cardiacbeginner10 min read

Hypertension

On this page

Interactive Diagrams

Blood Pressure Classification

Understand BP ranges and when treatment is needed.

At a Glance

High blood pressure damages blood vessels over time. Most people feel completely fine, which makes it dangerous — they skip medications because they feel normal. Lifestyle changes plus medication adherence are the foundation of management.

Must-Know NCLEX Points

Normal BP: < 120/80 mmHg
Elevated: 120-129 systolic AND < 80 diastolic
Stage 1 HTN: 130-139 systolic OR 80-89 diastolic
Stage 2 HTN: ≥ 140 systolic OR ≥ 90 diastolic
Hypertensive crisis: > 180/120 — requires immediate evaluation
Primary (essential) HTN: no identifiable cause (90-95% of cases)
Modifiable risk factors: obesity, high sodium intake, smoking, sedentary lifestyle, excessive alcohol, stress
"Silent killer" — typically asymptomatic until organ damage has occurred
Target organ damage affects: heart, brain, kidneys, eyes, blood vessels

Signs and Symptoms

Usually ASYMPTOMATIC — this is what makes it dangerous
Headache (especially occipital, often in the morning)
Dizziness or lightheadedness
Visual changes (blurred vision)
Epistaxis (nosebleeds) — not always related but commonly associated
Flushed face
Fatigue
In hypertensive crisis: severe headache, chest pain, vision changes, confusion, nausea/vomiting

Nursing Interventions

Teach DASH diet (rich in fruits, vegetables, low-fat dairy; low in sodium)
Sodium restriction: < 2,300 mg/day (ideally < 1,500 mg/day for most adults)
Encourage regular aerobic exercise (at least 150 min/week of moderate activity)
Weight management — even 5-10 lbs of weight loss can lower BP
Smoking cessation
Limit alcohol: ≤ 2 drinks/day for men, ≤ 1 drink/day for women
Stress management techniques (deep breathing, meditation)
Medication adherence education — the #1 priority teaching point
Teach proper home BP measurement technique (correct cuff size, sit quietly 5 min first)
Monitor for target organ damage (eyes, kidneys, heart)

Medication Focus

ACE Inhibitors (-pril: lisinopril, enalapril): Watch for dry cough, hyperkalemia, angioedema. Contraindicated in pregnancy.
ARBs (-sartan: losartan, valsartan): Alternative to ACE-I; fewer cough side effects. Also contraindicated in pregnancy.
Calcium Channel Blockers (-dipine: amlodipine): Watch for peripheral edema, constipation (with verapamil/diltiazem), dizziness
Beta-Blockers (-olol: metoprolol, atenolol): Watch for bradycardia, fatigue, mask hypoglycemia in diabetics. Do NOT stop abruptly — taper.
Thiazide Diuretics (HCTZ): Often first-line; watch for hypokalemia, hyperglycemia, hyperuricemia
Teach: NEVER stop BP meds abruptly, especially beta-blockers (risk of rebound hypertension)

Patient Teaching

Take medications every day, even when feeling well — HTN has no symptoms until damage is done
Never stop beta-blockers suddenly — must taper to avoid rebound crisis
Read food labels for sodium content — aim for < 2,300 mg/day
Rise slowly from sitting/lying to prevent orthostatic hypotension (especially with new meds)
Report dizziness, persistent dry cough, swelling of face/lips (possible angioedema with ACE-I)
Check BP at home regularly and keep a log for provider visits
Avoid excessive caffeine and OTC decongestants (can raise BP)

Memory Aid

Lifestyle modifications — "DASH WELL": D — DASH diet A — Activity/exercise regularly S — Sodium restriction (< 2,300 mg/day) H — Healthy weight management W — Weigh regularly E — Eliminate smoking L — Limit alcohol L — Lifelong medication adherence

NCLEX Strategy

NCLEX loves patient teaching questions for HTN. Key concepts: taking medications even when feeling well, not stopping beta-blockers abruptly, sodium restriction, and the DASH diet. A classic question format is asking which patient statement shows correct understanding. If a patient says "I only take my pills when I feel dizzy," that demonstrates a need for more teaching. ACE-I questions often test the cough side effect and the angioedema risk. Remember: ACE-I and ARBs are both contraindicated in pregnancy.

Quick Check

Test your understanding with 3 quick questions