D115 Unit 5: Hypertension and Cardiovascular Conditions Review

Grace J.
January 2, 2026January 2, 2026
D115, MSN, Western Governors University

Student Name

Western Governors University

D115 Advanced Pathophysiology for the Advanced Practice Nurse

Prof. Name

Date

Hypertension

What is Hypertension?

Hypertension is characterized by a persistent elevation in systemic arterial blood pressure. According to the 2014 guidelines, hypertension is diagnosed when systolic blood pressure is 140 mmHg or higher, or diastolic blood pressure is 90 mmHg or higher. The 2017 updated guidelines lowered these thresholds to a systolic pressure of 130 mmHg or above and a diastolic pressure of 80 mmHg or above, reflecting growing evidence on cardiovascular risk at lower blood pressure levels.

What is the Epidemiology of Hypertension?

Hypertension is the most prevalent primary diagnosis in the United States, affecting a significant portion of the population. Approximately 95% of hypertension cases are classified as primary (essential) hypertension, where no specific cause can be identified. Secondary hypertension, accounting for roughly 5% of cases, is due to underlying conditions such as kidney disease.

What Types of Hypertension Exist?

Type	Characteristics	Cause	Outcome
Primary (Essential)	No identifiable cause; caused by genetic and environmental factors	Genetic and environmental interactions	Leads to increased vascular tone and blood volume, causing sustained high blood pressure
Secondary	Resulting from specific disease (e.g., renal disorders)	Increased peripheral resistance or cardiac output	Potentially reversible with early treatment

What Are the Risk Factors for Primary Hypertension?

Risk factors are divided into three broad categories:

Nonmodifiable: Age, ethnicity, family history, and genetic predisposition.
Socioeconomic and Behavioral: Low education levels, socioeconomic status, tobacco use, stress, and conditions such as obstructive sleep apnea.
Dietary and Metabolic: High intake of sodium and fats, obesity, and glucose intolerance.

These factors are also significant contributors to cardiovascular disease risk.

What is the Pathophysiology of Hypertension?

Hypertension results from increased cardiac output, increased total peripheral resistance, or both. Persistent high blood pressure can cause damage to vital organs over time.

What are the Clinical Manifestations of Hypertension?

Hypertension is often called the “silent disease” because it usually lacks symptoms initially. Symptoms appear when target organs are affected and may include coronary heart disease, heart failure, kidney failure, stroke, cognitive impairment, visual disturbances, edema, or vascular occlusions.

How is Hypertension Diagnosed?

Diagnosis requires blood pressure measurement on at least two separate occasions, averaging two readings taken two minutes apart. Proper measurement technique is critical—patients should be seated comfortably, with the arm at heart level, rested, and without recent caffeine or smoking.

How is Hypertension Managed?

Management involves lifestyle changes such as diet modification, exercise, and stress reduction. Pharmacologic treatment is guided by the severity of hypertension and current clinical guidelines.

Metabolic Syndrome

What is Metabolic Syndrome?

Metabolic syndrome is a constellation of metabolic abnormalities that greatly increase the risk of developing type 2 diabetes and cardiovascular diseases.

What are the Components of Metabolic Syndrome?

Component
Central (abdominal) obesity
Dyslipidemia
Prehypertension
Elevated fasting blood glucose

What is the Epidemiology of Metabolic Syndrome?

The syndrome may begin in childhood and is common among sedentary adults and overweight youth, highlighting the importance of early detection and intervention.

How is Metabolic Syndrome Managed?

Routine screening and early identification are critical. Management focuses on aggressive lifestyle modifications, emphasizing weight loss, a healthy diet, and increased physical activity.

Deep Vein Thrombosis (DVT)

What is Deep Vein Thrombosis?

DVT is a venous thrombus that remains attached to the vessel wall, predominantly occurring in the lower extremities.

What are the Risk Factors for DVT?

Risk Factor
Hospitalization
Trauma
Orthopedic surgery
Age over 60
Pregnancy
Malignancy
Inherited thrombophilias (e.g., Factor V Leiden)

What is the Pathophysiology of DVT?

DVT develops through venous stasis, endothelial injury, and a hypercoagulable state, collectively known as Virchow’s triad. Clot formation progresses, especially near venous valves.

What are the Clinical Manifestations of DVT?

DVT may be asymptomatic but can present with unilateral limb pain, swelling, dilated superficial veins, or skin discoloration.

How is DVT Diagnosed?

A D-dimer test, which is highly sensitive but not specific, is often the initial screening tool. Definitive diagnosis is made with compression Doppler ultrasound.

What are the Prevention and Treatment Strategies for DVT?

Prevention includes early mobilization and use of compression devices in high-risk patients. Treatment involves anticoagulation therapy tailored to the patient’s risk profile.

Angina Pectoris

What is Angina Pectoris?

Angina pectoris is chest pain resulting from myocardial ischemia.

What Types of Angina Exist?

Type	Description	Clinical Features	Treatment
Stable Angina	Predictable and occurs with exertion	Relieved by rest; no myocardial necrosis	Lifestyle changes, nitrates
Unstable Angina	Occurs at rest or with increasing frequency	Associated with plaque rupture; risk of MI	Urgent medical treatment
Prinzmetal (Variant) Angina	Caused by coronary vasospasm	Occurs at rest, often nocturnal	Calcium channel blockers, nitrates

Heart Failure

What is Heart Failure?

Heart failure is the inability of the heart to maintain adequate cardiac output or filling pressures.

What are the Types of Heart Failure?

Type	Features
Left-sided Systolic (HFrEF)	EF < 40%, impaired myocardial contractility
Left-sided Diastolic (HFpEF)	Normal EF, impaired relaxation of the heart
Right-sided Heart Failure	Usually secondary to left-sided failure; causes systemic venous congestion

Cardiogenic Shock

What is Cardiogenic Shock?

Cardiogenic shock is a condition where the heart fails to pump enough blood despite normal filling pressures.

What are the Clinical Features of Cardiogenic Shock?

Symptoms include hypotension, tachycardia, dyspnea, and reduced organ perfusion leading to potential multi-organ failure.Hypoplastic Left Heart Syndrome (HLHS)

What is HLHS?

HLHS is a congenital defect characterized by underdevelopment of the left heart structures, resulting in insufficient systemic blood flow.

How Does HLHS Present?

Infants may appear normal at birth but rapidly deteriorate once the ductus arteriosus closes.

How is HLHS Managed?

Treatment involves prostaglandin infusion to keep the ductus arteriosus open, followed by staged surgical palliation through Norwood, Glenn, and Fontan procedures.

Hematologic Disorders

What are Some Key Hematologic Disorders?

Disorder	Description	Key Features
Sickle Cell Disease	Autosomal recessive hemoglobinopathy causing vaso-occlusion and hemolysis	Chronic organ damage due to sickled RBCs
Disseminated Intravascular Coagulation (DIC)	Systemic activation of coagulation and fibrinolysis	Leads to simultaneous thrombosis and bleeding
Pernicious Anemia	Vitamin B12 deficiency due to intrinsic factor loss	Causes megaloblastic anemia and neurologic symptoms
Iron Deficiency Anemia	Most common anemia worldwide, caused by blood loss or poor intake	Microcytic, hypochromic red blood cells

What Are Leukemias?

Type	Characteristics	Common Demographics
Acute Leukemias	Proliferation of immature blasts	ALL in children; AML in adults
Chronic Leukemias	Involvement of more mature cells	CLL characterized by smudge cells and immune dysfunction

Myocardial Infarction

What is a Myocardial Infarction?

Myocardial infarction (MI) occurs due to prolonged ischemia leading to myocardial cell death.

What are the Types of MI?

Type	Description
STEMI	Transmural infarction involving full thickness of myocardium
NSTEMI	Subendocardial infarction affecting inner myocardial layers

How is MI Diagnosed?

Diagnosis relies on elevated troponin levels and characteristic ECG changes.

What is the Management of MI?

Immediate reperfusion via percutaneous coronary intervention (PCI) or thrombolytics is essential. Antiplatelet and anticoagulant therapies are standard, along with long-term risk factor modification.

Neurologic Disorders

What are Important Concepts in Neurologic Disorders?

Cerebral perfusion pressure (CPP) equals mean arterial pressure (MAP) minus intracranial pressure (ICP). Elevated ICP reduces brain perfusion, leading to brain injury. Brainstem damage impacts consciousness and vital autonomic functions.

What Are Major Neurologic Conditions?

Some critical neurologic disorders include locked-in syndrome, subarachnoid hemorrhage, spinal cord injury with autonomic dysreflexia, cerebral edema and herniation, seizures, epilepsy, delirium, and dementia.

References

American College of Cardiology/American Heart Association Task Force. (2017). 2017 ACC/AHA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Journal of the American College of Cardiology, 71(19), e127-e248.

James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J., … & Ortiz, E. (2014). 2014 evidence-based guideline for the management of high blood pressure in adults. JAMA, 311(5), 507-520.