NURSING MANAGEMENT

GH – 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 modifications
 Unless 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 pressure
CINCINNATI, 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.
 Saltrestriction and fish oil
supplementation lower blood
pressure
ADELAIDE, 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
 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
 Beta-blockers may be a poor choice as an
antihypertensive medication for patients
who engage in vigorous exercise
ALBUQUERQUE, 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 hypertension
MIAMI, 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
pressure
NAPLES, 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.