One of the most deadliest and common non-communicable disease at this moment is hypertension. It is common in not only in adults, but in children also. According to the American Academy of Family Physicians (2006) the epidemic of childhood obesity, the risk of developing left ventricular hypertrophy, and evidence of the early development of atherosclerosis in children would make the detection of and intervention in childhood hypertension important to reduce long-term health risks; however, supporting data are lacking.
Most childhood hypertension, particularly in preadolescents, is secondary to an underlying disorder. Renal parenchymal disease is the most common (60 to 70%) cause of hypertension. Adolescents usually have primary or essential hypertension, making up 85 to 95% of cases. But how do we classify Hypertension? How would we know if a person has one? Hypertension is defined as a systolic blood pressure above 140 mmHg or a diastolic pressure above 90 mmHg, based on two or more measurements.
Hypertension can be classified as follows: Optimal: systolic 120mmHg; diastolic 80mmHg, Normal: systolic 130mmHg; diastolic 85mmHg, High normal: systolic 130 mmHg to 139 mmHg; diastolic 85 to 89 mmHg, Stage 1: systolic 140 to 159 mmHg; diastolic 90 to 99 mmHg, Stage 2: systolic 160 to 179 mmHg; diastolic 100 to 109 mmHg, Stage 3: systolic 180 mmHg or higher; diastolic 110mmHg or higher (Brunner & Suddarth, 2004; Textbook of Medical-Surgical Nursing-10th ed/Suzanne C. Smaltzer, Brenda G. Bare; 2004, Vol. 2 p. 652) There are two types of Hypertension, and that is Essential and Secondary Hypertension.
(Guyton & Hall) In the adult population with hypertension, between 90% and 95% have essential (primary) hypertension, which has no identifiable medical cause; it appears to be a multifactorial, polygenic condition. For high blood pressure to occur, an increase in peripheral resistance and/or cardiac output must occur secondary to increased sympathetic stimulation, increased renal sodium reabsorption, increased renin-angiotensin-aldosterone system activity, decreased vasodilatation of the arterioles, or resistance to insulin action.
On occasion, hypertension appears abruptly and severely and takes a “malignant” course that causes rapid deterioration, signaling an emergency state known as hypertensive crisis or hypertensive urgency. According to Brunner & Suddarth (2004) “Hypertensive crisis, or hypertensive emergency, exists when an elevated blood pressure level must be lowered immediately (not necessarily to less than 140/90 mmHg) to halt or prevent target organ damage. Hypertensive urgency exists when an blood pressure must be lowered within a few hours.
Hypertensive crisis requires prompt treatment in an intensive care setting because of the risk for serious organ damage. The medication regimen (eg. nitroprusside, nicardipine HCl) requires extremely close hemodynamic monitoring. Vital signs should be checked as often as every 5 minutes. ” Hypertension affects more women than men, but African-American men are less able to tolerate the disease. (Armenian Medical Network 2006) Secondary Hypertension is characterized by elevations in blood pressure with a specific cause, such as arterial disease, renal disease, certain medications, tumors, and pregnancy.
Hypertension can also be acute, a sign of an underlying condition that causes a change in peripheral resistance or cardiac output. It Clinical Manifestations are; Physical examination may reveal no abnormality other than high blood pressure, Changes in the retinas with hemorrhages (cotton-wool spots from small infarcts), exudates, narrowed arterioles, and papilledema may be seen in severe hypertension.
Symptoms usually indicate vascular damage related to organ systems served by involved vessels., Coronary artery disease with angina or myocardial infarction is the most common sequela. , Left ventricular hypertrophy may occur; left heart failure ensues. , Pathologic changes may occur in the kidney (nocturia and increased blood urea nitrogen (BUN) and creatinine levels). ,Cerebrovascular involvement may occur (stroke or transient ischemic attack [ie, temporary hemiplegia, sudden falls, dizziness, weakness, or alterations in vision or speech]). (Brunner & Suddarth 2004)