...Hypertension Blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure. Hypertension is the consistent elevation of systemic arterial blood pressure. It is also the most common primary diagnosis in the United States (Brashers, 2010). It is one of the most common worldwide diseases afflicting humans. Because of the associated morbidity and mortality and the cost to society, hypertension is an important public health challenge. Over the past several decades, extensive research, widespread patient education, and a concerted effort on the part of health care professionals have led to decreased mortality and morbidity rates from the multiple organ damage arising from years of untreated hypertension. I. Prevalence of disease (in US) and risk factors Hypertension is a major U.S. health problem affecting some 50 million individuals. Approximately 65% of Americans older than age 60 have hypertension. Of those diagnosed with hypertension, over 30% do not have their hypertension adequately treated and controlled. Ninety to ninety-five percent of hypertension is idiopathic and called primary hypertension. Five to ten percent of hypertension is the result of an identifiable etiologic cause and is called secondary hypertension. According to Center of Disease Control (CDC) the prevalence of hypertension, 45.3% had been treated...
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...It competitively binds to angiotensin converting enzyme (ACE) to prevent the cleaving of angiotensin II from angiotensin I, directly inhibiting the actions of angiotensin II, a potent vasoconstrictor, thus exerting its haemodynamic effects. It also results in the accumulation of bradykinin a potent vasodilator, which is usually broken down by ACE, resulting in cough as a side effect for some patients. Figure 1. Pharmacological action of ramipril Introduction Angiotensin converting enzyme (ACE) inhibitors are used for the treatment of cardiovascular disease in people with diabetes. Ramipril is a second-generation ACE inhibitor, and is prescribed in patients with diabetes for several clinical indications including the management of hypertension, following myocardial infarction (MI), in chronic heart failure, in diabetic nephropathy and in patients with increased cardiovascular risk, where it has been shown to reduce the risk of death and cardiovascular events. Pharmacology Figure 1 outlines the pharmacological action of ramipril, a monoethyl ester prodrug. Following oral ingestion and...
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...------------------------------------------------- Hypertensive emergency From Wikipedia, the free encyclopedia A hypertensive emergency is severe hypertension (high blood pressure) with acute impairment of an organ system (especially the central nervous system, cardiovascular system and/or the renal system) and the possibility of irreversible organ-damage. In case of a hypertensive emergency, the blood pressure should be substantially lowered over minutes to hours with an antihypertensive agent. Contents [hide] * 1 Treatment * 2 Incidence * 3 Definition * 3.1 Hypertensive emergency as a generic term * 4 Pathophysiology * 5 Mortality * 6 Clinical history * 7 References * 8 See also | ------------------------------------------------- [edit]Treatment Several classes of antihypertensive agents are recommended and the choice for the antihypertensive agent depends on the cause for the hypertensive crisis, the severity of elevated blood pressure and the patient's usual blood pressure before the hypertensive crisis. In most cases, the administration of an intravenous sodium nitroprusside injection which has an almost immediate antihypertensiveeffect is suitable but in many cases not readily available. In less urgent cases, oral agents like captopril, clonidine, labetalol, prazosin, which all have a delayed onset of action by several minutes compared to sodium nitroprusside, can also be used. It is also important that the blood pressure is lowered not too...
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...Hypertension and the Renin-Angiotensin-Aldosterone System Renin-Angiotensin-Aldosterone System The renin-angiotensin-aldosterone system, otherwise known as RAAS is a complex hormone system that regulates blood pressure and fluid balance in the human body. When blood volume is low, juxtaglomerular cells in the kidneys activate prorenin, which secretes renin directly into the blood stream circulation. Subsequently, a drop in blood volume additionally releases angiotensinogen from liver, in which renin converts into angiotensin I. Angiotensin I is then converted to angiotensin II through the enzyme angiotensin converting enzyme (ACE) found in the lung. Angiotensin II is a potent biological compound that causes blood vessels to constrict, resulting in an increase in blood pressure. Additionally, angiotensin II also stimulates the secretion of the hormone aldosterone from the adrenal cortex. Furthermore, thirst or antidiuretic hormone can effectively stimulates the pituitary gland, which could release corticotropin-releasing hormone stimulating the adrenal cortex and thereby releasing aldosterone. Aldosterone contributes to the RAAS system by causing the tubules of the kidneys to increase the reabsorption of sodium and water back into the blood stream. Thus, an increase in the reabsorption of water, increases the volume of fluid in the body, which increases the blood pressure. Once the blood volume and blood pressure stabilizes, these collective effects triggers a negative feedback...
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...mild kidney damage to end-stage renal disease (ESRD). Chronic renal disease is interchangeably used for CKD but to be unifom in usage, we will use the term Chronic Kidney Disease or CKD. In the U.S., there are 20 million adults who have chronic disease and over 400,000 persons have ESRD and require dialytic or transplantation therapy. In the Philippines, annually we have about 6,ooo patients started on dialysis most of which are caused by diabetis mellitus. Complications of this condition have also made this the 9th cause of death in our country. This is how important this disease entity has become over the last decade. Each of us has 2 kidneys, one on each side of our flanks. Chronic kidney disease is a permanent damage to both kidneys that persists for at least 3 months. If the kidney damage is temporary and has occurred less than 3 months, this is referred to as acute kidney or renal failure. Acuteness does not refer to the severity of the condition, but to a recent and temporary event, therefore, almost always reversible. Chronicity implies long-term event that is permanent and irreversible. This is probably why most patients fear to hear that they have kidney disease and would need dialysis. CKD has five (5) stages based on the kidney function as estimated by the glomerular filtration rate (GFR).The best overall measure of kidney function is the GFR and the preferred method for its estimation is the GFR by the Modification of Diet in Renal Disease (MDRD) calculation. ...
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...Central University of Technology, Bloemfontein Early detection and prevention of Chronic Kidney Disease Contents page Definition of key terms used in the assignment Abbreviations used in the assignment Introduction Chronic Kidney Disease, a condition characterised by a gradual loss of kidney function. CKD is often misdiagnosed owing to the lack of knowledge about the disease. With early detection and prevention of the progression of the disease CKD patients can still enjoy life to the fullest while they manage their disease, however if the healthcare professionals fail to identify the disease on time the patient can suffer dire consequences. Besides the financial implications associated with the disease, there are the emotional implications together with physical and psychological. This assignment seeks to explore such implications in an effort to highlight the importance of early detection and prevention of kidney disease, with the best interest of the patient at heart Background Normal kidney anatomy http://doctorstock.photoshelter.com/image/I000096SqkYwaLhE The bean-shaped kidneys lie in retroperitoneal position in the superior lumbar region. Extending approximately from T12 to L3, the kidneys receive some form of protection from the lower part of the rib cage (E.N. Marieb, K Hoehn, 2010) The kidneys functions can be divided into two, non-excretory functions and excretory functions. Under excretory we have Glomerular filtration, Tubule...
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... it is characterized by new onset hypertension (systolic blood pressure >140 mm Hg or diastolic blood pressure >90 mm Hg) and proteinuria (excretion of >300 mg daily) usually after 20 weeks of gestation with no history of hypertension (Wagner 2004, 3 Centre collaboration, & Stevenson & Billington 2007). Symptoms can include hypertension, proteinuria, headache, visual disturbance, epigastric pain, hyperemesis, oedema of hands and feet (Briley 2003, NICE 2008). Pre-eclampsia can affect the pregnant woman through pregnancy birth and postpartum. However the focus of this essay will discuss the possible impact on maternal and fetal health and wellbeing as well as the management of the woman and her condition during the intrapartum phase. The role of the midwife in provision of care in this case will also be explored. The woman in this case was a primigravida at 37+6 weeks gestation. On assessment at antenatal clinic it was found that her blood pressure [BP] had acutely risen to 190/110 and she had significant proteinuria, she was admitted to the labour ward for management. During labour her blood pressure fluctuated from 145/90 to 190/110, she had a severe headache, visual disturbance and was very anxious. This is classed as severe pre-eclampsia which is defined by blood pressure readings higher than 160/110 mm Hg and more than 5 g of protein in a 24-hour urine collection. Features of severe preeclampsia include hypertensive crisis, acute renal failure, cerebral and visual disturbances...
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...Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately (James et al., 2014). To prevent cardiovascular damage, it is recommended that persons aged 60 years or older to maintain BP goal of less than 150/90 mm Hg, if not, initiate antihypertensive regimen. Hypertension in African American is a major clinical and public health problem because of the high prevalence and premature onset of elevated blood pressure (BP) in this population (Flack, Nasser, & Levy, 2011). In this case study, Mr. CF who had been hypertensive and diabetic for the last twelve years, presented with a blood pressure reading of 162/90 despite being...
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...also a small amount of potassium in the extracellular fluid where its function is to maintain fluid balance, maintain acid-base balance, transmit nerve impulses, catalyze metabolic reactions, aid in carbohydrate metabolism and protein synthesis, and control skeletal muscle contractility. When potassium is not excreted properly, such as diabetes, chronic renal insufficiency, end-stage renal disease, severe heart failure and adrenal insufficiency, high potassium levels can then lead to hyperkalemia and other life-threatening cardiac arrhythmias. Hypertension, also known as high blood pressure, is a condition in which the arteries have persistently elevated blood pressure. It can lead to damaged organs, as well as several illnesses such as renal failure, an aneurysm, heart failure, stroke or heart attack. One of the numerous causes of hypertension includes insufficient calcium (or Vitamin D), potassium and magnesium consumption. There are two types of hypertension, primary and secondary. Primary hypertension is of an unknown cause, which could be a result of a combination of poor lifestyle choices and genetics. Secondary hypertension is the result of another disease, most often...
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...The Management of Hypertension Allison A. Torbert, Pharm.D. Roberta M. Skoronski, Pharm.D. Clinical Instructors UW School of Pharmacy Objectives • Explain the classification and goals of therapy in the treatment of hypertension based on JNC VI recommendations • Describe nonpharmacologic and pharmacologic treatment approaches • Recognize patients with hypertension and comorbid conditions in order to optimize therapy • Develop an approach to manage hypertensive patients Prevalence • Approximately 50-60 million Americans have HTN defined as: systolic BP (SBP) 140 mm Hg or > diastolic BP (DBP) 90 mm Hg or > • • • • Incidence increases with age Blacks > whites Men > women Greater in less educated, lower socioeconomic groups hard disk\course\728-721\htn.ppt 1 Classification of Blood Pressure for Adults Age 18 & Older* Category Optimal+ Normal High-normal Hypertension++ Stage 1 Stage 2 Stage 3 Systolic (mm Hg) < 120 < 130 130-139 140-159 160-179 > 180 & & & & & & Diastolic (mm Hg) < 80 < 85 85-89 90-99 100-109 > 110 *Not taking antiHTN drugs & not acutely ill. When SBP & DBP fall into different categories, highest classification should be used. Isolated systolic HTN defined as SBP > 140 and DBP < 90 and staged appropriately. In addition to classifying accordingly, clinicians should specify presence or absence of target organ disease & additional risk factors + Optimal BP with respect to CV risk is < 120/80; unusually low BP’s should be evaluated...
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...California Maternal Quality Care Collaborative calls preeclampsia hypertension in pregnant women and eclampsia hypertension with seizures in pregnant women. The criteria for preeclampsia are the following: blood pressure greater than or equal to 140/90 on two occasions at least four hours apart after 20 weeks gestation in a woman with previously normal blood pressure, proteinuria greater than or equal to 300mg per 24-hour urine collection, protein/creatinine ratio greater than or equal to 0.3, thrombocytopenia with a platelet count less than 100,000 microliters, renal insufficiency, impaired liver function, pulmonary edema, and cerebral or visual symptoms. California Maternal Quality Care Collaborative (CMQCC) discussed the acronym HELLP,...
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...Care Plan Elements of Hypertension Susan Salby American Sentinel University Care Plan Elements of Hypertension Worldwide, hypertension is the most common contributor to death of any medical risk factor. HTN contributes to the development of heart disease, heart failure, chronic renal failure requiring dialysis, stroke, peripheral vascular disease and cognitive decline. The risk of cardiovascular events doubles for every 20/10mmHg rise in blood pressure above 115/70mmHg. Untreated HTN causes progressive renal and vascular damage, eventually leading to a treatment resistant state. Hypertension is usually diagnosed and treated in the community. As this is largely an asymptomatic disease, particularly in its initial stages, compliance with treatment regimens can be problematic. Successful treatment of HTN relies on the patient establishing an ongoing therapeutic relationship with a trusted and knowledgeable health professional (Casey, 2011). Tools to manage care, such as clinical pathways, practice guidelines, and best practices have increased as the health care insurance industry has put more pressure on health care providers to improve care and provide more cost-effective care. These tools offer health care providers the opportunity to determine the best approaches to clinical problems based on current research and expertise (Finkleman, 2011). Best Practices Best practices are those treatments, procedures, tests, therapies and interventions that have consistently...
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...Our Patient’s Case Study Revelelations Our patient is a 62 year old female with cellulitis of her right lower leg. This patient has a history of smoking three packs a day for 40 years and unfortunately has admitted to smoking again. She has high blood sugar; however, she cannot remember the name of the medication she is taking for it. She has a “touch” of high blood pressure and claims she controls her hypertension by eating a low salt diet. Her husband passed away 14 years ago and she states that she misses him very much. As the weeks continue, our patient is experiencing dyspnea upon rising in the morning. She has bilateral diminished lung sounds along with crackles. Our patient’s condition continues to worsen and she is diagnosed with congestive heart failure. She is complaining of pain in her extremities and abdomen. Her lab work shows azotemia, red blood cells and protein in her urine, and elevated blood glucose level. The fluid buildup continues in her lungs and her urine output is minimal. Heart failure and fluid volume excess seems evident, as well as, her renal system appears to be impaired. Underlying Disease This patient’s underlying disease is diabetes mellulitis; she has uncontrolled high blood sugar that she has been neglecting to take care of. According to Porth (2007), “Diabetes is a disorder of carbohydrate, protein, and fat metabolism resulting from an imbalance between insulin availability and insulin need”. She states that she “does not remember”...
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...ACUTE RENAL FAILURE Overview Acute renal failure is the most common disease in the acute care setting. It is estimated that acute renal failure occurs in up to 25% of all patients admitted to the hospital with a critical illness (Broden, 2009). It is even noted that patients who are admitted to the intensive care unit with no prior renal insufficiencies seem to have worse outcomes than do patients who have preexisting acute renal failure (Broden, 2009). Acute renal failure is a rapid decrease in kidney function, leading to collection of metabolic waste in the body. The pathophysiology of acute renal failure is reduced blood flow to the kidneys, toxins, infections and obstruction (Broden, 2009). There are three types of acute renal failure. They are pre-renal azotemia. This is caused by poor blood flow to the kidneys. The most common causes of this are hypovolemic shock and heart failure. The second type is intra-renal acute renal failure. This is caused by infections, drugs, tumors, glomerulonephritis, and obstruction. The third type is post-renal azotemia. It is caused by an obstruction outside of the kidneys (Dirkes, 2011). Assessment Data Ongoing comprehensive assessments are critical for the acute renal failure patient. The nurse must be attentive to the signs and symptoms of renal disease as well as complications with other organs and systems. The primary effect of acute renal failure is a decrease in urinary output that leads to fluid retention and edema. Oliguria...
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...Pathophysiology for G,L ESRD: renal failure is progressive, from acute to chronic, then end stage. In ESRD, the kidneys fail to function. Once in chronic renal failure, damage to kidneys is progressive and irreversible. The nephrons are damaged, can't function and don't recover. Surviving nephrons then hypertrophy and increase their rate of filtration, reabsorption, and secretion. Compensatory excretion continues as GFR decreases. This leads to retention of water, waste products, oliguria, and even hypertension because the kidneys cannot excrete. Also due to ESRD, BUN, creatinine, are high, GFR decreases, resulting anemia, metabolic acidosis. Hypertension: progressive damage to major organs like the kidneys, brain or heart, lead to hypertension. The kidneys, through the renin-angiotensin system help control blood pressure, by releasing angiotensin II a vasoconstrictor, and aldosterone, which leads to sodium and water retention. Impairment in this system affects blood pressure. Also changes in blood vessels cause hypertension, if their force of contractility is increased due to blockage or structural changes. Diabetes mellitus: it is known as type 2 diabetes mellitus, and is as a result of relative insulin deficiency. The pancreas produces either normal or excessive amounts of insulin but the body s unable to use it effectively, so glucose levels remain elevated, thus know as insulin resistance. Also, failure of the pancreas to produce enough insulin to overcome this insulin...
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