lecture recording on 25 February 2025 at 18.12.45 PM

Overview of Hypertension and Treatment

• Hypertension Definition: High blood pressure, often with unknown causes (primary hypertension).

• Prevalence: Approximately 75 million people in the U.S. have high blood pressure.

Types of Hypertensive Medications

• Medication Initiation: Starts with 2 or more visits and specific blood pressure readings.

• Classes of Medications:

  • Adrenergic Drugs: 5 subcategories including clonidine and methyldopa.

  • Alpha Blockers: Indications for BPH (Benign Prostatic Hyperplasia) such as doxazosin, oral drugs for blood pressure management.

  • Beta Blockers: Medications like metoprolol and atenolol, contraindicated in asthma patients.

  • ACE Inhibitors: First-line treatment for hypertension; examples include lisinopril.

  • ARBs (Angiotensin II Receptor Blockers): Alternative to ACE inhibitors, often better tolerated.

  • Calcium Channel Blockers: Commonly used; amlodipine is an example.

Mechanisms of Action

• ACE inhibitors: Block the renin-angiotensin-aldosterone system, reducing workload on the heart and protecting kidneys.

• Beta Blockers: Reduce heart rate and blood pressure demand.

• Calcium Channel Blockers: As vasodilators, they decrease blood pressure and treat angina.

Common Side Effects

• ACE Inhibitors: Dry cough, angioedema, hyperkalemia.

• ARBs: Chest pain, hypotension ( overdose potential).

• Beta Blockers: Orthostatic hypotension, fatigue, bradycardia, potential elevation of blood sugar levels.

• Calcium Channel Blockers: Peripheral edema, constipation.

Patient Monitoring and Education

• Self-Monitoring: Patients should monitor their own blood pressure.

• Dietary Recommendations: Low-sodium diet, fluid management with diuretics.

• Lifestyle Changes: Weight management, stress reduction, avoidance of smoking and excessive alcohol consumption.

• Medication Adherence: Educate on continuous use unless directed otherwise by a healthcare provider.

Key Takeaways for Nursing Care

• Check vitals and potential drug interactions before administering medications.

• Identify contraindications such as asthma for beta blockers and monitor potassium levels for ACE inhibitors.

• Educate patients about the importance of dietary and lifestyle modifications to complement medication efficacy.

Overview of Hypertension and Treatment

Hypertension Definition:

Hypertension, commonly referred to as high blood pressure, is a chronic medical condition where the blood pressure in the arteries is consistently elevated. It is often categorized as primary hypertension when the cause is unknown, whereas secondary hypertension can result from another underlying condition or medication.

Prevalence:

Approximately 75 million adults in the United States have high blood pressure, representing about one in three adults. This condition can lead to serious health complications if not managed properly, including heart disease, stroke, and kidney failure.

Types of Hypertensive Medications

Medication Initiation:

The initiation of antihypertensive medication typically involves an evaluation after at least two separate visits to monitor blood pressure readings, which should ideally be taken under standardized conditions to ensure accuracy.

Classes of Medications:

• Adrenergic Drugs: These drugs have five subcategories, including centrally acting agents such as clonidine and methyldopa, which decrease sympathetic outflow and lower blood pressure.

• Alpha Blockers: Primarily indicated for patients with Benign Prostatic Hyperplasia (BPH), examples include doxazosin, which also has oral forms for managing blood pressure.

• Beta Blockers: Medications such as metoprolol and atenolol reduce heart rate and myocardial oxygen demand but are contraindicated in patients with asthma or certain types of heart block due to their bronchoconstrictive properties.

• ACE Inhibitors: Considered first-line treatment for hypertension, examples like lisinopril inhibit the angiotensin-converting enzyme, thereby lowering blood pressure and providing renal protection.

• ARBs (Angiotensin II Receptor Blockers): These serve as alternatives to ACE inhibitors for patients who may experience side effects; common examples include losartan and valsartan.

• Calcium Channel Blockers: Frequently prescribed, these medications, such as amlodipine, relax blood vessels and reduce heart workload by preventing calcium from entering cells of the heart and blood vessel walls.

Mechanisms of Action:

• ACE Inhibitors: Block the renin-angiotensin-aldosterone system (RAAS), resulting in decreased blood volume and lower blood pressure, which reduces the workload on the heart and provides kidney protection.

• Beta Blockers: Primarily work by decreasing heart rate and contractility, ultimately reducing cardiac output and lowering blood pressure.

• Calcium Channel Blockers: Function as vasodilators that lower blood pressure by relaxing the smooth muscles of the arterial walls and alleviating angina by improving blood flow to the heart.

Common Side Effects:

• ACE Inhibitors: May cause a persistent dry cough, angioedema (swelling), and hyperkalemia (elevated potassium levels).

• ARBs: While generally well-tolerated, they can lead to side effects such as chest pain and hypotension, especially in overdose scenarios.

• Beta Blockers: Patients may experience orthostatic hypotension, fatigue, bradycardia (slow heart rate), and potential elevations in blood sugar levels, particularly in diabetic patients.

• Calcium Channel Blockers: Commonly associated with peripheral edema (swelling in extremities) and constipation.

Patient Monitoring and Education:

• Self-Monitoring: Patients are encouraged to regularly monitor their own blood pressure to track their condition effectively.

• Dietary Recommendations: A low-sodium diet is strongly advised, along with fluid management potentially involving diuretics to alleviate pressure on the cardiovascular system.

• Lifestyle Changes: Important changes include weight management strategies, stress reduction techniques, and avoiding smoking or excessive alcohol use.

• Medication Adherence: Patients should be educated on the continuous use of medication, emphasizing the importance of compliance unless directed otherwise by a healthcare provider.

Key Takeaways for Nursing Care:

• Always check vital signs and assess for potential drug interactions prior to administering medications.

• Identify contraindications specific to each medication, such as avoiding beta blockers in patients with asthma and monitoring potassium levels in those taking ACE inhibitors.

• Patient education is pivotal, focusing on dietary modifications and lifestyle changes that not only enhance the effectiveness of medications but also improve overall health outcomes.