Classification and Assessment
Current guidelines classify blood pressure as normal (under 120/80), elevated (120-129/under 80), stage 1 hypertension (130-139/80-89), and stage 2 (140/90 or higher), with hypertensive crisis defined as systolic above 180 or diastolic above 120. Accurate measurement requires proper cuff size, seated position with feet flat, arm at heart level, and no caffeine or smoking 30 minutes prior. The NCLEX often tests whether you'll recheck an elevated reading before diagnosing, since a single elevated reading doesn't confirm hypertension. Secondary causes like renal disease, endocrine disorders, and medications such as NSAIDs or oral contraceptives should be considered in resistant cases.
Antihypertensive Drug Classes
ACE inhibitors (ends in -pril) reduce afterload but cause a dry cough and hyperkalemia risk; ARBs (ends in -sartan) are alternatives without the cough. Calcium channel blockers cause peripheral edema and reflex tachycardia in the dihydropine subclass. Beta-blockers reduce heart rate and should be tapered, not stopped abruptly, to avoid rebound hypertension and tachycardia. Diuretics like hydrochlorothiazide cause electrolyte imbalances and photosensitivity. All antihypertensives carry orthostatic hypotension risk, so teach clients to rise slowly and sit if dizzy, a frequently tested safety point for fall prevention in older adults.
Hypertensive Crisis and Lifestyle Teaching
Hypertensive emergency involves BP above 180/120 with evidence of target organ damage such as vision changes, chest pain, confusion, or acute kidney injury, requiring IV medications like labetalol or nicardipine with gradual BP reduction (no more than 25% in the first hour to avoid ischemia). Hypertensive urgency has severely elevated BP without organ damage and is managed with oral medications and close follow-up. Lifestyle teaching includes the DASH diet, sodium restriction to under 2,300 mg/day, weight loss, regular aerobic exercise, alcohol moderation, and smoking cessation. Emphasize medication adherence since hypertension is often asymptomatic, leading to poor compliance.