Tell me if you've ever had an experience like this. You can share in the comments
below it's okay. You go to the pharmacy or at your physician's office and you
have your blood pressure taken, now we know in the pharmacy you've got those
non-manual ones where you put your arm in and it cuffs up and it gets really
really strong and tight feels like your arms about to fall off and at the
doctor's office they do the automatic blood pressure cuff as well they wrap
you up and we let it just run and it always seems to go too high and then you
get your reading back and you're like oh my god what just happened? Why is my
blood pressure so high and should I be worried? I mean I feel fine, there's
nothing wrong with me. So we're going to dive into high blood pressure today also
known as hypertension right after this,
Welcome back my name is Tammy and this is NurseMinder and on this channel we
do everything nursing so if you're new here consider subscribing below so that
you get the next video when it's released. In today's video we're going to
talk about a few different things. First of all we're going to define what high
blood pressure. We are going to look at the differences between Canada the States
and the European countries because if you're a nurse watching this video
you're gonna want to know these things and we're also going to look at some
of the signs and symptoms, the risk factors, and then the four steps to
managing hypertension. So we've got a lot to cover
now stick to write to stick through to the end because I also have an analogy
to help you explain blood pressure to your patients and an NCLEX question.
Now before we can talk about what a hypertensive reading is let's take a
quick step back and look at the normal values. So systolic is the value that we
use to describe the most pressure in your vessel so that's what the heart
contracts and diastolic is the term we use to describe the pressure in your
vessel when it is at rest. So 120 over 80 or less would be considered healthy and
normal, no concern, with one caveat obviously you can get to low and that's
hypotension completely different topic.
So generally speaking a normal blood pressure is less than 120 over 80
and not so low that it's causing you symptoms which would then be classified
as hypotension. I've often seen people sitting in the 90s to 120 as normal and
then the diastolic can be less than 80.
In Canada, and it's important that I talk about Canada versus the states and the
European countries, because there are some differences in Canada when you have
a reading that is over or actually greater than or equal to 135 over 80 and
we have multiple readings that average out to being more than 135 over 80, so
you can have two or three readings done at the same time or over subsequent
visits then we would classify this as hypertension. Now again there's a caveat
because if you do have some health history such as diabetes we're going to
back that down to 130 over 80 anything greater equal to 130 over 80 would be
diagnostic of hypertension. Now of course it can't just be this easy can it? No
because there are some different things we need to consider if you're using an
automated office based visit so you're doing the cuff at the doctor's office or
you're doing the cuff at the pharmacy we know that research shows us the blood
pressure cuff in places like pharmacies and public places tends to read higher.
So what is more important is that you're getting an average and you're
documenting all of those different readings and then when you bring that
information into your doctor's office they can do their own assessment. Now if
we're doing a manual cuff pressure so this is what we're actually pumping it
up and we're listening with our ears, those values will shift a little bit
higher depending on where you live but in general these are the numbers that
you'll need to know, 120 over 80 the range was up to 135 if you're in Canada
130 if you have diabetes and you'll see here in a second I'm going to
show you the differences with the other countries at 130 over 80 is the standard
for a few other places that we need to be watching for. Now let's go to the
hypertension.ca website this is our Canadian guidelines and I want to show
the algorithm here. If you've done a blood pressure at home, in the pharmacy
or maybe you've had a blood pressure clinic at work and your reading is
greater than 130 over 80 we will want you to come in for a dedicated office visit. Now
when you come in if your blood pressure is greater than or equal to 180 systolic
over 110 diastolic that is a diagnosis of hypertension. If your reading is less
than that and you do not have a pre-existing condition of diabetes and
we are using an automated office blood pressure cuff we'll be looking for
readings to be less than 135 over 85. If you happen to have a reading that is
greater than 135 over 85 on this visit we will then look at implementing some
out of office measurements such as you will be completing tracking of your
blood pressure at home. If you're at home readings continue to be elevated over
135 over 85 we would consider that to be hypertension. If they resume to levels
below that we would consider this to be a white coat hypertension. Now if you're
using a non automated cuff so this is the manual cuff and your readings are
greater than 140 over 90, we do give a little bit of a leeway there, then we're
going to continue on with the same out-of-office measurements. If with either
method your blood pressure remains less than that when you come in there's no
diagnosis of hypertension. Now here's the caveat we want to talk about is diabetes.
We like to have your blood pressure less than 130 over 80 regardless of which
method we are using. If when you come into the office your blood pressure is
elevated over 130 over 80 that would be a diagnosis of hypertension. Now let's
take a look at the American and European guidelines. This is coming from the
Journal of the American College of Cardiology this is from 2019 and I want
to highlight this table here. We'll see here that the office / Clinic
blood pressure in the American College of Cardiology they're looking for values
of greater than or equal to 130 over 80. The European Society has a little bit
more of a range there and they're looking for greater than 140 over 90.
Let's take a look next at staging blood pressure. Starting with normal blood
pressure we're looking for values of less than 120 over 80. Pre hypertension
or elevated blood pressure is 120 to 129 over less than 80. Stage 1 is 130 to 139
systolic over 80 to 89 diastolic and stage 2 hypertension is greater than or
equal to 140 over 90. There's two different names we use to describe
hypertension. So we have our staging then we also have a name to describe the
cause. So what can cause high blood pressure? T he first term you may hear is
that you have essential hypertension and essentially what that means is we don't
know what's causing it. It's of an unknown origin and you'll often have
this diagnosed after they've done some testing; 90% of high blood pressure is
considered essential according to the research.The second type is called
secondary which means you've already had a pre-existing condition illness disease
process that is resulting in high blood pressure. Now the third type of high
blood pressure you may have is known as white coat hypertension that essentially
means that when you come into the physician's office and you see the
doctor and you're sitting there waiting just the presence of the medical team
the white coat we call it will cause you to become tense and your blood pressure
will elevate.
Hypertension is known as the silent killer and that's because when we're
looking at signs and symptoms to help us define and diagnose an illness, high
blood pressure often comes without any signs or symptoms. So it's really
important then that we talk about the risk factors so that you know if you
need to be monitored more closely for the potential of high blood pressure. So
when we look at some of those risk factors that you may want to be aware of to
determine if you're at higher risk for hypertension, we have a soon as
non-modifiable those things we cannot control and then modifiable. We're going
to first talk about those that we cannot control, so our non-modifiable risk
factors include our age, look as much as we want to be younger, physiologically
biologically it's just not going to happen so your age is a factor, family
history and ethnicity. Now in terms of those things that we have some control
over that we can influence the trajectory of our cardiovascular health
the list is a little longer so diet so if we are eating unhealthy foods higher risk
change those over to healthy foods lower the risk, exercise, stress, weight, we're
looking at smoking and alcohol use, we are looking at our sleep patterns, other
things such as kidney disease where we have had an opportunity to prevent the
onset, those are known as modifiable risk factors and will definitely impact the
longevity and the health of your cardiovascular system, Next I want to
talk about what happens when you have hypertension what are the risks to you.
One of the things that happens when our pressure is high, I mean this is like
pushing a ton of fluid in a small straw kind of thing, is that the vessels become
damaged. They get so stretched and so worn that they get thin and the wall
starts to become, there are tears in the wall, so those tears set of a
response in the body to repair it and what ends up happening is we can end up
having plaque and development which in is what's known as atherosclerosis, so as
a result of having high blood pressure we now
build up inside the arteries. This will decrease the ability of those vessel
walls to stretch and recoil so we lose some of that flexibility which will
increase the peripheral vascular resistance. Now when you have to push
harder to get the fluid through the same hole what happens is in the heart size
has to increase because now the heart is working harder so we get hypertrophy
which is now leading into further cardiovascular concern. We now have
increased oxygen demand, our heart is getting larger it's working harder, we're
gonna get tired faster, and we potentially can rupture or remove - the
pressure might lift off that plaque and it gets dislodged - and it can settle in
the smaller vessels in the brain so a stroke, in the heart a cardiac arrest, and
we can also end up having damage to the smaller vessels as well. You may also
know somebody who has high blood pressure and they complain of vision troubles
that's because it's not just the bigger arteries that we're worried about it's
just smaller arteries that we also have to be worried about. They can get damaged
easily as well, the eyes, the kidneys, the brain all really important pieces of our
body that are at high risk of insult and injury if we're not taking care of our
blood pressure. So now you may be wondering okay so I've had high blood
pressure for a while and so was my neighbor but he seems to be fine with
diet and I have to take two different pills why is that? Well there are
there are four different stages to treating high blood pressure and we
often will start with lifestyle changes. Remember those modifiable things? Diet,
exercise, stres,s sleep. We'll look to see if we can correct those because the goal
of therapy is to restore our blood pressure down to baseline and normal
levels. If we can do that without adding on medications, we're gonna start with
that. So in treating high blood pressure there's four steps we call them and we
always want to start lowest and build our way up. Now in previous videos we've
talked about many different factors that affect our blood pressure which means
there's a lot of potential in treating it. We always start with lifestyle
changes. We want to see if we can modify and reduce your blood pressure back down
to normal levels without the need for additional medications. One of the
primary reasons that is are targeted treatment of choice is we know a lot of
patients struggle with the side effects of taking an antihypertensive drug
because previous to taking the medication they had no symptoms. Remember
this is the silent killer. Many people have zero symptoms and now
all of a sudden when they take a medication they're having side effects
and that makes compliance a little harder. So lifestyle is number one. If we
can't get any changes with, if we can't get sufficient changes with lifestyle
modifications we are going to add a drug. Notice I said add. We're not going to
abandon lifestyle changes, we're going to ramp up our approach so we're adding a
drug. This may be a diuretic so potentially you've heard of something
like lasix and there's other drugs that can be used drug classifications that
can be selected here. If after this period of time the lifestyle changes
plus the drug are not getting the results we want we have two options for
stage 3. We can either change our initial drug choice to another classification
and see how that works or we keep this drug and we add a second. Remember this
is an additive step process. Now I have lifestyle plus one drug plus a second
drug. Different classifications because they work differently and then as you
guessed at if stage 3 we're not getting success we're going to add another drug
in stage 4. So potentially you will have many patients with hypertension all
being treated across that spectrum with different different strategies one
patient may be salt restrictions with a diuretic another patient may be they
don't really focus on diet because that never worked with them but we're looking
at stress reduction we have a diuretic and we have an ACE inhibitor because we
need to attack that blood pressure process at many different points to
achieve our ultimate goal of lowering blood pressure to a safe level.
So now it's time for an analogy. How do I help my patient understand just what
hypertension is, especially when we can't see it and we can't feel it. Well I've
got a visual and a tactile example for you there's actually two, the first one
is the water in the tap. If you turn the water on gently they can see that
there's a regular stream of flow coming through the tap. If you turn it all the
way on and the volume and the noise increases that would represent the blood
pressure increasing in your stream. The second analogy is to use the example of
an air mattress and when you pump it up it gets harder and harder and harder but
there's a moment where it's comfortable and then it's uncomfortable. So when
you're pumping up your air mattress and you've reached that perfect place that's
where you want your blood pressure to be. If you put just a little bit more air in
it's a little firm but it's manageable that would be stage 1 hypertension and
if you pump it up too high it's really firm that kind of represents the vessels
not having any stretch and recoil left in them so our vessels are really wide
and they're at risk of getting damaged that would be stage 2. Now it's time for
your NCLEX question. Okay so you've completed the blood pressure screening
for an adult patient today and these are the results. How do you interpret this
information? Go ahead and pause and come back when you're ready. Okay so you're
back. If you identified pre hypertension you
would be correct. Okay let's try one more. Your patient is
at the office for follow-up. On his last visit a diuretic was added to his
treatment plan for hypertension. Today his blood pressure is 148 over 92 what
do you anticipate will be the next step in his treatment plan? You will select
all that apply. Will it be a) add lifestyle changes such
as diet and exercise B) increase the dose of his diuretic C) consider a change in
the drug therapy so stop the diuretic and start an ACE inhibitor or D)
add another drug to his treatment plan. Go ahead and pause here and come back
when you're ready. Okay so did you answer add lifestyle changes such as diet and
exercise? If you did that's one of the most commonly picked answers but it's
not correct because remember this is an additive process and the lifestyle
changes would have been put in in step one. So we're currently entering into
step three so we will either increase the dose, change the drug, or add another
drug to his treatment plan. Thanks for watching we're gonna be
talking about the different medications to help treat hypertension in subsequent
videos so be sure to subscribe and hit the bell so you get notified when those
videos are released. In the comment section below
share your own journey and the things that are working for you and are not
working for you I think when we do sure that people can see that 1) they're not
alone 2) it's not always easy and 3) that there's multiple ways to help
patients navigate their blood pressure. Thanks for watching and until next time
make it a great day :)