrillation. Because the likelihood of AFib increases with age and people are living longer today, medical researchers predict the number of AFib cases will rise dramatically over the next few years (Smith,2018). Even though AFib clearly increases the risks of heart-related death and stroke, many patients do not fully recognize the potentially serious consequences. Associated risk factors for coronary artery disease is increasing age, male gender, heredity, tobacco use, elevated cholesterol, high blood pressure, physical inactivity, obesity, stress, alcohol consumption and poor diet.

Atrial fibrillation (AF) prevalence increases with age, making it the most common arrhythmia in patients older than 65 years. Typically people who have one or more of the following conditions are at higher risk for AFib:

  • Advanced age: The number of adults developing AFib increases markedly with older age. Atrial fibrillation in children is rare, but it can and does happen.
  • High blood pressure: Longstanding, uncontrolled high blood pressure can increase your risk for AFib.
  • Underlying heart disease: Anyone with heart disease, including valve problems, hypertrophic cardiomyopathy, acute coronary syndrome, Wolff-Parkinson-White (WPW) syndrome and history of heart attack. Additionally, atrial fibrillation is the most common complication after heart surgery.
  • Drinking alcohol: Binge drinking (having five drinks in two hours for men, or four drinks for women) may put you at higher risk for AFib.
  • Family history: Having a family member with AFib increases your chances of being diagnosed.
  • Sleep apnea: Although sleep apnea isn’t proven to cause AFib, studies show a strong link between obstructive sleep apnea and AFib. Often, treating the apnea can improve AFib.
  • Athletes: AFib is common in athletes and can be triggered by a rapid heart rate called a supraventricular tachycardia (SVT).
  • Other chronic conditions: Others at risk are people with thyroid problems (specifically hyperthyroidism), diabetes, asthma and other chronic medical problems (Hirji, Lee, & Kaneko, 2018).

Identify individual risk factors and clinical management necessary to avoid stroke-related injury in the older adult.

A stroke, or “brain attack,” occurs when blood circulation to the brain fails. Brain cells can die from decreased blood flow and the resulting lack of oxygen. There are two broad categories of stroke: those caused by a blockage of blood flow and those caused by bleeding into the brain. A blockage of a blood vessel in the brain or neck, called an ischemic stroke, is the most frequent cause of stroke and is responsible for about 80 percent of strokes. A risk factor is a condition or behavior that occurs more frequently in those who have, or are at greater risk of getting, a disease than in those who don’t. Having a risk factor for stroke doesn’t mean you’ll have a stroke. On the other hand, not having a risk factor doesn’t mean you’ll avoid a stroke. But your risk of stroke grows as the number and severity of risk factors increases.Some factors for stroke can’t be modified by medical treatment or lifestyle changes.

  • Age-Stroke occurs in all age groups. Studies show the risk of stroke doubles for each decade between the ages of 55 and 85. But strokes also can occur in childhood or adolescence. Although stroke is often considered a disease of aging, the risk of stroke in childhood is actually highest during the perinatal period, which encompasses the last few months of fetal life and the first few weeks after birth.
  • Gender- Men have a higher risk for stroke in young and middle age, but rates even out at older ages, and more women die from stroke. Men generally do not live as long as women, so men are usually younger when they have their strokes and therefore have a higher rate of survival.
  • Race- People from certain ethnic groups have a higher risk of stroke. For African Americans, stroke is more common and more deadly—even in young and middle-aged adults—than for any ethnic or other racial group in the United States. Studies show that the age-adjusted incidence of stroke is about twice as high in African Americans and Hispanic Americans as in Caucasians, and while stroke incidence has declined for whites since the 1990s, there has not been a decline for Hispanics or black Americans. An important risk factor for African-Americans is sickle cell disease, which can cause a narrowing of arteries and disrupt blood flow. The incidence of the various stroke subtypes also varies considerably in different ethnic groups.
  • Family history of stroke- Stroke seems to run in some families. Several factors may contribute to familial stroke. Members of a family might have a genetic tendency for stroke risk factors, such as an inherited predisposition for high blood pressure (hypertension) or diabetes. The influence of a common lifestyle among family members also could contribute to familial stroke (Kariasa, Nurachmah, Setyowati, & Koestoer, 2019)

Hirji, S. A., Lee, J., & Kaneko, T. (2018). Current Readings: An Update on Prevention and Management of Atrial Fibrillation Post Cardiac Surgery. Seminars in Thoracic & Cardiovascular Surgery30(3), 256–261.

Kariasa, I. M., Nurachmah, E., Setyowati, & Koestoer, R. A. (2019). Analysis of participants’ characteristics and risk factors for stroke recurrence. Enfermeria Clinica29, 286–290. (Links to an external site.)

Oliveira, I. M., Duarte, Y. A. de O., & Zanetta, D. M. T. (2019). Prevalence of Systemic Arterial Hypertension Diagnosed, Undiagnosed, and Uncontrolled in Elderly Population: SABE Study. Journal of Aging Research, 1–11. (Links to an external site.)

Smith, R. (2018). Myocardial Perfusion Study to Detect Coronary Artery Disease. Radiologic Technology90(2), 131–146. Retrieved from…

Latara’s additional response:(PartB)

Very informative post. I would like to further elaborate that peripheral vascular disease (PVD) is a blood circulation disorder that causes the blood vessels outside of the heart and brain narrow, block, or spasm. This can happen in your arteries or veins. PVD typically causes pain and fatigue, often in your legs, and especially during exercise. The pain usually improves with rest. The two main types of PVD are functional and organic PVD .Functional PVD means there’s no physical damage to your blood vessels’ structure (Lopes-Costa, & Amato-Vealey,2016). Instead, your vessels widen and narrow in response other factors like brain signals and temperature changes. The narrowing causes blood flow to decrease. Organic PVD involves changes in blood vessel structure like inflammation, plaques, and tissue damage. The most common causes of functional PVD are: emotional stress, cold temperatures, operating vibrating machinery or tools and drugs. The primary causes of organic PVD are smoking, high blood pressure, diabetes and high cholesterol. The two main goals of PVD treatment is to stop the disease from progressing and to help the patient manage their pain and symptoms so they can remain active. The treatments will also lower the patients risk for serious complications. The first-line treatment typically involves lifestyle modifications. If lifestyle changes alone aren’t enough, then the patient may need medication. If there is the presence of significant artery blockages the patient may require surgery such as angioplasty or vascular surgery.

What are ways to reduce the development of PVD? When should a patient with PVD contact their physician?

Lopes-Costa, E., & Amato-Vealey, E. (2016). Identifying beliefs about smoking in patients with peripheral vascular disease. Journal of Vascular Nursing34(4), 137–143.

Charli’S Response:

Discuss the clinical management of different types of hypertension.

There are many medications used for the treatment of hypertension. Depending on age, race, and other co-morbidities may determine what drug is selected for HTN management. ACE inhibitors or Angiotensin-converting enzyme inhibitors are often a first-line choice for any patient that has heart failure or asymptomatic LV dysfunction, ST elevation, MI, non-ST elevation MI, diabetes, systolic dysfunction, and proteinuric CKD patients (Mann, 2019). Angiotensin II receptor blockers (ARBs) are similar to ACE inhibitors and are often chosen for their cardioprotective properties. ARBs are often chosen as the drug of choice if the patient has an intolerance to an ACE. A patient with primary hypertension might be given a thiazide diuretic such as chlorthalidone or HCTZ, but HCTZ is less potent and is shorter acting then chlorthalidone or indapamide (Mann, 2019). Patients with osteoporosis that have HTN can benefit from thiazide-like diuretics as they help stimulate the distal tubular reabsorption of calcium with then leads to a a decrease in urinary calcium excretion (Mann, 2019). Calcium channel blockers are not always a first choice, but can help with rate control in patients with CAD and normal left ventricular systolic function or patients with COPD if beta blockers are contraindicated (Mann, 2019). A patient that has a MI, patients with HF, or LV dysfunction are often started on a beta blocker in conjunction with an ACE or ARB (Mann, 2019). Patients that need more medication to control their blood pressure are often started on an ACE or ARB with a combination of a thiazide diuretic.

Identify the risk factors for the development of CAD and atrial fibrillation in the older adult.

The prevalence of atrial fibrillation has been seen to increase with age. Changes in the size of the atria, elevation of atrial pressures, and infiltration or inflammation of the atria can cause atrial fibrillation to occur (Ganz & Spragg, 2019). The most common risk factors that are seen to be a underlying cause of AF are patients with HTN and coronary heart disease. Patients with coronary heart disease that have had an MI or have HF are more at risk for developing AF due to the ischemia and atrial stretching that occurs (Ganz & Spragg, 2019). Patients with valvular heart disease such as stenosis or regurgitation are at more risk as well. Other risk factors that can lead to AF are obesity, OSA, COPD, metabolic syndrome, and CKD (Ganz & Spragg, 2019).

The biggest two risk factors that are related to coronary heart disease are hypertension and diabetes mellitus. Males are often seen to have more incidents of CHD than women (Wilson & Douglas, 2019). Other causes or risk factors are smoking, high cholesterol, family history, high stress and sedentary lifestyle (Mayo Clinic, 2018).

Identify individual risk factors and clinical management necessary to avoid stroke-related injury in the older adult.

The major risk factors that can be avoided to decrease your risk for stroke are related to smoking, obesity, unhealthy diet, physical inactivity, dylipidemia, HTN, and DM (Hennekens, 2019). Many of these risk factors are seen together in patients. Teaching blood pressure control, exercise, healthy eating, avoiding smoking or stopping, medication for high cholesterol, controlling diabetes, avoiding alcohol, taking fish oil, and aspirin daily can all be beneficial to prevent stroke (Hennekens, 2019). Another major risk factor are patients with atrial fibrillation and carotid artery stenosis. Making sure patients are on anti-coagulation therapy and are following up with their PCP to check labs, vital signs, and overall health is very important.


Gans, L., & Spragg, D. (2019). Epidemiology of and risk factors for atrial fibrillation. UpToDate. Retrieved from (Links to an external site.)

Hennekens, C. (2019). Overview of primary prevention of coronary heart disease and stroke. UpToDate.Retrieved from (Links to an external site.)

Mann, J. (2019). Choice of drug therapy in primary (essential) hypertension. UpToDate. Retrieved from (Links to an external site.)

Mayo Clinic. (2018). Coronary artery disease. Retrieved from (Links to an external site.)


Wilson, P., & Douglas, P. (2019). Epidemiology of coronary heart disease. UpToDate. Retrieved from (Links to an external site.)