CH. 50 Antihypertensives

Classification of BP 

• Normal: Systolic BP below 120 mm Hg and diastolic BP below 80 mm Hg

• Elevated: Systolic BP of 120 to 129 mm Hg to and diastolic BP greater than 80 mm Hg

• Hypertension 

• Stage 1: Systolic BP of 130  to 139 mm Hg to or diastolic BP greater than 80 to 89 mm Hg

• Stage 2: Systolic BP greater than 140 mm Hg to or diastolic BP greater than 90 mm Hg

Types of Hypertension 

• Primary (essential): No identifiable cause, chronic progressive disorder 

• Population: older adults, african americans, postmenopausal women

• Treated but not cured

• Secondary: identifiable primary cause

• Possible to treat cause directly

• Some individuals can be cured

Consequences of hypertension 

• Heart disease: MI, HF, angina pectoris

• Kidney disease

• Stroke 

Considerations for hypertension 

• Benefits of lowering blood pressure

• Patient evaluation: 

• is it primary (essential) or secondary 

• What factors increase cardiovascular risk

• Diagnostic tests

• lifestyle changes:

• Sodium restriction

• DASH (dietary approach to stop hypertension)

• Alcohol restriction

• aerobic exercise

• smoking cessation

• Maintenance of potassium and calcium intake 

Classes of antihypertensive drugs  

• Diuretics: Loop, Thiazide, Potassium-sparing

• Sympatholytics: (antiadrenergic drugs): Beta-adrenergic blockers, alpha 1 blockers, beta blockers, alpha 1 antagonists, adrenergic neuron blockers

• Direct-acting vasodilators: hydralazine and minoxidil

• Calcium channel blockers

• Drugs that suppress RASS: ace inhibitors, angiotensin 2 receptor blockers, aldosterone antagonists, direct renin inhibitors (type 2 diabetes mellitus precautions)

Antihypertensive drugs for pregnancy

• Chronic hypertension: Ace inhibitors, ARB’s (angiotensin receptor blockers) and DRI’s (direct renin inhibitors) are contraindicated 

• Preeclampsia and eclampsia: hydralazine and magnesium sulfate (anticonvulsant)