Discussion of the Disease

Hypertension, also known as high or raised blood pressure, is a condition in which the blood vessels have persistently raised
pressure. Blood is carried from the heart to all parts of the body in the vessels. Each time the heart beats, it pumps blood into the
vessels. Blood pressure is created by the force of blood pushing against the walls of blood vessels (arteries) as it is pumped by the
heart. The higher the pressure the harder the heart must pump.

The Seventh Report of The Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure (JNC
7) classifies BP of adults aged 18 years or older has been as follows:

Classification Systolic (mm Hg) Diastolic (mm Hg)

Normal <120 and <80
Prehypertension 120-139 or 80-89
Stage 1 hypertension 140-159 or 90-99
Stage 2 hypertension ≥160 or ≥100

Hypertension may be primary, which may develop because of environmental or genetic causes, or secondary, which has
multiple etiologies, including renal, vascular, and endocrine causes. Primary or essential hypertension accounts for 90-95% of adult
cases, and secondary hypertension accounts for 5-10% of cases. However, secondary forms of hypertension, such as primary
hyperaldosteronism, account for 20% of resistant hypertension (hypertension in which BP is >140/90 mm Hg despite the use of
medications from 3 or more drug classes, 1 of which is a thiazide diuretic).

Especially severe cases of hypertension, or hypertensive crises, are defined as a BP of more than 180/120 mm Hg and may
be further categorized as hypertensive emergencies or urgencies. Hypertensive emergencies are characterized by evidence of
impending or progressive target organ dysfunction, whereas hypertensive urgencies are those situations without progressive target
organ dysfunction.

In hypertensive emergencies, the BP should be aggressively lowered within minutes to an hour by no more than 25%, and then
lowered to 160/100-110 mm Hg within the next 2-6 hours. Acute end-organ damage in the setting of a hypertensive emergency may
include the following:

Neurologic: hypertensive encephalopathy, cerebral vascular accident/cerebral infarction, subarachnoid hemorrhage, intracranial
hemorrhage
Cardiovascular: myocardial ischemia/infarction, acute left ventricular dysfunction, acute pulmonary edema, aortic dissection, unstable
angina pectoris
Other: acute renal failure/insufficiency, retinopathy, eclampsia, microangiopathic hemolytic anemia
 With the advent of antihypertensives, the incidence of hypertensive emergencies has declined from 7% to approximately 1%.
In addition, the 1-year survival rate associated with this condition has increased from only 20% (prior to 1950) to more than 90% with
appropriate medical treatment.
 Health Care Pharmacotherapeutic Goal Recommendations/Interventions Monitoring Desired Frequency
Needs for therapy Parameters Endpoint (of
monitoring)
Treatment of  Patient compliance to  Monitor BP every 3-6 months, Vital signs
Hypertension prescribed medication assuming no signs or
 Minimal adverse drug symptoms of acute target- BP <140/90 mm q shift
reaction organ disease. Hg
 Absence of signs and  The medications that the Cholesterol
symptoms patient is taking must be level <200mg/dL
 BP within normal and properly monitored for
acceptable limits undesirable interactions. One Lipid level
 Reduce cardiovascular may have interaction to the  Tryglyceride <150 mg/dL q 3 months
events other medicine given.  HDL >150 mg/dL
 To improve quality of  Patient should participate in  LDL <100 mg/dL
life activities that avoid stress and  TC <200 mg/dL
reduce BP/cardiac work load.
 Auscultate patient’s heart tone Unexplained
ad breathing sound. muscle pain Eliminate pain q shift
 Assess weight gain.
 Maintain activity restrictions Blood chem
(bedrest or chair rest);  BUN 2.8-6.4 mmol/L q 3 months
schedule periods of  Creatinine 58-110 mmol/L
uninterrupted rest; assist
patient with self-care activities BMI Normal BMI q month
as needed.
 Provide comfort measures
(back and neck massage).
 Control pain because it may
increase blood pressure.
 Monitor the risk of taking
Losartan with other
antihypertensive agents.
 Ensure patient diet/exercise.
 Continue and comply with
Angiotensin Receptor
Blockers.