Clinical Scenario
Mr. Devon Jones is a 40-year-old African American male with a long-standing history of uncontrolled hypertension. Both of his parents died from hypertension, and his mother also had Type II diabetes. Mr. Jones is a police officer in a high-crime neighborhood. He stopped smoking about 5 years ago when diagnosed with hypertension. He drinks several beers every evening and does not pay attention to his intake of sodium, fat, or carbohydrates. His weight has increased by 20 pounds during the past year with reported shortness of breath during activity.
Primary (Essential) Hypertension
Primary hypertension, also referred to as essential hypertension, is high blood pressure caused by a variety of factors and not one specific cause. The causative factors include obesity, alcohol use disorder, a family history of hypertension, a diet high in salt, sleeping issues, and a sedentary lifestyle (Iqbal & Jamal, 2023).
Secondary Hypertension
Secondary hypertension is a type of high blood pressure with a clearly identifiable cause. The different factors result in arterial hypertension, which occurs when there is high systemic vascular resistance and cardiac output (Hegde et al., 2023). Factors include adrenal gland disorders such as Cushing's syndrome, kidney diseases, anti-inflammatory drugs, sleep apnea, and preeclampsia.
Complicated Hypertension
Complicated hypertension is high blood pressure characterized by multiple complications such as end organ damage. It is resistant in nature, meaning the condition is hard to manage when blood pressure spikes (Naranjo et al., 2023). Causative factors include central nervous disorders, adrenal disorders, thyroid disorders, structural heart diseases, and substance withdrawal.
Clinically Significant History for Mr. Jones
Mr. Jones has several compounding risk factors:
- Family history: Both parents died due to hypertension, indicating genetic disposition
- Alcohol consumption: Causes blood vessels to become narrower, increasing hypertension risk
- Unregulated sodium intake: High sodium causes fluid retention that elevates blood pressure
- High fat intake: Raises LDL cholesterol levels and narrows blood vessels
- Sedentary lifestyle: Leads to extra fat mass accumulation increasing sympathetic nervous system activity
Pathologic Effect: Heart Failure
High blood pressure increases peripheral vascular resistance and left ventricular afterload, and prolonged exposure to pressure leads to left ventricular remodeling (Oh & Cho, 2020). Heart failure results from diastolic dysfunction and increased stiffness of the left ventricle. Chronic hypertension leads to functional and structural changes in the heart, resulting in heart failure.
Self-Care Recommendations
- Limiting tobacco and alcohol use
- Regular physical activity for weight control
- Healthy diet with whole grains, fruits, vegetables, fish, and lean meat
- Quality and undisrupted sleep (Jaarsma et al., 2021)
References
- Hegde, S., Ahmed, I., & Aeddula, N. R. (2023). Secondary hypertension. StatPearls.
- Iqbal, A. M., & Jamal, S. F. (2023). Essential hypertension. StatPearls.
- Jaarsma, T., et al. (2021). Self-care of heart failure patients. European Journal of Heart Failure, 23(1), 157-174.
- Naranjo, M., Chauhan, S., & Paul, M. (2023). Malignant hypertension. StatPearls.
- Oh, G. C., & Cho, H. J. (2020). Blood pressure and heart failure. Clinical Hypertension, 26, 1-8.
Related: Explore our neurological case study or browse all nursing sample papers.