6 Hypertension Nursing Care Plans


Your nursing care planning guide includes 6 nursing diagnoses for hypertension (HTN). Get to know the common nursing diagnosis for hypertension, nursing assessment, nursing interventions, and rationale, including teaching and goals. 

What is Hypertension? 

Hypertension is the term used to describe high blood pressure. Hypertension is repeatedly elevated blood pressure exceeding 140 over 90 mmHg. It is categorized as primary or essential (approximately 90% of all cases) or secondary due to an identifiable, sometimes correctable pathological condition, such as renal disease or primary aldosteronism.

Classifications of Hypertension

The American College of Cardiology and American Heart Association published new guidelines (as of 2018) and ways to categorize blood pressure. 

Normal: Less than 120/80 mmHg; 
Elevated: Systolic between 120-129 and diastolic less than 80; 
Stage 1: Systolic between 130-139 and diastolic 80-89
Stage 2: Systolic 140 or higher and diastolic at 90 or higher. 
Hypertensive Crisis: Higher than 180 for systolic and diastolic higher than 120.
Classification of blood pressure for adults.

Nursing Care Plans

Nursing care planning goals for hypertension include lowering or controlling blood pressure, adherence to the therapeutic regimen, lifestyle modifications, and prevention of complications.

Here are six nursing diagnoses for hypertension nursing care plans

  1. Risk for Decreased Cardiac Output
  2. Decreased Activity Tolerance
  3. Acute Pain
  4. Ineffective Coping
  5. Overweight
  6. Deficient Knowledge
  7. Other possible nursing care plans

Risk for Decreased Cardiac Output

Blood pressure is the product of cardiac output multiplied by peripheral resistance. Hypertension can result from an increase in cardiac output (heart rate multiplied by stroke volume), an increase in peripheral resistance, or both.

Nursing Diagnosis

Risk factors may include

The following are the common related factors for the nursing diagnosis risk for decreased cardiac output secondary to hypertension:

  • Increased vascular resistance, vasoconstriction
  • Myocardial ischemia
  • Myocardial damage
  • Ventricular hypertrophy/rigidity

Possibly evidenced by

  • Not applicable. Existence of signs and symptoms establishes an actual nursing diagnosis.

Goals and desired outcomes

Below are the common expected outcomes for decreased cardiac output secondary to hypertension:

  • Patient will participate in activities that reduce BP/cardiac workload.
  • Patient will maintain BP within individually acceptable range.
  • Patient will demonstrate stable cardiac rhythm and rate within patient’s normal range.
  • Patient will participate in activities that will prevent stress (stress management, balanced activities and rest plan).

Nursing Assessment and Rationale

Here are the nursing assessments for the nursing diagnosis risk for decreased cardiac output secondary to hypertension.

1. Review clients at risk as noted in Related Factors and individuals with conditions that stress the heart.
Persons with acute or chronic conditions may compromise circulation and place excessive demands on the heart.

2. Check laboratory data (cardiac markers, complete blood cell count, electrolytes, ABGs, blood urea nitrogen and creatinine, cardiac enzymes, and cultures, such as blood, wound, or secretions).
To identify contributing factors.

3. Monitor and record BP. Measure in both arms and thighs three times, 3–5 min apart while the patient is at rest, then sitting, then standing for initial evaluation. Use correct cuff size and accurate technique. Comparison of pressures provides a complete picture of vascular involvement or the scope of the problem. Severe hypertension is classified in adults as a diastolic pressure elevation of 110 mmHg; progressive diastolic readings above 120 mmHg are considered first accelerated, then malignant (very severe). Systolic hypertension is also an established risk factor for cerebrovascular disease and ischemic heart disease when elevated diastolic pressure. See updated guidelines for classifying hypertension above

4. Note the presence, and quality of central and peripheral pulses.
Bounding carotid, jugular, radial, and femoral pulses may be observed and palpated. Pulses in the legs and feet may be diminished, reflecting the effects of vasoconstriction (increased systemic vascular resistance [SVR]) and venous congestion.

5. Auscultate heart tones and breath sounds.
S4 heart sound is common in severely hypertensive patients because of atrial hypertrophy (increased atrial volume and pressure). Development of S3 indicates ventricular hypertrophy and impaired functioning. The presence of crackles and wheezes may indicate pulmonary congestion secondary to developing or chronic heart failure.

6. Observe skin color, moisture, temperature, and capillary refill time.
The presence of pallor; cool, moist skin; and delayed capillary refill time may be due to peripheral vasoconstriction or reflect cardiac decompensation and decreased output.

7. Note dependent and general edema.
May indicate heart failure, renal, or vascular impairment.

8. Evaluate client reports or evidence of extreme fatigue, intolerance for activity, sudden or progressive weight gain, swelling of extremities, and progressive shortness of breath.
To assess for signs of poor ventricular function or impending cardiac failure.

Nursing Interventions and Rationales

Here are the therapeutic nursing interventions for the nursing diagnosis risk for decreased cardiac output secondary to hypertension.

1. Provide calm, restful surroundings, and minimize environmental activity and noise. Limit the number of visitors and length of stay.
It helps lessen sympathetic stimulation; promotes relaxation.

2. Maintain activity restrictions (bedrest or chair rest); schedule uninterrupted rest periods; assist patient with self-care activities as needed.
Lessens physical stress and tension that affect blood pressure and the course of hypertension.

3. Provide comfort measures (back and neck massage, the elevation of head).
Decreases discomfort and may reduce sympathetic stimulation.

4. Instruct in relaxation techniques, guided imagery, and distractions.
Can reduce stressful stimuli, and produce a calming effect, thereby reducing BP.

5. Monitor response to medications to control blood pressure.
Response to drug therapy (usually consisting of several drugs, including diuretics, angiotensin-converting enzyme [ACE] inhibitors, vascular smooth muscle relaxants, and beta and calcium channel blockers) is dependent on both the individual and the synergistic effects of the drugs. Because of side effects, drug interactions, and patient’s motivation for taking antihypertensive medication, it is important to use the smallest number and lowest dosage of medications.

6. Administer medications as indicated:

  • 6.1. Thiazide diuretics: chlorothiazide (Diuril); hydrochlorothiazide (Esidrix/HydroDIURIL); bendroflumethiazide (Naturetin); indapamide (Lozol); metolazone (Diulo); quinethazone (Hydromox).
    Diuretics are considered first-line medications for uncomplicated stage I or II hypertension and may be used alone or in association with other drugs (such as beta-blockers) to reduce BP in patients with relatively normal renal function. These diuretics potentiate the effects of other antihypertensive agents as well, by limiting fluid retention, and may reduce the incidence of strokes and heart failure.
  • 6.2. Loop diuretics: furosemide (Lasix); ethacrynic acid (Edecrin); bumetanide (Bumex), torsemide (Demadex).
    These drugs produce marked diuresis by inhibiting resorption of sodium and chloride and are effective antihypertensives, especially in patients who are resistant to thiazides or have renal impairment.
  • 6.3. Potassium-sparing diuretics: spironolactone (Aldactone); triamterene (Dyrenium); amiloride (Midamor).
    May be given in combination with a thiazide diuretic to minimize potassium loss.
  • 6.4. Alpha, beta, or centrally acting adrenergic antagonists: doxazosin (Cardura); propranolol (Inderal); acebutolol (Sectral); metoprolol (Lopressor), labetalol (Normodyne); atenolol (Tenormin); nadolol (Corgard), carvedilol (Coreg); methyldopa (Aldomet); clonidine (Catapres); prazosin (Minipress); terazosin (Hytrin); pindolol (Visken).
    Beta-Blockers may be ordered instead of diuretics for patients with ischemic heart disease; obese patients with cardiogenic hypertension; and patients with concurrent supraventricular arrhythmias, angina, or hypertensive cardiomyopathy. Specific actions of these drugs vary, but they generally reduce BP through the combined effect of decreased total peripheral resistance, reduced cardiac output, inhibited sympathetic activity, and suppression of renin release. Note: Patients with diabetes should use Corgard and Visken with caution because they can prolong and mask the hypoglycemic effects of insulin. The elderly may require smaller doses because of the potential for bradycardia and hypotension. African-American patients tend to be less responsive to beta-blockers in general and may require increased dosage or use of another drug (monotherapy with a diuretic).
  • 6.5. Calcium channel antagonists: nifedipine (Procardia); verapamil (Calan); diltiazem (Cardizem); amlodipine (Norvasc); isradipine (DynaCirc); nicardipine (Cardene).
    May be necessary to treat severe hypertension when a combination of a diuretic and a sympathetic inhibitor does not sufficiently control BP. Vasodilation of healthy cardiac vasculature and increased coronary blood flow are secondary benefits of vasodilator therapy.
  • 6.6. Adrenergic neuron blockers: guanadrel (Hylorel); guanethidine (Ismelin); reserpine (Serpalan).
    Reduce arterial and venous constriction activity at the sympathetic nerve endings.
  • 6.7. Direct-acting oral vasodilators: hydralazine (Apresoline); minoxidil (Loniten).
    Action is to relax vascular smooth muscle, thereby reducing vascular resistance.
  • 6.8. Direct-acting parenteral vasodilators: diazoxide (Hyperstat), nitroprusside (Nitropress); labetalol (Normodyne).
    These are given intravenously for the management of hypertensive emergencies.
  • 6.9. Angiotensin-converting enzyme (ACE) inhibitors: captopril (Capoten); enalapril (Vasotec); lisinopril (Zestril); fosinopril (Monopril); ramipril (Altace). Angiotensin II blockers: valsartan (Diovan), guanethidine (Ismelin).
    The use of an additional sympathetic inhibitor may be required for its cumulative effect when other measures have failed to control BP or when congestive heart failure (CHF) or diabetes is present.

7. Implement dietary sodium, fat, and cholesterol restrictions as indicated.
These restrictions can help manage fluid retention and, with the associated hypertensive response, decrease myocardial workload.

8. Prepare for surgery when indicated.
When hypertension is due to pheochromocytoma, removal of the tumor will correct the condition.


Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy.

NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses as reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.

Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of it’s evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions show how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care 
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health 
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.

See also

Other recommended site resources for this nursing care plan:

Other nursing care plans for cardiovascular system disorders:

References and Sources

Recommended journals, books, and other interesting materials to help you learn more about hypertension nursing care plans and nursing diagnosis:

  1. Arbour, R. (2004). Intracranial hypertension: monitoring and nursing assessmentCritical Care Nurse24(5), 19-32.
  2. Black, J. M., & Hawks, J. H. (2009). Medical-surgical nursing: Clinical management for positive outcomes (Vol. 1). A. M. Keene (Ed.). Saunders Elsevier.
  3. Chapman, J. M., & Massey Jr, F. J. (1964). The interrelationship of serum cholesterol, hypertension, body weight, and risk of coronary disease: Results of the first ten years’ follow-up in the Los Angeles Heart Study. Journal of Chronic Diseases, 17(10), 933-949.
  4. Chummun, H. (2009). Hypertension–a contemporary approach to nursing careBritish Journal of Nursing18(13), 784-789.
  5. Cohen, J. B. (2017). Hypertension in obesity and the impact of weight loss. Current cardiology reports19(10), 1-8.
  6. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2016). Nurse’s pocket guide: Diagnoses, prioritized interventions, and rationales. FA Davis.
  7. Drevenhorn, E. (2006). Counselling patients with hypertension at health centres-a nursing perspective. Inst of Health and Care Sciences.
  8. Giles, T. D., Berk, B. C., Black, H. R., Cohn, J. N., Kostis, J. B., Izzo Jr, J. L., & Weber, M. A. (2005). Expanding the definition and classification of hypertensionThe Journal of Clinical Hypertension7(9), 505-512.
  9. Gulanick, M., & Myers, J. L. (2016). Nursing Care Plans: Diagnoses, Interventions, and Outcomes. Elsevier Health Sciences.
  10. Hamilton, G. A. (2003). Measuring adherence in a hypertension clinical trialEuropean Journal of Cardiovascular Nursing2(3), 219-228.
  11. Hong, W. H. S. (2010). Evidence-based nursing practice for health promotion in adults with hypertension: a literature review. Asian Nursing Research4(4), 227-245.
  12. Johnson, F., & Wardle, J. (2011). The association between weight loss and engagement with a web-based food and exercise diary in a commercial weight loss programme: a retrospective analysisInternational Journal of Behavioral Nutrition and Physical Activity8(1), 1-7.
  13. Julius, S., Valentini, M., & Palatini, P. (2000). Overweight and hypertension: a 2-way street?. Hypertension35(3), 807-813.
  14. Julius, S., PASCUAL, A. V., Sannerstedt, R., & Mitchell, C. (1971). Relationship between cardiac output and peripheral resistance in borderline hypertension. Circulation43(3), 382-390.
  15. Sacco, M., Meschi, M., Regolisti, G., Detrenis, S., Bianchi, L., Bertorelli, M., … & Caiazza, A. (2013). The relationship between blood pressure and painThe journal of clinical hypertension15(8), 600-605.
  16. Sheps, D. S., Bragdon, E. E., Gray III, T. F., Ballenger, M., Usedom, J. E., & Maixner, W. (1992). Relation between systemic hypertension and pain perceptionThe American journal of cardiology70(16), F3-F5.



Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Finding help online is nearly impossible. His situation drove his passion for helping student nurses by creating content and lectures that are easy to digest. Knowing how valuable nurses are in delivering quality healthcare but limited in number, he wants to educate and inspire nursing students. As a nurse educator since 2010, his goal in Nurseslabs is to simplify the learning process, break down complicated topics, help motivate learners, and look for unique ways of assisting students in mastering core nursing concepts effectively.
  • Real i like the website as i’m a nursing student third year, i wish if could get an app from play store for Android, “Nurseslabs.com” with this materials care plans for different medical conditions to guide on caring patients according to standard and finally saving life of many patients through competence and experience.👊🙏

  • Hi! Its really helpful but couldn’t find any nursing interventions as assessments are not considered as an intervention!! Just a request if you could add some nursing interventions for hypertension, it’ll be great. Thank you.

  • I love your website and info provided. Please make an App for my phone/tablet as I am a PACE RN CM and could really use it for in the field.

  • I always run to you. Thank you so much.
    I’m kindly requesting you to help us with more of the nursing interventions for the different nursing diagnoses of this condition plus those of other conditions in the different care plans. May God bless you exceedingly and abundantly.

  • I am currently in nursing school and I find this information very useful it does help me out a lot and I would recommend whether you are in nursing school or in the field to use it as a refresher course

  • Thank you for this material. I am glad to learn anymore. great. do you have this material on ppt slide? would you share? thanks

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