NURSING MANAGEMENTGH – PREECLAMPSIA – ECLAMPSIA –

HELLP SYNDROME

The degree to which hypertension can be prevented depends on a number of features including: current blood pressure level, changes in end/target organs (retina, kidney, heart - among others), risk factors for cardiovascular diseases and the age at presentation. Unless the presenting patient has very severe hypertension, there should be a relatively prolonged assessment period within which repeated measurements of blood pressure should be taken. Following this, lifestyle advice and non-pharmacological options should be offered to the patient, before any initiation of drug therapy.

The process of managing hypertension according the guidelines of the British Hypertension Society suggest that non-pharmacological options should be explored in all patients who are hypertensive or pre-hypertensive. These measures include;

PREVENTION

Weight reduction and regular aerobic exercise (e.g., walking) are recommended as the first steps in treating mild to moderate hypertension. Regular exercise improves blood flow and helps to reduce resting heart rate and blood pressure. Several studies indicate that low intensity exercise may be more effective in lowering blood pressure than higher intensity exercise. These steps are highly effective in reducing blood pressure, although drug therapy is still necessary for many patients with moderate or severe hypertension to bring their blood pressure down to a safe level.

Reducing dietary sugar intake. Reducing sodium (salt) in the diet may be effective: It decreases blood pressure

in about 33% of people (see above). Many people use a salt substitute to reduce their salt intake.

Additional dietary changes beneficial to reducing blood pressure includes the DASH diet (dietary approaches to stop hypertension), which is rich in fruits and vegetables and low-fat or fat-free dairy foods. This diet has been shown to be effective based on research sponsored by the National Heart, Lung, and Blood Institute. In addition, an increase in daily calcium intake has the benefit of increasing dietary potassium, which theoretically can offset the effect of sodium and act on the kidney to decrease blood pressure. This has also been shown to be highly effective in reducing blood pressure.

Treatment

Lifestyle modificationsUnless hypertension is severe, lifestyle changes such as those discussed in the preceding section are strongly recommended before initiation of drug therapy. Adoption of the DASH diet is one example of lifestyle change repeatedly shown to effectively lower mildly-elevated blood pressure. If hypertension is high enough to justify immediate use of medications, lifestyle changes are initiated concomitantly.

Olive oil lowers blood pressure NAPLES, ITALY. Several studies have shown that replacing saturated fat with unsaturated fat in the diet can help lower blood pressure in hypertensive individuals. Research has shown that some unsaturated fats (oils) are more effective in lowering blood pressure than others. Fish oils containing eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), for example, have been found quite effective in lowering both blood pressure and triglyceride levels. Now researchers at the University of Naples report that olive oil is also highly effective in lowering blood pressure.

Fish oil supplementation reduces blood pressureCINCINNATI, OHIO. Conventional blood pressure lowering medications often have detrimental effects on quality of life and may lead to unfavourable changes in cholesterol levels. Several studies have found that supplementation with large amounts of fish oil (5-15 grams/day) lowers blood pressure significantly in hypertensive individuals. Whether smaller amounts are equally effective has been open to question.

Salt restriction and fish oil supplementation lower blood pressureADELAIDE, AUSTRALIA. Salt (sodium) restriction can help lower blood pressure in people with hypertension, but is less effective in people with normal pressure. Blood pressure tends to rise with age and there is some evidence that sodium restriction may help reduce this age-related increase. Fish oil supplementation is also effective in lowering blood pressure in hypertensive individuals, but its effect on people with normal pressure is unclear.

Vitamin C combats hypertension BOSTON, MASSACHUSETTS. There is increasing evidence that free radicals (reactive oxygen species) play a significant role in essential hypertension (high blood pressure). Now researchers at the Boston University School of Medicine report that daily supplementation with vitamin C (ascorbic acid) can significantly reduce blood pressure in people suffering from hypertension. Their randomized, placebo-controlled study involved 39 patients (average age of 49 years) 29 of whom were taking antihypertensive medication.

Beta-blockers may be a poor choice as an antihypertensive medication for patients who engage in vigorous exerciseALBUQUERQUE, NEW MEXICO. This review of the effect of blood-pressure-lowering drugs on exercise performance found that the converting enzyme inhibitors, calcium channel blockers, and alpha-blockers have the least potential for adverse effects. Beta-blockers and the CCB, verapamil, were found to impair left ventricular function during exercise. The CCB's nifedipine and diltiazem preserved myocardial contractility better while other antihypertensive agents had negligible effects. Beta-blockers and CCB's (verapamil and diltiazem) have mild antiarrhythmic properties and may provide some protection against ventricular tachycardia. Beta-blockers however, reduce time to exhaustion - nonselective beta-blockers to a greater extent than selective beta-blockers.

Cigarette smoking may interfere with treatment of hypertensionMIAMI, FLORIDA. A comparative study of the efficacy of propranolol and hydrochlorothiazide in treatment of hypertension was analyzed to determine if patients who were non-smokers reacted differently than did smokers. The study involved 105 smokers, 81 former smokers, and 147 who never smoked. It was found that smokers responded less to propranolol than did non-smokers; however, further stratification of the data showed that most of the effect was attributable to black patients. A similar trial involving nadolol and bendroflumethiazide showed no difference between smokers and non-smokers in their response to nadolol. This study involved 96 smokers and 187 non-smokers.Materson, Barry J., et al. Cigarette smoking interferes with treatment of hypertension. Archives of Internal Medicine, Vol. 148, No. 10, October 1988, pp. 2116-19

Potassium proves effective in lowering blood pressureNAPLES, ITALY. Researchers at the University of Naples have concluded a one-year trial to determine if an increased potassium intake decreases the need for anti-hypertensive medication. A group of 54 patients who were all controlling their high blood pressure with medication participated in the study. Half of the group maintained their regular diet while the diet of the other half was modified to increase the amount of potassium-rich food. The extent of the dietary modification was such that the sodium to potassium ratio was 1:1 rather than the customary 3.5:1. At the end of the trial period the group on the high potassium diet consumed less medication than the other group and 38% of them had discontinued medication altogether. The group on the potassium-rich diet also reported a significant (55%) reduction in symptoms related to their hypertension. NOTE: Increasing potassium intake may be dangerous when taking certain diuretics such as spironolactone.