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Pathophysiology of Primary Diagnosis

Several mechanisms contribute to the development of hypertension. These include increased vascular wall thickness, neurohormonal disorders, autonomic dysregulation, and hemodynamic changes (Oliveros et al., 2020). Vascular wall thickness contributes to the narrowing of arterial lumen, which increases peripheral resistance and leads to hypertension. Autonomic dysregulation through increased adrenergic tone mediated by catecholamines like epinephrine contributes to the disruption of cardiovascular homeostasis and, consequently, increased arterial blood pressure. Hemodynamic changes like increased intravascular volume through sodium-sparring effects of aldosterone and neurohormonal disorders involving vasoconstrictor effects of angiotensin II released by the renin-angiotensin-aldosterone system (RAAS) also contribute to the development of hypertension.

Causes

Risk Factors (genetic/ethnic/physical)

Hypertension is classified into essential and secondary types. The causes of essential hypertension are idiopathic, but interactions between environmental and genetic factors are the most likely cause (Oliveros et al., 2020). Secondary hypertension is due to renal, endocrine, cardiovascular, and neurologic causes.

· Advanced age, black ethnicity, family history, genetics, obesity/overweight, tobacco use, alcohol intake, stress, and excess consumption of dietary salt (Oparil et al., 2019).

Signs and Symptoms – Common presentation

How does the diagnosis impact each body system? Complications?

· Headache

· Visual changes

· Palpitations

· Shortness of breath

· Nausea

Hypertension is a multi-systemic disorder. It accelerates the rate of end-organ damage for most of the major organs in the body.

The complications of hypertension include:

· Hemorrhagic stroke in the brain

· Hypertensive retinopathy affecting the eyes

· Myocardial ischemia and hypertensive cardiomyopathy in the heart

· Chronic renal failure in kidneys

· Arteriosclerosis in arterial blood vessels (Loscalzo et al., 2022).

a. Renal artery stenosis

b. Pheochromocytoma

c. Obstructive uropathy

d. Eclampsia in pregnant women

e. Coarctation of the aorta

a. At least two serial elevated blood pressure readings are needed to diagnose hypertension.

b. Hematocrit

c. Urea, creatinine, and electrolytes

d. Echocardiogram

e. Serum metanephrine test to rule out pheochromocytoma (Loscalzo et al., 2022)

f. Renal ultrasound to rule out obstructive uropathy

g. CT angiogram to rule out renal artery stenosis

A two-pronged approach utilizing pharmacological and non-pharmacological interventions is used in the management of hypertension. Non-pharmacological interventions include tobacco cessation, dietary modification, increased physical activity, and proper weight management in overweight and obese patients. Pharmacological interventions involve administering antihypertensives either in monotherapy or fixed-dose combinations. The commonly prescribed drug classes include calcium channel blockers, thiazide diuretics, angiotensin-2 receptor blockers, and beta blockers. These drugs are initiated in patients with blood pressure above 140/90 (Oparil et al., 2019).

Possible referrals would be guided by hypertension-related complications. The services consulted would include cardiology, nephrology, ophthalmology, and neurology.