NTA Level 4 • Semester 1 • PST04102

Identification of Patients with Hypertension

Disease Control and Prevention • Source Session/Topic 35

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Session 35: Identification of Patients with Hypertension

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Causes of Hypertension

• Describe Types of Hypertension

• Describe Major Signs and Symptoms of Hypertension

• Explain Treatment Of Hypertension

• Explain Prevention and Control of Hypertension

Resources Needed

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Hypertension (5 minutes)

• Hypertension or high blood pressure is a chronic medical condition in

which the blood pressure in the arteries is persistently raised

• Blood pressure is expressed by two measurements:

o The systolic pressure occurs when the left ventricle contract

o The diastolic pressure occurs when the left ventricle relaxes before

the next contraction

• Normal blood pressure at rest is within the range of 100–140 millimeters

mercury (mmHg) systolic and 60–90 mmHg diastolic.

• Hypertension is present if the blood pressure is persistently at or above

140/90 mmHg for most adults

STEP 3: Types of Hypertension (20 minutes)

|Activity: Buzzing (5 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What are the types of hypertension? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Hypertension is classified as either:

• Primary (essential) hypertension defined as high blood pressure with no

obvious underlying cause.

o About 90–95% of cases are categorized as primary hypertension

• Secondary hypertension; defined as hypertension due to an identifiable

cause

o Accounts for remaining 5–10% of cases of hypertension,

o Causes of secondary hypertension;

▪ chronic kidney disease,

▪ pregnancy

▪ alcohol

▪ narrowing of the aorta or kidney arteries

▪ Endocrine disorder e.g. excessive aldosterone, cortisol,

or catecholamines

▪ Drugs such as corticosteroids, non-steroidal anti-inflammatory

drugs

[pic]

STEP 4: Signs and Symptoms of Hypertension (15 minutes)

• Hypertension usually does not cause symptoms initially

• Some patients report;

o Headaches (particularly at the back of the head and in the morning)

o Vertigo,

o Tinnitus (buzzing or hissing in the ears)

o Altered vision or fainting episodes

• Sustained hypertension over time is a major risk factor for:

o Heart disease

o Coronary artery disease

o Stroke

o Aortic aneurysm

o Peripheral artery disease

o Chronic kidney disease

STEP 5: Treatment of Hypertension (20 minutes)

• Refer patients to the hospital for investigations and initial treatment

and follow up may be even done at dispensary or health centre

• Antihypertensive medications are available for treating hypertension

• First line medications for hypertension include:

o Tthiazide – diuretics e.g. hydrochlorothiazide

o Calcium channel blockers, e.g. diltiazem

o Angiotensin converting enzyme inhibitors e.g. captopril

o Angiotensin receptor blockers e.g. losartan

▪ These drugs may be used alone or in combination

▪ The majority of people require more than one medication to

control their hypertension.

STEP 6: Prevention and Control of Hypertension (40 minutes)

|Activity: Group discussion (30 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What are preventive and control measures of hypertension? |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• Lifestyle changes are recommended to lower blood pressure, before

starting drug therapy.

o Maintain normal body weight for adults (e.g. Body mass index 20 –

25 kg/m2)

o Reduce dietary sodium intake

o Engage in regular physical activity e.g. Walking

o Limit alcohol consumption

• consume a diet rich in fruit and vegetables

• Stop smoking and reduce intake of dietary saturated fat and cholesterol

• Lifestyle modification may lower blood pressure as much as

antihypertensive drug

• Patient education

o Hypertension is a lifelong disorder

▪ Long-term commitment to lifestyle modifications and

pharmacological therapy is required.

▪ Repeated in-depth patient education and counselling improve

compliance and reduce cardiovascular risk factors.

STEP 7: Key Points (5 minutes)

• Hypertension is diagnosed by properly measuring elevated blood pressure

at three or more separate occasions based on 2 or more readings.

• Treatment approach in hypertension is based upon its severity by

classification ranging from non pharmacological to pharmacological.

• Patient’s education repeatedly carries a great role for optimal control

of hypertension by lifelong commitment to lifestyle modification and drug

therapy.

STEP 8: Evaluation (5 minutes)

• What is hypertension?

• How is hypertension classified?

• What is the pharmacological treatment of hypertension?

• What are preventive measures of hypertension?

STEP 9: Assignment (5 minutes)

|Activity: Take Home Assignment (5 minutes) |

| |

|ASK the students to work individually on the following Assignment |

|Explain preventive measures for hypertension |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended references |

References

Braunwald, E. & Fauci, A.N. (2008).Harrison’s Principles of Internal

Medicine (17thed.). Oxford: McGraw Hill.

Davidson, S. (2006). Principles and Practice of Medicine (20thed.).

Churchill: Livingstone.

Kumar, P.J. & Clark, M. (2006).Textbook of Clinical Medicine. Churchill:

Livingstone.

MOHSW (2005).Tanzania National Formulary. Dar es Salaam: MoHSW

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