Primary Hypertension

Primary (essential) hypertension accounts for roughly 90-95% of all hypertension cases and has no single identifiable cause. It develops from a combination of genetic predisposition, excessive sodium intake, obesity, physical inactivity, chronic stress, and aging-related arterial stiffness. Current ACC/AHA guidelines classify blood pressure as normal (<120/<80 mmHg), elevated (120-129/<80), Stage 1 hypertension (130-139 or 80-89), and Stage 2 hypertension (≥140 or ≥90). Chronic elevation damages vascular endothelium, accelerating atherosclerosis and increasing workload on the left ventricle. Target organ damage includes left ventricular hypertrophy, chronic kidney disease (monitor serum creatinine and GFR), retinopathy, and stroke. Nursing management centers on lifestyle modification teaching first — DASH diet, sodium restriction to less than 2,300 mg/day (ideally <1,500 mg/day per AHA), weight loss, regular aerobic exercise (150 min/week), limiting alcohol, and smoking cessation. Medication adherence is a core nursing concern because the disease is asymptomatic; clients frequently stop taking antihypertensives when they feel well. Teach clients to avoid abruptly discontinuing beta-blockers (rebound hypertension/tachycardia) and to monitor for orthostatic hypotension with any antihypertensive.