The basis for hypertension is thought to be dysfunction of the neurohormonal system. Overactivation of both angiotensin and aldosterone result in an increase in blood pressure. Over time, this sustained increase results in a permanent remodeling and thickening of the blood vessels. As a result, there is increased peripheral resistance and a back-up of pressure to organs affected by the vascular system, such as the brain, heart, and kidneys. Disorders resulting from hypertension include thickening of the myocardium, enlargement of the ventricles, heart failure, myocardial infarction (MI), cerebrovascular accident (stroke), and kidney damage.
There are many risk factors for the development of hypertension. Significant risks are a family history of hypertension, race, aging, sleep apnea, and metabolic disorders such as type 2 diabetes mellitus, obesity, and high cholesterol. Lifestyle risk factors include a sedentary lifestyle; excessive alcohol consumption; high dietary intake of salt, fats, and calories; and use of oral contraceptives in women.
Remember Mrs. Renfrow, the wife of a man who is overweight and diagnosed with hypertension? The nurse would need to incorporate information about various risk factors for developing hypertension as well as information about risk related to hypertension in the teaching plan for Mrs. Renfrow.
Hypertension can be controlled by medications and lifestyle changes. Some of the categories of antihypertensive medications include diuretics (to decrease fluid volume), beta-adrenergic blockers (to block sympathetic stimulation and decrease cardiac output), vasodilators and calcium channel blockers (to relax smooth muscles of arterioles and decrease peripheral vascular resistance), and angiotensin-converting enzyme (ACE) inhibitors (to prevent vasoconstriction by angiotensin II and decrease circulatory fluid volume by reducing aldosterone production). Lifestyle changes include following a low-calorie, low-fat diet; losing excess weight and maintaining weight loss; limiting alcohol intake; managing and coping with stress; reducing salt intake; and engaging in regular physical activity. Nurses can influence the health of the public through screenings, education, and referrals. See Promoting Health Literacy in Patients With Hypertension for more information.
Promoting Health Literacy
IN PATIENTS WITH HYPERTENSION
Patient Scenario
Harry Miller, 66 years old, went to his primary health care provider for his annual health assessment. He had gained 15 lb in the past year. When the office nurse took his blood pressure, it was 166/92 mm Hg. The nurse took Mr. Miller’s blood pressure again and then repeated it later after his health assessment was completed. Although the reading varied by a few points, it remained consistently high. Mr. Miller was obviously surprised at having hypertension, because he said, “It has never been this high before. There must be something wrong with your machine.” His health care provider tried to discuss the need for changes in his lifestyle as well as the need to take the medication prescribed for his blood pressure, but Mr. Miller said he had no questions and rushed out of the examining room.
Nursing Considerations: Tips for Improving Health Literacy
Provide Mr. Miller with printed literature about high blood pressure, including causes and risks. Explain that it is important to control his high blood pressure to prevent serious risks, such as heart attack and stroke. Urge Mr. Miller and his wife to talk to a dietitian about a nutritious diet that would help him lose weight; contains recommended servings of fiber, fruits, and vegetables; and contains less salt. Explain the action of the prescribed medication and the importance of taking the medication to reduce and control his blood pressure. Encourage Mr. Miller to make an appointment to return to the office on a regular basis and to be prepared to ask his provider the following three questions:
• What is my main problem?
• What do I need to do?
• Why is it important for me to do this?
What additional measures can you take to help maintain health literacy in this patient and his wife? What other measures would be helpful for Mr. Miller if he did not speak English, could not read, or had other learning deficits?
