Patho 7

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Hypertension: Pathophysiology, Diagnosis, Lifespan Considerations, and Case Study

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Hypertension is a chronic cardiovascular disease that is defined as having high blood pressure for a long period of time. It occurs when the blood pressure of blood in the arteries is constantly high, making the blood vessels and heart more difficult to work. Dudenbostel and Calhoun (2023) have suggested that hypertension is a combination of a number of physiological mechanisms: an activation of the renin-angiotensin-aldosterone system (RAAS), increased sympathetic nervous system (SNS) activity, endothelial dysfunction, and elevated vascular resistance. These changes help to cause blood vessels to get narrower and cause fluid to build up, which in turn results in high blood pressure that doesn't go away.

Primary or secondary is the etiology of hypertension. Most cases are due to primary hypertension, and this is caused by a combination of genetic factors, ageing, obesity, lack of exercise, over consumption of sodium, smoking and stress. Hypertension is secondary hypertension if it is caused by an underlying condition like kidney disease, endocrine disorders or obstructive sleep apnea (Brown et al., 2022). Advanced age, family history, obesity, diabetes, smoking, sedentary lifestyle, excessive drinking and ethnicity (African American) are risk factors.

For many people with high blood pressure, symptoms do not occur and it is often said to be the “silent killer.” Symptoms may include headache, dizziness, blurred vision, fatigue, chest pain or shortness of breath. Untreated high blood pressure can lead to serious complications like heart attack, stroke, heart failure, chronic kidney disease, peripheral artery disease and loss of vision. High blood pressure causes long-term damage by causing blood vessels to become progressively damaged and the organs to suffer (Dudenbostel & Calhoun, 2023).

Blood pressure is the primary method of diagnosing hypertension, and this is done in several visits to health-care providers. Clinical guidelines indicate that a diagnosis of hypertension is made if a person's blood pressure is persistently above 130/80 mmHg. Results of the assessment can be high blood pressure, blood vessels changes in the eye, left ventricular hypertrophy or organ damage. Laboratory tests help to find out what is causing the headache and any complications. A complete metabolic panel, fasting glycemia, lipid profile, urinalysis, serum creatinine, estimated glomerular filtration rate are common laboratory tests performed. Sometimes, imaging tests are performed, such as an electrocardiogram (ECG), echocardiogram, chest radiograph, or renal ultrasound. Obstructive sleep apnea can also be suspected to be a contributing factor to sleep studies (Brown et al., 2022).

The mechanism of hypertension and its clinical manifestations may change with age. High blood pressure is less prevalent in children and usually is caused by congenital or renal or endocrine system disorders. Symptoms can be mild and include headaches, irritability or poor growth. Hypertension can present during pregnancy as gestational hypertension or preeclampsia which can pose a threat to mother and baby. Pregnant people need careful monitoring to avoid complications like placental insufficiency and premature birth. Medications may be needed to control hypertension in breastfeeding mothers and some can be used during breastfeeding. For older people, low vascular elasticity and increased arterial stiffness are a major factor in the increase of SBP. Elevated blood pressure for a prolonged period of time puts older adults at a higher risk for cardiovascular and cerebrovascular complications.

Case Study

Diagnosis: Primary Hypertension

Patient's Name: Michael Johnson

Age: 56 years

Gender: Male

Social Background:

Married and working as an office manager.

A lack of physical activity.

Eats junk food more than a few times per week.

Smokes 1 pack of cigarettes a day for 25 years.

Mentions drinking alcohol from time to time.

Chief Complaint:

Frequent headache and occasional dizziness of three months' duration.

History of Present Illness:

Complains of fatigue and some blurring of vision.

States experience exacerbation of symptoms at times of work-related stress.

Has not visited a health care professional for over 2 years.

Past Medical History:

Obesity (BMI 33 kg/m²).

Hyperlipidemia.

No history of cardiovascular events.

Family History:

At the age of 68, Father passed away from a stroke.

Mother suffers from hypertension and Type 2 Diabetes.

Assessment Findings:

Systolic/diastolic blood pressure, on two occasions, each being 162/98 mmHg.

Heart rate: 88 beats per minute.

Weight: 245 pounds.

During the examination mild retinal vascular changes were noted.

Laboratory Results:

Total cholesterol: 245 mg/dL.

LDL cholesterol: 165 mg/dL.

Fasting glucose: 112 mg/dL.

Serum creatinine: 1.1 mg/dL.

Urine is clean/clear and protein is negative.

Diagnostic Studies:

ECG shows that the left ventricle is enlarged.

On echocardiogram, the walls of the left ventricle are mildly thickened.

Clinical Reasoning:

Hypertension was caused by multiple risk factors such as obesity, smoking and family history, sedentary lifestyle, and hyperlipidaemia.

The diagnosis of primary hypertension is supported by repeated high blood pressure reading and the presence of target organ damage.

Plan of Care:

Start anti-hypertensive treatment as prescribed.

Educate patient about sodium, smoking, weight loss and exercise.

Schedule follow up blood pressure checks and cardiovascular risk assessment.

Promote compliance with medication and lifestyle changes to prevent stroke, myocardial infarction and kidney disease.

References

Brown, J., Yazdi, F., Jodari-Karimi, M., Owen, J. G., & Reisin, E. (2022). Obstructive sleep apnea and hypertension: updates to a critical relationship. Current hypertension reports, 24(6), 173-184.

Centers for Disease Control and Prevention. (2024). Facts about hypertension.

Dudenbostel, T., & Calhoun, D. A. (2023). Resistant hypertension, obesity, sleep apnea, and aldosterone: Theory and therapy. Hypertension, 81(2), 234–242.

Koo, P., Muntner, P., Hall, M. E., Gjelsvik, A., McCool, F. D., & Eaton, C. B. (2022). Relationship between risks for obstructive sleep apnea, resistant hypertension, and aldosterone among African American adults in the Jackson Heart Study.  American journal of hypertension,  35(10), 875-883.

Loh, H. H., Lim, Q. H., Chai, C. S., Goh, S. L., Lim, L. L., Yee, A., & Sukor, N. (2023). Influence and implications of the renin–angiotensin–aldosterone system in obstructive sleep apnea: an updated systematic review and meta‐analysis.  Journal of Sleep Research,  32(1), e13726.