Hypertension Questions

Respond to the questions using the lessons and vocabulary found in the readings. Support your answers with examples and research. Your responses should clarify your understanding of the topic. They should be your own, original, and free from plagiarism. Follow APA format 7th edition for writing style, spelling and grammar, and citation of sources. Participate in the discussion by analyzing each response for completeness and accuracy and by suggesting specific additions or clarifications for improving the discussion question response

QUESTION #1******* How does obesity influence Hypertension?

QUESTION #2*********************************

Luciana

In this discussion question a 76-year-old woman with a history of hypertension and peripheral artery disease, hyperlipidemia, and lower extremities edema visits her Primary Care Physician (PCP) for an evaluation. The patient has been experiencing episodes of hypertension with fatigue. Based on the BMI index this patient is overweight. This patient is on several medications to include, but not limited to blood pressure medications, blood thinners, as well as medications to control cholesterol levels. This patient has uncontrolled hypertension at the time of PCP visit.

Hypertension (HTN), also known as high blood pressure, is a common condition in which the long-term force of the blood against your artery walls is high enough to cause health concerns, such as heart disease (Mayo Clinic, 2020). Blood pressure is derived from the amount of blood that your heart pumps in correlation with the amount of resistance of blood flow in arteries. It is noted that hypertension is developed over many years due to this resistance, but it can also exist without symptoms at all. Mayo Clinic, 2020, states that hypertension develops over several years, and it eventually affects everyone at some point during the human lifespan.

Review factors that affect blood pressure control with age, and explain from a pathophysiology standpoint what could be contributing to the ongoing issues with hypertension.

According to Singh et. al. (2020), physiologic changes associated with aging leads to an increase in systolic blood pressure. The increase in blood pressure seen with aging is most likely related to arterial changes. Aging results in narrowing of the vessel lumen and stiffening of the vessel walls through a process known as atherosclerosis. Atherosclerosis leads to structural alterations including increased vascular calcification causing earlier reflected pressure waves during blood pressure wave propagation. The pressure wave arrives back from the aortic root during systole and contributes to the increase in systolic blood pressure. Diastolic blood pressure tends to increase up to the age of about 50 and the increase is due to the rise in arteriolar resistance. The large artery stiffening that occurs later in life contributes a wider pulse pressure including a decreased diastolic blood pressure. The increase in arteriolar resistance along with large artery stiffening leads to a significant increase in systolic blood pressure, pulse pressure and mean arterial pressure (Singh et. at. 2020).

Explain the four factors that affect cardiac output and that impact on blood pressure control.

Preload is the volume inside the ventricle at the end of diastole. When preload extends beyond its range, muscle stretching takes place. The stretching of this heart muscle causes decrease cardiac output.
Afterload is the resistance to ejection during systole causing a decreased afterload or an increased afterload. A decreased afterload takes place when the heart contracts too rapidly. An increased afterload takes place when the heart slows down its contracts causing an increase in the workload.
Myocardial Contractility is the ability of the heart muscle to contract. Dong et. al. 2020, states that aging decreases the cardiac tolerance to stress and increases susceptibility to ischemia.
Heart Rate is the number times the heart beats per minute. The average heart rate does not vary change during aging, but the ability for the heart rate to rise during activity does.

What impact does her other medical conditions potentially have on the blood pressure control? Support with evidence while discussing these pathologies.

The likelihood of a person being diagnosed with hypertension increases with age. This patient is 76 years old and women are more likely to develop high blood pressure after the age of 65 according to Mayo Clinic (2020). Peripheral artery disease can impact blood pressure in several ways. High blood pressure causes damage to the arteries, which in turn puts the patient at risk for peripheral artery disease (PAD) is a result of arthrosclerosis. Due to the fatty deposit buildup in the arteries, this patient is currently receiving medication management of Clopidogrel (Plavix) 75mg once a day as well as an Aspirin 81mg once a day. Aspirin and Plavix are a blood thinner. Based on the BMI matrix, this patient is overweight. Average BMI range is 18-24.9. This patient is 32 which is Grade 1 overweight. This patient reported the mild weight gain and moderate fatigue. Fatigue is a classic symptom of weight gain. The more weight you gain the more blood needed to supply oxygen and nutrients to the body’s tissues. As the volume of blood circulates the blood vessels increases, causing more pressure of the artery walls.

There are two types of hypertension which are primary (essential) hypertension and secondary hypertension. Primary (essential) hypertension tends to develop gradually over many years. According to Formanowicz et. al. (2020), recent studies have shown that the innate and adaptive immune system, along with low-grade inflammation, may play an important role in essential hypertension. Secondary hypertension tends to appear suddenly with a higher blood pressure than primary hypertension, due to the association of underlying medical conditions. Examples of conditions that can lead to secondary hypertension includes obstructive sleep apnea, kidney problems, adrenal gland tumors, thyroid concerns, certain medication management, and illegal drug use (Mayo Clinic, 2020).

Dong Ming,Y., Ziyi,F., Hongcheng, et al. Aging Attenuates Cardiac Contractility and Affects Therapeutic Consequences for Myocardial Infarction[J]. Aging and disease, 2020, 11(2): 365-37

Formanowicz, D., Rybarczyk, A., Radom, M., & Formanowicz, P. (2020). A Role of Inflammation and Immunity in Essential Hypertension—Modeled and Analyzed Using Petri Nets. International Journal of Molecular Sciences, 21(9), 3348. https://doi-org.su.idm.oclc.org/10.3390/ijms21093348

Mayo Clinic. 2020. High Blood Pressure (Hypertension). Retrieved from https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410

McCance K., L., & Huether, S., E. (2018). Pathophysiology: The Biologic Basis for Disease in Adults and Children (8th ed.) St Louis, MO: Mosby Inc; ISBN-13: 978-0323583473

Singh, J.N., Nguyen T., Kerndt, C.C., et al. Physiology, Blood Pressure Age Related Changes. [Updated 2020 Sep 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537297/

QUESTION #3

Erica Millward

In the case study, our patient is being treated for hypertension with four anti-hypertensive drug therapies, and despite these interventions, she is experiencing continued hypertension. When hypertension is treated by 3 drugs, including a diuretic, and continues to persist, it is considered resistant hypertension. Patients with resistant hypertension are at a higher risk for developing end-organ damage. Although not the instance with all cases, patient’s with resistant hypertension are likely to have a secondary cause. The most common secondary co-morbidities of resistant hypertension are obstructive sleep apnea, chronic kidney disease, and primary hyperaldosteronism. (Yaxley & Thambar, 2015). Our patient is experiencing resistant hypertension and is at a higher risk for developing end-organ damage. Treatment options to consider are dietary modifications, weight loss, physical exercise, sodium restriction, and smoking cessation. Especially when combined with drug therapy lifestyle modifications can enhance the reduction in blood pressure (Heuther & McCance, 2019; Yaxley & Thambar, 2015). What co-morbidities or conditions could our patient be at risk for if her hypertension continues to remain in sub-therapeutic levels?

Reference:

Huether, Sue & McCance, Kathryn. (2019). Pathophysiology: The Biologic Basis for Disease in Adults and Children (Eighth Edition) Elsevier, Inc.

Yaxley, J.P., & Thambar, S.V. (2015) Resistant hypertension: An approach to management in primary care. Journal of Family Medicine and Primary Care. 4(2): 193-199. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4408700/#:~:text=Resistant%20hypertension%20is%20defined%20as,or%20have%20no%20identifiable%20cause.

Subject: Masters Nursing

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Hypertension Questions

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