Calixtro, Laidelle Jascinth M.
BSN-III
NARRATIVE PATHOPHYSIOLOGY OF HYPERTENSION
High blood pressure (HBP or hypertension) is when your blood pressure, the force of
your blood pushing against the walls of your blood vessels, is consistently too high.
Hypertension is defined by World Health Organization is when blood pressure is too high.
Blood pressure is the force exerted by circulating blood against the walls of the body’s arteries,
the major blood vessels in the body. It has a systolic blood pressure (SBP) of 140 mm Hg or
higher or a diastolic blood pressure (DBP) of 90 mm Hg or higher, based on the average of
two or more accurate blood pressure measurements taken 1 to 4 weeks apart by a healthcare
provider (Weber et al., 2014). Hypertension is classified into three, namely; Prehypertension,
Stage 1 hypertension, and Stage 2 hypertension. Salt intake, obesity and insulin resistance,
the renin-angiotensin system, and the sympathetic nervous system are the etiological factors
of this condition.
The pathophysiology of hypertension starts with the condition on which there must be
a change in one or more factors affecting peripheral resistance or cardiac output. Moreover,
there must also be a problem with the body’s control systems that monitor or regulate
pressure. Blood pressure is the product of cardiac output multiplied by peripheral resistance.
Cardiac output is the product of the heart rate multiplied by the stroke volume. Each time the
heart contracts, pressure is transferred from the contraction of the heart muscle to the blood
and then pressure is exerted by the blood as it flows through the blood vessels. Hypertension
can result from increases in cardiac output, increases in peripheral resistance (constriction of
the blood vessels), or both. Increases in cardiac output are often related to an expansion in
vascular volume. Although no precise cause can be identified for most cases of hypertension,
it is understood that hypertension is a multifactorial condition. The renin-angiotensin system
may be the most important of the endocrine systems that affect the control of blood pressure.
Renin is responsible for converting renin substrate (angiotensinogen) to angiotensin I, a
physiologically inactive substance which is rapidly converted to angiotensin II in the lungs by
angiotensin converting enzyme (ACE). Angiotensin II is a potent vasoconstrictor and thus
causes a rise in blood pressure. In addition, it stimulates the release of aldosterone from the
zona glomerulosa of the adrenal gland, which results in a further rise in blood pressure related
to sodium and water retention. Sympathetic nervous system stimulation can cause both
arteriolar constriction and arteriolar dilatation. Hence, the autonomic nervous system has a
vital role in maintaining a normal blood pressure. It is also essential in the mediation of short-
term changes in blood pressure in response to stress and physical exercise. Other various
vasoactive systems and mechanisms affecting sodium transport and vascular tone are
involved in the maintenance of a normal blood pressure. Persistent hypertension may develop
into complicated hypertension, in which target organ damage to the aorta and small arteries,
heart, kidneys, retina, and central nervous system is evident.
Untreated hypertension is notorious for increased risk of mortality and is often
described as a silent killer. Mild to moderate hypertension, if left untreated, may be associated
with risk of atherosclerotic disease in 30% of people and organ damage in 50 % of people
within 8-50 years of onset. The prognosis for Hypertension varies on the underlying disease
affecting it. Controlling of blood pressure can minimize manifestation of symptoms. Detecting
the cause of persistent hypertension is a significant factor on evaluating the mortality chance
of the patient.
REFERENCES:
Cheever, K. H., & Hinkle, J. L. (2018). Brunner & Suddarth's textbook of medical-
surgical nursing. Philadelphia: Wolters Kluwer.
Hypertension. (n.d.). Retrieved December 04, 2020, from [Link]
room/fact-sheets/detail/hypertension
Hypertension. [Link]. (2020). Retrieved 4 December 2020, from
[Link]
sheets/detail/hypertension#:~:text=Hypertension%20is%20when%20blood%20pressure,the
%20heart%20rests%20between%20beats.
Matthew R Alexander, M. (2020, March 22). Hypertension. Retrieved December 04,
2020, from [Link]
What is High Blood Pressure?. [Link]. (2020). Retrieved 4 December 2020,
from [Link]
pressure/what-is-high-blood-pressure.
