Hypertension (Week 6 Perfusion)

Drug Therapy: Direct Vasodilators

Hydralazine

• IV push used PRN for hypertensive crisis (SBP > 160 mmHg), not used as monotherapy for HTN management

Nitroglycerine

• Sublingual tablet or spray for acute coronary syndromes/MI, sometimes used IV in ICU for hypertensive crisis

Drug Therapy: Beta Blockers

Metoprolol, Atenolol, Propranolol, Labetalol, Carvedilol

• Blocks beta adrenergic receptors (Beta-1 = heart) to slow heart rate, decrease contraction force

• Suppresses renin activity in kidneys, promoting vasodilation and decreased vascular resistance

• Stopping medication suddenly may cause rebound hypertension

• Monitor both HR and BP, do not administer for HR <60 or SBP <90-100 (per provider order)

• Non-cardio-selective beta-blockers (Propranolol) are contraindicated in asthma (block Beta-2 receptors in lungs)

Drug Therapy: Angiotensin-Converting Enzyme (ACE) Inhibitors

Benazepril, Captopril, Enalapril, Lisinopril

-pril

• Prevent conversion of angiotensin I to angiotensin II (key enzyme in regulation of blood pressure), which prevents vasoconstriction and sodium/water retention

• Dilates blood vessels, increases amount of blood pumped to the heart and decreases oxygen demand of the heart

• Increases peripheral blood flow

• Monitor for hypotension, orthostatic hypotension, renal function, hyperkalemia

• Persistent dry cough

• Angioedema (swelling of the face and airway) is a severe adverse effect and emergency

Drug Therapy: Angiotensin II Receptor Blocker (ARB)

Losartan, Valsartan

-sartan

• Clients who reported cough with ACE inhibitor may be switched to an ARB

• Combining an ACEI with an ARB may adversely affect renal function

• Patient education: change position slowly, report findings of angioedema, edema, will require monitoring of potassium levels, effects may take 3-6 weeks

Drug Therapy: Thiazide diuretics

Hydrochlorothiazide can cause hypokalemia

and hypercalcemia

Drug Therapy: Loop Diuretics

Furosemide can cause hypokalemia, greater

diuretic effect than thiazides but shorter duration

Drug Therapy: Potassium-sparing diuretics

Spironolactone can cause hyperkalemia

Diuretics Nursing Care

Monitor: K, Na, & Ca levels, V/S, orthostatic hypotension, assess

for muscle weakness, irregular pulse, dehydration, I&O

Hypertension Diet

1. fruits

2. veggies

3. fat-free or low-fat milk

4. whole grains

5. fish

6. poultry

7. beans

8. seeds

9. nuts

10. low sodium

11. low fat (saturated and cholesterol)

12. limit alcohol

S/S of prolonged or acute hypertension:

• Bounding pulses

• Headache

• Facial Flushing

• Dizziness

• Fainting

• Retinal/vision changes

• Nocturia

• Proteinuria

• Long term: PAD, CAD, MI, HF, TIA, CVA

Why is the bottom number, diastole, important?

The force of the heart’s contraction alone would not be

able to pump blood throughout the entire vascular system.

Arterial muscle tone acts as a “push” as blood stretches

the walls of the arteries and they contract using elastic

force (much like peristalsis in the GI tract), aiding the

forward propulsion of blood. If the arteries are too

contracted, blood has to work against increased

pressure... but if they’re too floppy then there is not as

much elastic stretch and contraction to help blood move

forward

Primary Hypertension

elevated BP without an identified cause

Secondary Hypertension

clinical findings relate to underlying cause; we know why BP is high

Elevated BP range

SBP: 120-129

DBP: <80

Hypertension Stage 1 BP Ranges

SBP: 130-139

DBP: 80-89

Hypertension Stage 2 BP Range

SBP: >140

DBP: >90