Hypertension Concept Map

Primary Diagnosis: _Hypertension ________________________________________________

Describe the pathophysiology of the primary diagnosis in your own words. What are the patient’s risk factors for this diagnosis?

Pathophysiology of Primary Diagnosis
Hypertension is a cardiovascular disorder characterized by sustained elevated blood pressure. Gabb (2020) defines hypertension as systolic blood pressure (SBP) values of 130 mm Hg or more and/or diastolic blood pressure (DBP) of more than 80 mm Hg. The pathophysiologic principle underlying this condition is the increased activation of the sympathetic nervous system, volume expansion attributed to increased salt absorption, and the dysfunctional response of the renin-angiotensin-aldosterone system. These changes result in an increase in the total peripheral resistance and afterload and, consequently, hypertension (Harrison et al., 2021).
Causes	Risk Factors (genetic/ethnic/physical)
Hypertension has a multifactorial etiology. While the majority of cases of hypertension are idiopathic, disorders of the kidneys, endocrine system, and arteries have also been shown to cause the disease (Harrison et al., 2021).	The risk factors of hypertension include being overweight or obese, excessive salt intake, excessive alcohol consumption, smoking, age over 65, family history of the disease, and being an ethnic black.

What are the patient’s signs and symptoms for this diagnosis? How does the diagnosis impact other body systems, and what are the possible complications?

Signs and Symptoms – Common presentation

How does the diagnosis impact each body system? Complications?

Hypertension is a silent disease. It is often reported as an accidental finding during clinical visitation in primary healthcare (Gabb, 2020). People with the disease may, however, manifest with severe headaches, chest pains, difficulty breathing, dizziness, blurred vision, nausea, and vomiting.

If left unmanaged, hypertension may have significant impacts on various organs. In the central nervous system, hypertension is a risk factor for cerebrovascular accidents. It is a leading cause of stroke (Yu et al., 2023). In the renal system, hypertension can result in chronic kidney disease and, eventually, kidney failure. In the cardiovascular system, uncontrolled hypertension can result in left ventricular hypertrophy and, subsequently, heart failure. Hypertension can also cause visual loss (Yu et al., 2023).

What is another potential diagnosis that presents in a similar way to this diagnosis (differentials)?

Hyperaldosteronism, aortic valve disease, renal artery stenosis, and chronic kidney disease are some of the differential diagnoses in the assessment of hypertension. These conditions are often implicated as factors in secondary hypertension and usually present with symptoms similar to those seen in the primary disease.

What diagnostic tests or labs would you order to rule out the differentials for this patient or confirm the primary diagnosis?

Blood pressure measurements are the only sure way of diagnosing the disease. According to the American College of Cardiology, at least two office measurements on two separate occasions are necessary to diagnose the disease. Other diagnostic tests may be required to assess the signs of end-organ damage. These include fundoscopy for retinopathy, 12 lead electrocardiograms to assess left ventricular hypertrophy, a blood workup to assess an underlying disease, and an Ankle-brachial pressure index to assess peripheral artery disease. Imaging may be necessary when deemed feasible.

What treatment options would you consider? Include possible referrals and medications.

Comprehensive management of hypertension utilizes pharmacological and non-pharmacological interventions. Non-pharmacological approaches are centered on diet and physical activity. Restriction of salt intake and exercise have been shown to optimize blood pressure control. They are part of the first line management of the disease in mild disease. As part of patient education at the point of care, detailed instruction on dietary salt restriction, reduction in alcohol consumption, smoking cessation, exercise, adequate sleep, and weight management should be given to the patients (Carey et al., 2021). The pharmacological approach utilizes antihypertensive medications. These include angiotensin-converting enzyme inhibitors such as enalapril, angiotensin receptor blockers such as losartan, diuretics such as thiazide, beta-blockers such as metoprolol, and calcium channel blockers such as amlodipine.

A referral may be necessary if an underlying cause is established.

References

Carey, R. M., Wright, J. T., Taler, S. J., & Whelton, P. K. (2021). Guideline-driven management of hypertension. Circulation Research, 128(7), 827–846. https://doi.org/10.1161/circresaha.121.318083

Gabb, G. (2020). What is hypertension? Australian Prescriber, 43(4), 108–109. https://doi.org/10.18773/austprescr.2020.025

Harrison, D. G., Coffman, T. M., & Wilcox, C. S. (2021). Pathophysiology of hypertension. Circulation Research, 128(7), 847–863. https://doi.org/10.1161/circresaha.121.318082

Yu, E. Y., Wan, E. Y., Mak, I. L., Chao, D. V., Ko, W. W., Leung, M., Li, Y. C., Liang, J., Luk, W., Wong, M. M., Ha, T. K., Chan, A. K., Fong, D. Y., & Lam, C. L. (2023). Assessment of hypertension complications and Health Service use 5 years after implementation of a multicomponent intervention. JAMA Network Open, 6(5). https://doi.org/10.1001/

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