Hypertension was previously defined as blood pressure greater than 140/90 mm Hg by the 1992 Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure and was classified in stages, according the the degree of severity. In 2003, new guidelines were issued by the National Heart, Lung, and Blood Institute (NHLBI) that include a lower “normal blood pressure,” a “prehypertension” level, and a merging of staging categories.
Normal blood pressure is now defined as measurements less than 120/80 mm Hg and prehypertension as 120–139/80–89 mm Hg. Hypertension is defined as pressure greater than 140/90 mm Hg; and is classified according to the degree of severity. Stage I (mild) is 140/90–159/99. Stage II (moderate) is 160/100 or greater. Stage III (severe) is present when systolic pressure is greater than 180 and diastolic pressure is greater than 110. Stage IV (very severe) occurs when systolic pressure is 210 or greater with diastolic pressure greater than 120. Stages II and III hypertension have essentially been combined in the new guidelines, as their treatment is the same.
Hypertension is also categorized according to etiology: as primary/essential (approximately 95% of all cases), when it has no identifiable cause; or secondary, which occurs as a result of an identifiable, sometimes correctable, pathologic condition (e.g., kidney disorders, use of medications, drugs or other chemicals, adrenal gland tumors, or primary aldosteronism).
Hypertension increases with age and is one of the major risk factors in the development of cardiovascular disease. Current research has demonstrated that the systolic blood pressure is a more important determinant of cardiovascular risk in people over 50 years of age; however, in clients under 50 years old, the diastolic blood pressure is the major predictor.
Blood pressure in the “prehypertension” range responds well to lifestyle changes (e.g., weight management and exercise), and is not usually treated with medications unless other risk factors are present, such as diabetes or heart disease. However, recent studies indicate that persons with prehypertension are at high risk for developing hypertension and death from heart diease and stroke.
The goal of treatment is to prevent the long-term sequelae of the disease (i.e., target organ disease [TOD]). Although the elderly are most prone to this disorder and its sequelae, it is a growing health problem across many cultures, and is demonstrated in youger people in multiple populations.
CARE SETTING
Although hypertension is usually treated in a community setting, management of stages III and IV with symptoms of complications/ compromise may require inpatient care, especially when TOD is present. The majority of interventions included here can be used in either setting.
Although hypertension is usually treated in a community setting, management of stages III and IV with symptoms of complications/ compromise may require inpatient care, especially when TOD is present. The majority of interventions included here can be used in either setting.
RELATED CONCERNS
Cerebrovascular accident/stroke, Myocardial infarction, Psychosocial aspects of care, Renal failure: acute, Renal failure: chronic
Cerebrovascular accident/stroke, Myocardial infarction, Psychosocial aspects of care, Renal failure: acute, Renal failure: chronic
