Figure 2 lists a number of risk factors that a person may change to reduce his/her risk of developing hypertension and/or to lower his/her blood pressure. Figure 2: Risk Factors for Hypertension (adapted from Rizzo, Odle & Costello, 2006, Risk Factors section, ¶ 1).

Diagnostic Tests

Sharp (2006), purports that the four goals of evaluation for hypertension include:

1. Identifying lifestyle factors that contribute to elevated blood pressure and increased risk for cardiovascular disease,

2. assessing linking modifiable cardiovascular risk factors,

3. assessing for target organ disease, and

4. determining whether a secondary root exists for the elevation of the person's blood pressure (Sharp, 2006).

The instrument for measuring blood pressure, a sphygmomanometer, consists of a cloth-covered rubber cuff, which is wrapped around the upper arm and inflated. Rizzo, Odle and Costello (2006) explain the process:

When the cuff is inflated, an artery in the arm is squeezed to momentarily stop the flow of blood. Then, the air is let out of the cuff while a stethoscope placed over the artery is used to detect the sound of the blood spurting back through the artery. This first sound is the systolic pressure, the pressure when the heart beats. The last sound heard as the rest of the air is released is the diastolic pressure, the pressure between heartbeats. Both sounds are recorded on the mercury gauge on the sphygmomanometer (Rizzo, Odle & Costello, 2006, Diagnosis section, ¶ 2).

To evaluate hypertension, the typical physical examination includes:

Medical and Family History

Physical Examination

Ophthalmoscopy: Examination of the Blood Vessels in the Eye

Blood and Urine Tests. (Rizzo, Odle & Costello, 2006, Diagnosis section, ¶ 4)

When evaluating a person for hypertension, the physician may examine the blood vessels in the eyes with an ophthalmoscope, to see if any hemorrhages, narrowing, or thickening exists in the blood vessels. The physician may also perform blood and urine to detect the presence of particular substances that may indicate an underlying condition that may factor into the hypertension. Generally, along with the physical examination and medical history the physician performs, blood tests and urine tests prove sufficient to make the diagnosis of hypertension. At times, however, other tests may be necessary to rule out other medical conditions or to assess possible damage from hypertension and/or its treatment. Figure 3 lists a number of tests the physician may perform:

Figure 3: Common Test Utilized for Hypertension (adapted from Rizzo, Odle & Costello, 2006, Diagnosis section, ¶ 9).

Medical or Nursing Therapies

No cure currently exists for primary hypertension, however, the correct treatment can almost always blood pressure be lowered. In treating hypertension, the physician attempts to "lower blood pressure to levels that will prevent heart disease and other complications of hypertension that could manifest in adulthood. In secondary hypertension, the disease that is responsible for the hypertension is treated in addition to the hypertension itself" (Rizzo, Odle & Costello, 2006, Treatment section, ¶ 1). When the underlying disorder is successfully treated, the secondary hypertension may simultaneously be cured.

Some treatments for hypertension considered alternative and complementary therapy, may include approaches not considered as mainstream of traditional health care. Acupuncture and biofeedback training, as well as yoga, tai chi, meditation, guided imagery, and relaxation training denote a few techniques to induce relaxation and reduce stress, and as a result may prove helpful in controlling blood pressure. "Dietary supplements, including garlic, fish oil (omega-3 fatty acids), L-arginine, soy, coenzyme Q10, phytosterols, and chelation therapy may be beneficial, but the exact nature of their effects on blood pressure is unknown" (Rizzo, Odle & Costello, 2006, Alternative Treatment section, ¶ 3). Little scientific evidence, albeit, exists to confirm that these type therapies do in fact lower blood pressure and/or prevent complications that accompany high blood pressure

Commonly Prescribed Medication

Diuretics, the oldest, least expensive class of drugs used to treat hypertension, "water pills," help the kidneys eliminate sodium and water from the body, the article, "Medications for treating hypertension," (2007) explains. When one cannot control his blood pressure by adopting healthier habits, "such as limiting salt, increasing exercise, and quitting smoking - then it's time for medications" (Medications for & #8230;2007). No one particular medication, however, suits each individual. The Mayo Clinic staff (2009) reports that a physician may initially prescribe a diuretic to treat hypertension as these medications flush excess water and sodium from the body; in turn lowering blood pressure. Along with lifestyle changes, this may control the individual's blood pressure.

Typical Dose

Vergara, Wang and Banfi (2008) report that...

In fact, few studies have been conducted with Puerto Rican participants. "Preliminary results of a double-blind, placebo controlled trial on hypertension in Hispanic-Americans support the efficacy of thiazide diuretics, such as Dyazide" (Vergara, Wang & Banfi, 2008, Treatment section, ¶ 2). Due to the increased predisposition for Hispanics to develop insulin resistance, diabetes mellitus, dyslipidemia and syndrome X, the National High Blood Pressure Education Program Working Group recommends that initially for the treatment of hypertension, the physician prescribes the lowest possible dose of thiazide diuretics or beta-blockers.
Dr. Peters prescribed Dyazide for Juan's high blood pressure. When Juan attended a follow-up checkup, after taking Dyazide for over a month, he reported he had not experienced any side effects. At this checkup, Juan's blood pressure measured within the normal range.

Common Side Effects

As treating the patient with Dyazide decreases blood volume, the person's heart has less blood to pump with each beat. Consequently, this lowers blood pressure.

Loop diuretics, which act on the part of the kidney tubules called the loop of Henle, block sodium and chloride from being reabsorbed from the tubule into the bloodstream. Thiazide diuretics act on another portion of the kidney tubules to stop sodium from re-entering circulation. Some common side effects of these medication can be weakness, confusion, potassium depletion, gout, fatigue, thirst, frequent urination, lightheadedness, muscle cramps, diarrhea or constipation, increased sensitivity to sunlight, allergic reaction in people allergic to sulfa drugs, impotence. (Medications for…2007, p. 1)

The individual taking Dyazide would need to report any significant side effects to his physician immediately.

Purpose and Common Interactions/Symptoms

Noreen Kassem (2009), a physician in training from Vancouver, Canada, stresses that medications are needed when diet and lifestyle changes alone do not control hypertension or when hypertension advances to dangerous stages. In the journal publication, "Medications for high blood pressure," Kassem explains that four main classes of drugs lower blood pressure. Frequently, the physician may prescribe combinations of the different classes of drugs together. Kassem explains:

Diuretics: Increase sodium and water loss through increased urination, which results in a reduction of blood volume and in turn, less pressure.

Beta blockers: Block receptors on blood vessel walls, which cause the arteries to relax and reduces the force of heart contraction.

Calcium channel blockers: Block passage of calcium into cell walls, which hinders constriction of the blood vessels.

Angiotensin-converting enzyme (ACE) inhibitors: Prevent the development of angiotensin, a substance which increases blood volume and restricts blood vessels (Kassem, 2009, p. 1).

Life Style Changes

Health promotion/Appropriate Activities

Rizzo, Odle & Costello (2006) explain that dietary guidelines are individualized, depending on the age and lifestyle of the patient. Healthcare providers regularly recommend the following low-fat dietary guidelines:

Total fat intake should be limited to 30% or less of total calories the person consumes daily.

Calories consumed as saturated fat should not exceed 8 to 10% of total calories the person consumes per day.

Total cholesterol intake should be limited to less than 300 mg/dl each day.

Elevated blood pressure may also be reduced by a diet that accentuates fruits, vegetables, and low-fat dairy foods, also low in saturated fat, total fat, and cholesterol. "The DASH diet is recommended for patients with hypertension and includes whole grains, poultry, fish, and nuts. Fats, red meats, sodium, sweets, and sugar-sweetened beverages are limited. Sodium should also be reduced to no more than 1,500 milligrams per day" (Rizzo, Odle & Costello, 2006, Nutritional Concerns section, ¶ 1-3). Dr. Peters provided a copy of the DASH diet to Juan and recommended he decrease his intake of hot dogs, as well as consider the ingredients and calories of the hot dogs he ate.

Along with changing his diet, Juan and Celia have started walking a minimum of two miles, five days each week, in the evening after their dinner. Juan also asked Celia to help him more in the management aspect of their family hot dog business. Celia's help in this area has, in turn lowered Juan's stress level. Juan, in line with the DASH diet, reduced his intake of fatty foods. Now, instead of eating his favorite, "Juan's Dogs," he eats, "Juan's Healthy Heart Dogs." He continues to smoke but has cut down from two packs to 1/2 pack of cigarettes a day. He is scheduled to attend a Stop Smoking Clinic during the next month. Juan has also learned to trust and respect Dr. Peters, his family…