Hypertension Management: The Critical Role of Nurses

Abstract

Hypertensive crises, encompassing hypertensive emergencies and urgencies, are acute elevations in blood pressure that require prompt intervention to prevent target organ damage. Hypertensive emergencies, characterized by a systolic blood pressure exceeding 180 mmHg or a diastolic blood pressure above 120 mmHg with evidence of acute target organ damage, are associated with significant mortality risk if left untreated. Most patients experiencing hypertensive crises have a history of uncontrolled essential hypertension, with medication nonadherence and sympathomimetic agents being common contributors. Pathophysiological mechanisms involve overactivation of the renin-angiotensin-aldosterone system, pressure-induced natriuresis, and increased systemic vascular resistance. Assessment includes a focused history, physical examination, and diagnostic testing to identify the underlying cause and target organ dysfunction. Treatment goals prioritize identifying the etiology, mitigating organ damage through controlled blood pressure reduction, and monitoring for adverse effects. First-line pharmacologic therapy involves intravenous medications tailored to the specific target organ damage and patient comorbidities. Nurses play a critical role in monitoring, ensuring patient comfort, and providing comprehensive discharge education. Discharge planning should address social determinants of health, medication adherence strategies, and the importance of lifelong hypertension management through nonpharmacologic and pharmacologic interventions.