Specific Nursing Care

 

High Blood Pressure

 

 

 

Introduction

 
Blood pressure (BP) is the measurement of how hard your blood is pushing against the inside of your blood vessels (arteries).  A certain amount of pressure is needed to carry the blood through your body. However, if that pressure is too great, you have high blood pressure (hypertension).
 
Around 1 in 5 Singaporeans aged 18 to 69 years have hypertension.  The trend increases with age.  In the 60 - 69 years age group, more than 1 in 2 persons have hypertension.
 
Hypertension is often called the “silent killer” as there may not be any symptoms even though the condition is severe.  Headaches or giddiness, which is also present in other diseases, are not specific symptoms of hypertension.
    

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The Risk Factors

 

Major risk factors that cannot be changed:

  • Family history

  • Males

  • Older people

The risk of developing hypertension is increased with:

  • High blood cholesterol levels

  • Obesity

  • Sedentary, lack of exercise

  • Smoking

  • Stress

  • High fat, salty diet

  • Birth control pills

  • Diabetes

  • Frequent wine and dine

These risk factors can be changed by adopting a healthy lifestyle.

 

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Classifications of Blood Pressure

 

The heart is the main organ that pumps blood round the body.  When it contracts, it is called systolic pressure.  When it relaxes, it is called diastolic pressure.  If your blood pressure (BP) is 120/80, the systolic BP is 120mmHg and the diastolic BP is 80mmHg (mmHg denotes millimetre of mercury).

 

        Normal Reading : 120/80
        Pre-hypertension : 120/80 - 139/89
        Stage 1 : 140/90 to 159/99
        Stage 2 : >160/100

 

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Factors Affecting Blood Pressure

 

Anxiety, excitement or fear

Tea, coffee, cola or smoking

Exercise

After a meal

A full urinary bladder

Hard and narrow blood vessels

Increased blood volume

Stress

 

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Medications for High Blood Pressure

 

A. Diuretics
 

Diuretics help get rid of water from your body

 
Example:  Hydrochlorthiazide

 
Side Effects:  Frequent passing of urine, tiredness, giddiness
 
B. Calcium Channel Blockers
 

These drugs cause your blood vessels to become wider so that blood flows through them more easily

 
Examples:  Nifedipine , Norvasc
 

Side Effects:  Headaches, flushing, leg swelling, constipation

C. Beta Blockers
 

This group of medicine causes your heart to beat a little more slowly and so lowers your blood pressure
 

Examples:  Propranolol, Atenolol
 

Side Effects:  Depression, giddiness, disturbed sleep

D. Angiotension Converting Enzyme (Ace)
 

This drug causes blood vessels to become wider so that blood flows through them more easily
 

Examples:  Captopril, Enalapril (Renitec)
 

Side Effects:  Cough, postural hypertension, eye swelling
 

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Homecare Tips

 

Medication is important in the management of high blood pressure.  Take them as directed by your doctor.

 

Eat healthy.  Follow a low fat, low salt, low sugar and high fibre diet.

 

Restrict sodium intake to less than 2g per day (1 teaspoonful of salt).

 

When reading food label, choose food that contain less than 0.1g of sodium per 100g.

 

Measure blood pressure (BP) at least once a day.

 

To obtain an accurate reading of BP:

 

- Use a validated, well maintained BP monitor

- Use appropriate cuff size

- Avoid tea, coffee, cola or smoking hour before checking BP

- After exercise : rest for at least 20 minutes

- Click here for tips in using an electronic BP monitor
 

Keep a record of the person’s BP readings and bring along this record every time you see your doctor. The following detail must be included:

 

- date and time of measurement

- systolic and diastolic pressures

- dose of any medicine

- any unusual event that could affect the BP e.g. a fall
 

Avoid drinking alcohol.  However, if the person drinks alcohol, moderate consumption to no more than two standard drinks per day (for woman) and three standard drinks per day (for man).  A standard drink is defined as 220 ml of beer, 100 ml of wine or 30 ml of spirits.

 

Discourage smoking if the person smokes.

 

Encourage regular exercises at least 30 minutes a day, 5 days a week. Increase physical activities help to burn more calories.

 

Advise on losing weight if the person is overweight or obese.  Seek professional advise for weight management.

 

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Complications of High Blood Pressure

 

High blood pressure makes the heart work harder and consequently damaging the blood vessels throughout the body.  Untreated high blood pressure gradually damages body organs.  Lowering blood pressure can reduce the following complications:

  • Stroke - lack of blood supply to the brain

  • Heart attack - lack of blood supply to the heart muscle

  • Heart failure - the heart muscle becomes too weak to pump blood to the whole body

  • Kidney failure – damage of blood vessels in the kidneys

  • Blindness - damage of optical nerves

 

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