nursing care of clients with hypertension

Maria Carmela L. Domocmat

Instructor

School of Nursing

Northern Luzon Adventist College

� Systolic pressure: pressure at the height of

the pressure pulse

� Diastolic pressure: the lowest pressure

Pulse pressure: the difference between � Pulse pressure: the difference between

systolic and diastolic pressure

� Mean arterial pressure: represents the

average pressure in the arterial system during

ventricular contraction and relaxation

� Represents the pressure of the blood as it

moves through the arterial system

� Cardiac output = HR x SV

Vascular resistance� Vascular resistance

� Mean arterial pressure = CO x VR

� Short-term regulation: corrects temporary

imbalances in blood pressure

� Neural mechanisms

� Humoral mechanisms

� Long-term regulation: controls the daily,

weekly, and monthly regulation of blood

pressure

� Renal mechanism

� Systolic pressure

� The characteristics of the stroke volume being ejected from the heart

� The ability of the aorta to stretch and accommodate the stroke volume

Diastolic pressurestroke volume

� Diastolic pressure

� The energy that is stored in the aorta as its elastic fibres are stretched during systole

� The resistance to the runoff of blood from the systemic blood vessels

� Physical

� Blood volume and the elastic properties of the

blood vessels

� Physiologic factors � Physiologic factors

� Cardiac output

� Systemic vascular resistance

Which of the following does not directly affect

arterial blood pressure?

a. Heart rate

b. Vascular resistanceb. Vascular resistance

c. Venous constriction

d. Blood volume

� BP of › 140/90 in individuals who do not have

diabetes.

� systolic blood pressure greater than or equal to

140 mm Hg and/or a diastolic blood pressure 140 mm Hg and/or a diastolic blood pressure

greater than or equal to 90 mm Hg

� BP of ›130/85 in individuals with diabetes

and/or renal impairment

� systolic blood pressure of 130 mm Hg and/or a

diastolic blood pressure of 85 mm Hg or higher

� affects 1.5 billion people worldwide

� 1: 4 � One in every four Filipino

adults suffers from hypertension or highhypertension or high

� 11: 100 � least 11 in every 100

Filipinos have pre-hypertension

� 5th leading cause mortality & morbidity in the Philippines

MORBIDITY: 10 Leading Causes, Number and Rate*5-Year Average (2000-2004) & 2005

Diseases5-Year Average (1955-1959) 2005

Number Rate Number Rate

1. Acute Lower Respiratory Tract Infection and Pneumonia**

694,209 884.6 690,566 809.9

2. Bronchitis/Bronchiolitis 669,800 854.7 616,041 722.5

3. Acute watery diarrhea 726,211 928.3 603,287 707.6

4. Influenza 459,624 587.0 406,237 476.5

5. Hypertension 314,175 400.5 382,662 448.85. Hypertension 314,175 400.5 382,662 448.8

6. TB Respiratory 109,369 139.7 114,360 134.1

7. Diseases of the Heart 43,945 56.1 43,898 51.5

8. Malaria 35,970 46.1 36,090 42.3

9. Chicken Pox 79,236 41.1 30,063 36.3

10. Dengue fever 15,383 19.6 20,107 23.6

* per 100,000 population

** Does not include ALRI, Pneumonia cases only from 2000-2002

http://www.doh.gov.ph/kp/statistics/morbidity

MORBIDITY: 10 Leading Causes, Number and Rate*5-Year Average (1999-2003) & 2004

Diseases5-Year Average (1999-2003) 2004

Number Rate Number Rate

1. Acute Lower Respiratory Tract Infection and Pneumonia**

677,563 875.8 776,562 929.4

2. Bronchitis/Bronchiolitis 669,246 866.4 719,982 861.6

3. Acute watery diarrhea 792,479 1027.0 577,518 690.7

4. Influenza 486,481 629.6 379,910 454.7

5. Hypertension 287,368 370.5 342,284 409.65. Hypertension 287,368 370.5 342,284 409.6

6. TB Respiratory 117,712 152.6 103,214 123.5

7. Chicken Pox 77,020 38.9 46,779 56.0

8. Diseases of the Heart 49,160 63.8 37,092 44.4

9. Malaria 45,622 59.3 19,894 23.8

10. Dengue fever 14,039 18.1 15,838 19.0

* per 100,000 population

** Pneumonia only from 1999-2002

http://www.doh.gov.ph/kp/statistics/morbidity

� systolic blood pressure (SBP) › 140 mm Hg

� diastolic blood pressure (DBP) › 90 mm Hg

� based on the average of > 2 BP

measurements taken on different occasionsmeasurements taken on different occasions

� the higher the systolic or diastolic pressure,

the greater the risk.

1. _____________ or __________________� Idiopathic cause

� reason for elevation BP is unknown

� most common (90 to 95%)most common (90 to 95%)

2. _____________________________

� With an identifiable cause

� e.g. pheochromocytoma, narrowing of the renal arteries, renal parenchymal disease, hyperaldosteronism (mineralocorticoidhypertension) certain medications, pregnancy, and coarctation of the aorta

3. ___________________________

� severe type of elevated blood pressure that is

rapidly progressive.

� morning headaches, blurred vision, and dyspnea

and/or symptoms of uremia

� BP › 200/150 mm Hg

4 _____________________

- intermittently elevated BP

5. _____________________

- does not respond to usual treatment- does not respond to usual treatment

6. _____________________

- elevation of BP only during clinic visits

7. ______________________

- sudden elevation of Bp requiring immediate lowering to prevent complications

� _______________________

� Both the systolic and diastolic pressures are

elevated

� _______________________� _______________________

� The diastolic pressure is selectively elevated

� ________________________

� The systolic pressure is selectively elevated

Renal failure results in Na+ and water retention.

This results in hypertension. How would you

classify this type of hypertension?

a. Primary hypertensiona. Primary hypertension

b. Secondary hypertension

c. Malignant hypertension

d. Systolic hypertension

� Same risk factors for atherosclerotic heart

disease

� dyslipidemia (abnormal blood fat levels)

diabetes mellitus. � diabetes mellitus.

� Race: African Americans.

� Cigarette smoking

� Family history

� Age-related changes in blood pressure

� Insulin resistance and metabolic

abnormalitiesabnormalities

� Circadian variations

� Lifestyle factors

� High salt intake

� Obesity

� Excess alcohol consumption

Dietary intake of potassium, calcium, and � Dietary intake of potassium, calcium, and

magnesium

� Oral contraceptive drugs

� Stress

� As a Sign� nurses and other health care professionals use BP to

monitor a patient’s clinical status.

� Elevated pressure may indicate an excessive dose of vasoconstrictive medication or other problems. vasoconstrictive medication or other problems.

� As a risk factor� hypertension contributes to rate at which

atherosclerotic plaque accumulates within arterial walls.

� As a disease� hypertension is a major contributor to death from

cardiac, renal, and peripheral vascular disease.

� is the amount of force on the walls of the arteries as the blood circulates around the body.body.

High blood pressure/ Hypertension result from a change in cardiac output, a change

in peripheral resistance, or both.

_________ ___________

=

x↑ ↑

↑=

Blood Pressure↑

� Multifactorial condition

� Causes:

� change in one or more factors affecting peripheral

resistance or cardiac output resistance or cardiac output

� problem with control systems that monitor or

regulate pressure.

� Single gene mutations or polygenic (mutations in

more than one gene)

� Stabilizing mechanisms exist in the body to

exert an overall regulation of systemic arterial

pressure and to prevent circu latory collapse.

Four control systems play a major role in Four control systems play a major role in

maintaining blood pressure: the arterial

baroreceptor system, regulation of body fluid

volume, the renin-angiotensinaldosterone

system, and vascular autoregulation.

� found primarily in carotid sinus, also in aorta and wall of left ventricle.

� Monitor level of arterial pressure� counteracts rise in arterial pressure through vagally

mediated cardiac slowing and vasodilation with decreased sympathetic tone. sympathetic tone.

� Therefore reflex control of circulation elevates the systemic arterial pressure when it falls and lowers it when it rises.

� Why this control fails in hypertension is unknown. There is evidence for upward resetting of baroreceptor sensitivity so that pressure rises are inadequately sensed even though pressure decreases are not.

� Changes in fluid volume also affect the systemic arterial pressure.

� excess of salt and water in a person's body, the blood pressure rises through complex physiologic mechanisms that change the venous return to the mechanisms that change the venous return to the heart, producing a rise in cardiac output.

� If the kidneys are functioning adequately, a rise in systemic arterial pressure produces diuresis and a fall in pressure.

� Pathologic conditions that change the pressure threshold at which the kidneys excrete salt and water alter the systemic arterial pressure.

� Renin, angiotensin, and aldosterone also

regulate blood pressure

� kidney produces renin

an enzyme that acts on a plasma protein � an enzyme that acts on a plasma protein

substrate to split off angiotensin I

� which is converted by an enzyme in the lung to

form angiotensin II.

� Angiotensin II � strong vasoconstrictor

� is the controlling mechanism for aldosterone release.

� With Aldosterone inhibit sodium excretion, resulting in an elevation in blood pressure. elevation in blood pressure.

� Inappropriate secretion of renin may cause increased peripheral vascular resistance in essential (primary) hypertension. In high blood pressure, renin levels should be expected to fall because the increased renal arteriolar pressure should inhibit renin secretion. In most people with essential hypertension, however, renin levels are normal.

� The process of vascular autoregulation, which

keeps perfusion of tissues in the body

relatively constant, appears to be important

in causing hypertension accompanying salt in causing hypertension accompanying salt

and water overload. This mechanism is poorly

understood.

• Increased SNS activity r/t dysfunction of ANS

� Increased renal reabsorption of Na, Cl, and H20 r/t genetic

variation in pathways by which kidneys handle Na

� Increased activity of RAAS, resulting in expansion of

extracellular fluid volume and increased systemic vascular extracellular fluid volume and increased systemic vascular

resistance

� Decreased vasodilation of arterioles r/t dysfunction of

vascular endothelium

� Resistance to insulin action

� which may be a common factor linking hypertension, type 2 diabetes

mellitus, hypertriglyceridemia, obesity, and glucose intolerance

� Modifiable and nonmodifiable risk factors� Nonmodifiable risk factors ▪ Family history, gender, race, and age-related increases

in blood pressure

� Modifiable risk factors� Modifiable risk factors▪ Sedentary lifestyle, poor dietary habits, abdominal

obesity, impaired glucose tolerance or diabetes mellitus, smoking, dyslipidemia, drug use, and stress

� family history of

hypertension is a major risk

factor.

� In families with

hypertension, there may

be a defect in renal factor. be a defect in renal

secretion of sodium or a

heightened sympathetic

nervous system response

to stress.

� Age

� More common in younger men than younger women

� More common in the elderly� Race� Race

� The Ontario Survey of the prevalence and control of hypertension

� More common in blacks and South Asians� Socioeconomic group

� More common in lower socioeconomic group

ESSENTIAL (PRIMARY)

� No known cause

� Associated risk factors

� Family history of

SECONDARY

� Renal vascular and renal parenchymaldisease

� Primary aldosteronism� Pheochromocytoma� Cushing's disease� Family history of

hypertension

� High sodium intake

� Excessive calorie

consumption

� Physical inactivity

� Excessive alcohol intake

� Low potassium intake

� Cushing's disease� Coarctation of the aorta� Brain tumors� Encephalitis� Psychiatric disturbances� Pregnancy� Medications� Estrogen (e.g., oral contraceptives)� Glucocorticoids� Mineralocorticoids� Sympathomimetics� estrogen-containing oral

contraceptives

Why is hypertension

sometimes called sometimes called

“the silent killer”?

� Hypertension is sometimes called “the silent

killer” because people who have it are often

symptom free.

� Asymptomatic

� High blood pressure � Headache ( especially upon waking)

� Most characteristic sign� Most characteristic sign� Dizziness� Chest pain� Tinnitus� Epistaxis

� Visual disturbances� retinal changes

� hemorrhages, exudates (fluid accumulation), arteriolar narrowing, and cottonwool spots (small arteriolar narrowing, and cottonwool spots (small infarctions)

� Papilledema� swelling of the optic disc

� For severe hypertension

� postural (orthostatic) changes� s/s of primary cause

� thorough health history and physical examination are necessary.

� Retinas examined (fundoscopy)� laboratory studies

� Urinalysis� Urinalysis

� blood chemistry (ie, Na, K, creatinine, FBS, lipid profile

� 12-lead ECG

� Echocardiography (Left ventricular hypertrophy)

� Renal damage may be suggested by elevations in BUN and creatinine levels or by microalbuminuria or macroalbuminuria. Additional studies, such as creatinineclearance, renin level, urine tests, and 24-hour urine protein, may be performed.

� psychosocial stressors

� Job-related, economic, and other life

stressors

client's response to these stressors. � client's response to these stressors.

� coping with the lifestyle changes needed to

control hypertension.

� Assess past coping strategies.

� Prolonged BP elevation eventually damages

blood vessels throughout the body,

particularly in target organs such as the

heart, kidneys, brain, and eyes. heart, kidneys, brain, and eyes.

� Coronary artery disease (angina or MI)

� Left ventricular hypertrophy

� HF

Renal failure � Renal failure

� Cerebrovascular involvement [stroke or

transient ischemic attack (TIA)]

� Impaired vision

� goal : prevent death and complications by

achieving and maintaining the arterial blood

pressure at 140/90 mm Hg or lower.

Initial Drug TherapyInitial Drug Therapy

Lifestyle Lifestyle

ModificationModification

Without Compelling Without Compelling

IndicationIndication

With Compelling With Compelling

IndicationIndication

Normal BPNormal BP EncourageEncourage N/AN/A N/AN/A

PrehypertensionPrehypertension YesYes No meds No meds

Drugs for compelling Drugs for compelling

indication (DM, heart indication (DM, heart

failure, MI, renal failure)failure, MI, renal failure)

Stage I HPNStage I HPN YesYes

ThiazideThiazide--type diuretics, type diuretics,

ACE inhibitors, ARBs, ACE inhibitors, ARBs,

CCBs, Beta blockersCCBs, Beta blockers Drugs for compelling Drugs for compelling

indications + other indications + other

antihypertensivesantihypertensives

Stage II HPNStage II HPN YesYes TwoTwo--drug combinationsdrug combinations

� Weight reduction if BMI is 27 or higher

� Increase aerobic physical activity

� 30 to 45 minutes most days of the week

� brisk walking, running, cycling, swimming, or stair � brisk walking, running, cycling, swimming, or stair

climbing, 30 to 45 minutes three to five times a week.

� Initiate gradually

� should stop and notify the physician if severe

shortness of breath, fainting, or chest pain occurs.

� should avoid muscle-building isometric exercise

(weight lifting, wrestling, rowing)

� Sodium restriction � no more than 2.4 g sodium or 6 g NaCl

� Explain it takes 2 to 3 months for the taste buds to adapt to changes in salt intake may help the patient adjust to reduced salt intake. adjust to reduced salt intake.

� avoid adding salt at the table

� avoid cooking with salt

� avoid adding seasonings that contain sodium

� limit consumption of canned, frozen, or other processed foods

� read labels on processed foods

� Maintain adequate intake of dietary K

(approximately 90 mmol per day).

� Maintain adequate intake of dietary

Ca and Mg for general health.Ca and Mg for general health.

� Reduce intake of dietary saturated fat and

cholesterol

� Stop smoking / Avoid tobacco

� Moderation of alcohol intake

� Support groups for weight control, smoking

cessation, and stress reductioncessation, and stress reduction

� Stress reduction

FOOD GROUPFOOD GROUP NO. SERVINGS PER NO. SERVINGS PER

DAYDAY

GrainsGrains 7 7 –– 88

VegetablesVegetables 4 4 –– 55

FruitsFruits 4 4 –– 55

Low fat dairy foodsLow fat dairy foods 2 2 –– 33

Meat, fish, poultryMeat, fish, poultry 2 or less2 or less

Nut, seeds, dry beansNut, seeds, dry beans 4 4 –– 5 weekly5 weekly

� Yoga

� Massage

� Biofeedback

Music therapy� Music therapy

� Hypnosis

� diuretics, beta-blockers, or both

� uncomplicated hypertension and no specific

indications for another medication

� gradual reduction of types and doses of � gradual reduction of types and doses of

medication

� when BP less than 140/90 mm Hg for at least 1

year

� Diuretics

� Adrenergic Agents (alpha and beta blockers)

� Vasodilators

ACE Inhibitors� ACE Inhibitors

� ARBs

� CCB

� Thiazide Diuretics� chlorthalidone (Hygroton)

� quinethazone (Hydromox)

� chlorothiazide (Diuril)

hydrochlorothiazide (Esidrix; HydroDIURIL)

chlorothiazide (Diuril)

� hydrochlorothiazide (Esidrix; HydroDIURIL)� Loop Diuretics

� furosemide (Lasix)

� bumetanide (Bumex)� Potassium-Sparing Diuretics

� spironolactone (Aldactone)

� triamterene (Dyrenium)

What electrolyte are you going to

monitor when a client is in loop or monitor when a client is in loop or

thiazide diuretics?

� Beta-Blockers

� propranolol (Inderal)

� metoprolol (Lopressor)

� nadolol (Corgard)

Can you give Beta-Blockers to client with

hx of asthma? Why or why not?

� Alpha Blocker/ Alpha-adrenergic receptor

agonists

� prazosin hydrochloride (Minipress)

How do alpha blockers help lower

BP?

� Combined Alpha and Beta Blocker

� labetalol hydrochloride (Normodyne, Trandate)

� Peripheral Agents

� reserpine (Serpasil)

� Central Alpha Agonists

� methyldopa (Aldomet)

� clonidine hydrochloride (Catapres)

▪ transdermal patch

▪ Provide control of BP for as long as 7 days.

� s/e: sedation, postural hypotension, impotence

� Nitroglycerin (Nitro-Bid)

� hydralazine hydrochloride (Apresoline)

� sodium nitroprusside (Nipride, Nitropress)

fenoldopam mesylate� fenoldopam mesylate

� Minoxidil (Loniten)

� diazoxide (Hyperstat, NitroBid IV, Tridil)

� captopril (Capoten)

� enalapril (Vasotec)

� lisinopril (Prinivil, Zestril)

benazepril (Lotensin)� benazepril (Lotensin)

� enalaprilat (Vasotec IV)

� ramipril (Altace)

� trandolapril (Mavik)

• Instruct to stay in bed for 3 to 4 hours

� If receiving for first time

� to avoid the severe hypotensive effect (Postural

(orthostatic) hypotension) that can occur with (orthostatic) hypotension) that can occur with

initial use.

� Monitor BP q 15 min after first dose.

� Or angiotensin II receptor antagonists

� losartan (Cozaar)

� irbesartan (Avapro)

candesartan (Atacand)� candesartan (Atacand)

� valsartan (Diovan)

� telmisartan (Micardis)excellent options for clients who complain of cough

associated with ACE inhibitors and for those with

hyperkalemia

� Nondihydropyridines� diltiazem hydrochloride (Cardizem SR, Cardizem CD,

Dilacor XR, Tiazac)

� verapamil (Isoptin SR Calan SR, Verelan, Covera HS)� verapamil (Isoptin SR Calan SR, Verelan, Covera HS)

� Dihydropyridines� nifedipine (Procardia Adalat CC)

� amlodipine (Norvasc)

� felodipine (Plendil)

� nicardipine (Cardene)

� nisoldipine (Sular)

� Caution patient and caregivers antihypertensive

medications can cause hypotension.

� Low blood pressure or postural hypotension

should be reported immediately.should be reported immediately.

� change positions slowly when moving from a

lying or sitting position to a standing position.

� elderly : use supportive devices such as hand

rails and walkers when necessary to prevent falls

that could result from dizziness.

� Monitor BP� Obtain complete history

� to assess for symptoms that indicate target organ damage (whether other body systems have been damage (whether other body systems have been affected by the elevated blood pressure).

� Ex: anginal pain; shortness of breath; alterations in speech, vision, or balance; nosebleeds; headaches; dizziness; or nocturia.

� Pulse � rate, rhythm, and character of apical and peripheral

pulses

� Deficient knowledge regarding the relation

between the treatment regimen and control

of the disease process

Noncompliance with therapeutic regimen � Noncompliance with therapeutic regimen

related to side effects of prescribed therapy

� objective : lowering and controlling the blood pressure without adverse effects and without undue cost

� support and teach the patient to adhere to treatment regimen regimen � Implement necessary lifestyle changes

� Take medications as prescribed

� Schedule regular follow-up appointments� Teach disease process and how lifestyle changes and

meds can control hypertension. � emphasize concept of controlling hypertension rather

than curing it

1. Most common side effects of diuretics are potassium depletion and orthostatic hypotension.

2. The most common s/e of different antihypertensive drugs is orthostatic hypotensiondrugs is orthostatic hypotension

3. Take meds at regular basis

4. Assume sitting or lying position for few minutes

5. Change position gradually

6. Avoid very warm bath, prolonged sitting or standing

� Avoid smoking cigarettes or drinking caffeine

for 30 minutes before blood pressure is

measured.

Sit quietly for 5 minutes before the reading.� Sit quietly for 5 minutes before the reading.

� Sit comfortably with the forearm supported

at heart level on a firm surface, with both feet

on the ground; avoid talking during

measurement.

� Assessment is based on the average of at

least two readings. (If two readings differ by

more than 5 mm Hg, additional readings are

taken and an average reading is calculated taken and an average reading is calculated

from the results.)

� Note: patients should be given a written

record of his or her blood pressure at the

screening.

� Provide written information : expected effects and side effects of medications; report s/e

� rebound hypertension � rebound hypertension � sexual dysfunction

� some medications, such as beta-blockers, may cause sexual dysfunction and that, if a problem with sexual function or satisfaction occurs, other medications are available.

� Monitor BP at home.

� Gestational hypertension

� Chronic hypertension

� Preeclampsia-eclampsia

Preeclampsia superimposed on chronic � Preeclampsia superimposed on chronic

hypertension

� Early prenatal care

� Refraining from alcohol and tobacco use

� Salt restriction

Bed rest � Bed rest

� Carefully chosen antihypertensive

medications

� Blood pressure norms for children are based on age, height, and gender-specific percentiles

� Secondary hypertension is the most common form of high blood pressure in infants and children

� Kidney abnormalities � Kidney abnormalities

� Coarctation of the aorta

� Pheochromocytoma and adrenal cortical disorders

� In infants, associated most commonly with high umbilical catheterization and renal artery obstruction caused by thrombosis

http://www.cardeneiv.com/acute_hypertension.html

http://www.cardeneiv.com/acute_hypertension.html

� There are two hypertensive crises that

require nursing intervention:

� hypertensive emergency

� hypertensive urgency.

� Hypertensive emergencies and urgencies

may occur in patients whose hypertension

has been poorly controlled or in those who

have abruptly discontinued their

medications.

� is a situation in which blood pressure must be lowered immediately (not necessarily to less than

� 140/90 mm Hg) to halt or prevent damage to the target organs.

� Conditions associated � Conditions associated

� acute myocardial infarction

� dissecting aortic aneurysm

� intracranial hemorrhage� are acute, life threatening BP elevations that require

prompt treatment in an intensive care setting because of the serious target organ damage that may occur.

� admitted to critical care units� Intravenous vasodilators

� have an immediate action that is short lived minutes to 4 hours

� used as the initial treatment

� sodium nitroprusside (Nipride, Nitropress)� sodium nitroprusside (Nipride, Nitropress)

� nicardipine hydrochloride (Cardene)

� fenoldopam mesylate (Corlopam)

� enalaprilat (Vasotec I.V.)

� nitroglycerin (Nitro-Bid IV, Tridil)

� labetalol (Normodyne)

� diazoxide (Hyperstat IV)

• sublingual nifedipine (Procardia, Adalat)

� is a situation in which blood pressure must be

lowered within a few hours.

� Ex: severe perioperative hypertension

� oral doses of fast-acting agents � loop diuretics (bumetanide [Bumex], furosemide

[Lasix])

� beta-blockers propranolol (Inderal), metoprolol(Lopressor), nadolol (Corgard)(Lopressor), nadolol (Corgard)

� angiotensin-converting enzyme inhibitors (benazepril [Lotensin], captopril [Capoten], enalapril[Vasotec]),

� calcium antagonists (diltiazem [Cardizem], verapamil [Isoptin SR, Calan SR, Covera HS])

� alpha2-agonists, such as clonidine (Catapres) and guanfacine (Tenex)

� Extremely close hemodynamic monitoring of

the patient’s blood pressure and cardiovascular

status is required during treatment of

hypertensive emergencies and urgencies. hypertensive emergencies and urgencies.

� VS every 5 minutes or 15 or 30 minutes intervals

if stable.

� A precipitous drop in blood pressure can occur,

which would require immediate action to restore

blood pressure to an acceptable level.

� An abnormal decrease in blood pressure on

assumption of the upright position

� Decrease in venous return to the heart due to

pooling of blood in lower part of body

� Inadequate circulatory response to decreased

cardiac output and a decrease in blood cardiac output and a decrease in blood

pressure

� Conditions that decrease vascular volume

� Dehydration

� Conditions that impair muscle pump

function function

� Bed rest

� Spinal cord injury

� Conditions that interfere with

cardiovascular reflexes

� Medications

� Disorders of autonomic nervous system

� Effects of aging on baroreflex function

� Excessive use of diuretics

� Excessive diaphoresis

� Loss of gastrointestinal fluids through

vomiting and diarrheavomiting and diarrhea

� Loss of fluid volume associated with

prolonged bed rest

� Dizziness

� Visual changes

� Head and neck discomfort

Poor concentration while standing� Poor concentration while standing

� Palpitations

� Tremor, anxiety

� Presyncope, and in some cases syncope

Increased vascular compliance may contribute

to which condition?

a. Systolic hypertension

b. Orthostatic hypotensionb. Orthostatic hypotension

c. Orthostatic hypertension

d. Diastolic hypertension

� LWW ppt presentation. Chapter 23 Disorders

of Blood Pressure Regulation

� Brunner

Ignatavicius� Ignatavicius