🏠 Study Hub 🖼️ Infographics
Nursing Field Notes / Cardio · Med-Surg & Pharmacology Course

Hypertension 🩸

HTN — the silent killer, staged, sourced & matched to the right drug class

NG-068 Cardio ADHD-friendly visual edition

Persistently elevated arterial blood pressure — usually silent until it has already damaged an organ. Two big questions drive this whole topic: where is it coming from (primary vs secondary), and which lever fixes it — lifestyle first, then the right drug class for the right patient. This page is the overview that ties your ACE inhibitor, ARB, beta blocker, CCB, clonidine, diuretic & nitrate pages together — it won't re-teach each drug, just where each one fits.

📄 Simple Nursing original — opens in Drive →

🤫 The silent killerUsually no symptoms until it has already damaged an organ — that's why routine screening matters.
📊 Numbers shift by sourceCut-offs below follow the ACC/AHA scheme common in current texts. Staging has changed over the years — confirm the version your course tests.
🧬 ~90% primaryNo single cause. The other ~10% (secondary) has one identifiable, often fixable cause.
🥗 Lifestyle firstDASH · sodium · weight · exercise · alcohol limits — before, and alongside, any drug.
🧬

CAUSE

STEP 1 · PRIMARY vs SECONDARY

Same number on the cuff, two very different reasons it got there.

⭐ The core equation — everything else is commentary on this

BP = CO × SVR  (Cardiac Output × Systemic Vascular Resistance)

Anything that raises how much blood the heart pumps out, or how tightly the vessels squeeze around it, raises the pressure. Every risk factor, every cause, and every drug class on this page works by pushing one of those two numbers up or down.

🧠 “Pump harder or squeeze tighter — either one raises the number.” Diuretics and vasodilators attack the equation from opposite sides but land on the same number.

🧭 Primary vs secondary — where the ~90/10 split comes from

🧬 PRIMARY — ~90–95% multifactorial — no single cause 🧬 Genetics / family history 🧂 High-sodium diet ⚖️ Obesity 📅 Aging, stiffening vessels 😖 Chronic stress HIGH BP manage risk factors, not "cure" 🩻 SECONDARY — ~5–10% one identifiable, often fixable cause Renal — renal artery stenosis, CKD Endocrine — Cushing's, pheochromocytoma, aldosteronism, thyroid 🫁 OSA 💊 Meds (NSAIDs, OCPs) 🤰 Pregnancy (preeclampsia) 🫀 Coarctation of aorta HIGH BP fix source → BP often improves
🧠 “ROPE” for secondary causes — Renal disease · OSA · Pheochromocytoma / aldosteronism · Endocrine & Estrogen (OCPs, pregnancy). Pull the rope (fix the cause) and the BP often comes down on its own.

⚠️ Modifiable risk factors — the ones she can change

  • 🧂 High-sodium diet
  • ⚖️ Obesity
  • 🛋️ Physical inactivity
  • 🚬 Smoking
  • 🍺 Excess alcohol
  • 😖 Chronic stress, poor sleep
🧠 These six are exactly the six targets of the lifestyle modification card in the CARE section below.

🧬 Non-modifiable risk factors — the ones she can't

  • 📅 Age — risk rises as vessels stiffen
  • 🧬 Family history / genetics
  • 🌍 Race — Black adults have earlier onset, higher rates & often more severe disease
  • 🚻 Sex — higher risk in men at younger ages; women's risk rises after menopause
🧠 Can't change these — so the modifiable list works harder to compensate.
🔎

CLUES

STEP 2 · STAGING & TARGET ORGANS

Numbers on a chart — until they've been high long enough to hit an organ.

📏 BP categories — a labeled bar scale

Systolic / Diastolic mmHg — low to high, left to right NORMAL ELEVATED STAGE 1 STAGE 2 HYPERTENSIVE CRISIS <120 and <80 120–129 and <80 130–139 or 80–89 ≥140 or ≥90 >180 and/or >120 needs urgent eval ⚠️ Numbers shown follow the ACC/AHA scheme common in current texts. Older sources (e.g. JNC7) use different cut-offs. Confirm which version your course tests.

Only one value has to fall in a category to qualify for it — whichever number (systolic or diastolic) is worse determines the stage.

🧠 “130 starts the staging, 180 is a crisis.” Anchor those two numbers and interpolate the rest — but always double-check the exact table your instructor is using.

🚨 Hypertensive crisis — urgency vs emergency

Urgency: severely elevated BP without acute symptoms of organ damage. Usually managed with oral meds and close follow-up.

Emergency: severely elevated BP with acute target-organ damage — chest pain, dyspnea, vision changes, confusion, worsening renal function. This is an ICU-level, IV-drip situation.

🧠 Symptoms are what turn "urgency" into "emergency." Same terrifying number, totaly different level of response.

🤫 Why it's the "silent killer"

Most people feel nothing until damage has already started. When symptoms do show up — severe headache, visual changes, nosebleed, dizziness — the pressure is often already very high.

This is exactly why routine screening matters more than waiting for symptoms.

🧠 A disease with no early warning system needs a nurse with a cuff instead.

🗺️ Target organ damage — the body map

🧠 BRAIN Stroke, TIA, vascular dementia, encephalopathy 👁️ EYES Hypertensive retinopathy — narrowed vessels, hemorrhages 🫀 HEART LVH, heart failure, CAD / MI 🫘 KIDNEYS Nephrosclerosis, CKD progression, proteinuria 4 sites, 1 disease — the "quiet" damage happens here first
🧠 "HEBK" — Heart · Eyes · Brain · Kidneys. Say it like "he broke" — that's exactly what unchecked HTN quietly does.
🩺

CARE

STEP 3 · LIFESTYLE + THE RIGHT DRUG

Lifestyle changes come first and stay first — drugs get layered on top, matched to who the patient is.

✅ Lifestyle modification — the five levers

🥗 DASH diet fruit · veg · low-fat dairy · low sat. fat 🧂 Sodium limit intake — per AHA guidance ⚖️ Weight loss even modest loss lowers BP 🏃 Exercise regular moderate aerobic activity 🍷 Alcohol limit to moderate intake or less All five are recommended first — and continued even after a drug is started.

DASH = Dietary Approaches to Stop Hypertension: fruits, vegetables, whole grains, low-fat dairy, lean protein; low in saturated fat, sodium & added sugar. Sodium restriction guidance commonly cited by the AHA is roughly <2,300 mg/day, with greater BP benefit closer to 1,500 mg/day — confirm the exact figure your course uses. Weight loss and exercise (regular moderate aerobic activity most days of the week) both independently lower BP; alcohol should be kept to a moderate amount or avoided.

🧠 "DASH away the salt, walk off the weight, pour less wine." Five levers, zero prescriptions — and they're never optional just because a drug got added.

🎯 Which drug class for which patient — the overview

This is the map, not the manual — full mechanism, side effects & teaching for each class live on their own pages.

Patient picturePreferred classSee the full page
No compelling indication — first-line for most adultsThiazide diuretic, ACE inhibitor, ARB, or CCBDiuretics · ACE Inhibitors · ARBs · CCB
Diabetes or CKD with proteinuriaACE inhibitor or ARB — kidney-protectiveACE Inhibitors · ARBs
Black adult, no CKDCCB or thiazide diuretic often preferred firstCCB · Diuretics
Heart failure with reduced EFACE inhibitor/ARB + beta blocker + diureticACE Inhibitors · Beta Blockers · Diuretics
Post-MI / coronary artery diseaseBeta blocker + ACE inhibitorBeta Blockers · ACE Inhibitors
Angina alongside HTNBeta blocker or CCB for daily control; nitrates for acute chest pain, not routine daily HTN dosingBeta Blockers · CCB · Nitrates
Needs rate control for a tachyarrhythmiaBeta blocker or a non-dihydropyridine CCBBeta Blockers · CCB
Cough intolerable on an ACE inhibitorSwitch to an ARB — same benefit, no bradykinin coughACE Inhibitors · ARBs
PregnancyAvoid ACE inhibitors & ARBs — teratogenic; other agents preferred per OB protocolACE Inhibitors · ARBs
Resistant HTN — still uncontrolled on 3 classesAdd-on options may include clonidineClonidine
Hypertensive emergency needing an IV dripIV agents per protocol (e.g. IV nitrates)Nitrates
🧠 Match the patient, not just the number. Two people with the exact same BP can walk out with different prescriptions — kidneys, race, pregnancy status, and comorbid heart disease all change the answer.

⚠️ One NCLEX trap that lives on this page

Never let clonidine stop abruptly — rebound hypertensive crisis. It's the single most-tested safety point that touches this overview; full teaching is on the Clonidine page.

🧠 Clonidine doesn't get to just stop — it gets tapered.

🔁 The theme across every class

Every one of these drug classes attacks BP = CO × SVR from a different angle: diuretics shrink volume, ACEi/ARB relax vessels & protect kidneys, beta blockers slow & soften the heart, CCBs relax vessels or slow the heart depending on type, clonidine turns down sympathetic outflow centrally, and nitrates dilate veins to drop preload.

🧠 Learn the equation once here, then every drug page is just "which side of CO × SVR does this one push?"
⚡

QUICK RECALL

SAY IT OUT LOUD
🤫 Silent killerNo symptoms until organ damage — screen regularly.
📏 Normal <120/<80Stage 1 starts around 130/80, crisis >180/>120 — but confirm your course's exact table.
🧬 90% primary, 10% secondarySecondary has a fixable ROPE: Renal, OSA, Pheo/aldosteronism, Endocrine/Estrogen.
🎯 Match the patientDASH + sodium + weight + exercise + alcohol first, then the drug class that fits this patient.
🎯 Cover & check — 4 rapid-fire questions
Q1: What's the core equation behind every blood pressure number?
BP = Cardiac Output × Systemic Vascular Resistance. Every risk factor and every drug class pushes one of those two numbers.
Q2: A patient has HTN caused by pheochromocytoma. Primary or secondary — and what's different about the plan?
Secondary — there's one identifiable cause. Treating the pheochromocytoma can improve or resolve the BP, unlike primary HTN which is managed, not cured.
Q3: Which four organs make up the target-organ-damage body map?
Heart, Eyes, Brain, Kidneys — "HEBK."
Q4: A patient with diabetes and proteinuria needs an antihypertensive. Which class, and why?
ACE inhibitor or ARB — kidney-protective, reduces proteinuria. See the ACE Inhibitors / ARBs pages for the mechanism and teaching.