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The Importance of Understanding Hypertension: The Role of a Registered Nurse as an Investigator

by Gary D. Goldberg, PhD
Clinical Professor of Medical Education
Angeles College of Nursing, Los Angeles, Ca. 


ABSTRACT
 

Background- 
  Hypertension is a chronic medical ‘condition’ in which the blood pressure is elevated. Hypertension also, referred to as high blood pressure, (i.e., HT, HTN or HPN). The word “Hypertension” (i.e., elevation within the circulatory system) and by itself refers to a systemic, arterial hypertension.

  Hypertension by definition has been classified as ‘essential and/or idiopathic,’ 1 (i.e., primary or secondary concerning metabolic syndrome), multiplex risk factors for cardiovascular disease (CVD) or Syndrome X.2 Primary HTN means that no medical or scientific cause was notable, to explain the raised blood pressure. Metabolic syndrome is a major growing concern among physicians and nursing practitioners’ working in the emergency room department and outpatient clinics. Today, Syndrome X has been placed on the primary essential assessment list for new patients that have no known history for cause. In addition, Syndrome X has become common among the younger adults in the United States since 2000.3  About 90-95% of HT is ‘essential hypertension.’ Secondary HT too, indicates high blood pressure because of, (i.e., Secondary to another condition, such as pathophysiology, metabolic or abnormal organ function). For example, chronic kidney functions, liver, cardiovascular, or tumor diseases.
Keywords: essential hypertension, syndrome x, persistent hypertension, , un-spoken-evidence-based practice, markedly elevated in the chronic state, initial observation, in the state of etiology, the goal of treatment should be in B/P control.

Methods- 
  Today, we need to have a better understanding of “persistent hypertension” which is a key component and a high risk factor for strokes, (i.e., CVA, heart attacks, i.e., Ac³MI, heart failure, i.e., CHF, and arterial aneurysm, i.e., AA). In addition, HTN is indeed a leading cause of chronic renal failure in the United States.4 Even with moderate elevation, in arterial blood pressure well lead to a shortened life expectancy. In the cause of severer high blood pressure, (i.e., B/P as defined as mean arterial pressure 50% or more above average), a person can expect to live no more than a few years unless appropriately treated.5 

  All registered nurses learn that the beginning of a systolic pressure represents (i.e., at peak pressure in the arteries), which occurs near the end of the cardiac cycle, when the ventricles are contracting @ 115 mmHg. Also, the diastolic pressure (i.e., which is minimum pressure in the arteries), occurs near the beginning of the cardiac cycle when the ventricles are filled with blood @ 75 mmHg. Sometimes noted as 115/75 mmHg. Cardiovascular disease (CVD) risk will double for each increment of 20/10 mmHg factor.6 

Investigation- 
  The practitioner or primary care nurse’s role will continue to evolve with the focus of patient care moving from ‘secondary care to prime investigator.’ In today’s highly specialized medical care practice, the nurses are taking the lead role in chronic disease management such as diabetes, respiratory conditions and of hypertension disorder. Indeed, to run this nursing-based-management safely, nurses must have the necessary knowledge and skills in accordance with the American Heart Guidelines and the American Nursing Association is backing for code of conduct. In the UK today the governing guidelines are set forth through the NMC code of conduct;7,8 the guidelines are not only to protect the nurse’s but also the patients who are in treatment. It is highly important and vital to the success of ‘nurse-led-clinics’ that an agreed set of guidelines are developed and a framework is maintained , and reviewed on a regular basis between the physician’s group practice and the nurses.

  A current classification through the American Heart Association , Scientific Division (AHA), recommends blood pressure criteria for defining: normal range, pre-hypertension, hypertension (stage I and II), and isolated systolic hypertension,9 which is common among the elderly. The clinical studies are based on the average of ‘seated’ B/P readings that were properly measured during two or more office visits. In individuals older than 50 years of age, according to AHA guidelines, HTN is considered present when a patient’s B/P is consistently are at least 140-mmHg systolic or 90 mmHg diastolic. Patients with B/P over 130/80 mmHg along with Type 1 or Type 2 diabetes, or kidney disease will require further treatment.10 

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