Editing Medical-Surgical Nursing (section)

=== Hypertension ===

Hypertension is usually asymptomatic until organ damage occurs, which is why it is called the silent killer. Complications include stroke, myocardial infarction, heart failure, kidney failure, and retinopathy.

Nursing application: teach the DASH eating pattern, sodium restriction, weight loss, aerobic activity, limited alcohol, and smoking cessation. Warn about orthostatic hypotension with antihypertensives, especially alpha blockers and vasodilators, and teach the patient to change positions slowly. Emphasize that feeling fine is not a reason to stop the medication; nonadherence is the leading cause of treatment failure.

Hypertensive crisis with a systolic pressure above about one hundred eighty mm Hg accompanied by headache, blurred vision, chest pain, or neurologic change requires emergent evaluation and controlled, gradual lowering of pressure.