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Transcript of Hypertension
African-American adults and older adults
Do not respond with ACEI monotherapy, but do respond when taken with diuretic.
Not given during pregnancy due to reduction of placental blood flow.
Not to be taken with K+ sparing diuretics due to elevated K+ levels.
Usually taken with food due to possible GI upset.
Constant, irritating cough, insomnia, dizziness, headache, tachycardia, &
Angiotensin-Converting Enzyme (ACE) Inhibitors
Alpha-Adrenergic Blockers (Alpha Blockers)
Sodium and water retention, peripheral edema, dry mouth, bradycardia
Diuretics are frequently prescribed to avoid fluid retention.
Avoid abruptly stopping drug.
Rebound hypertension may result.
Impaired liver function
Centrally Acting Alpha2 Agonists
Centrally acting alpha2 agonists
Alpha1- and beta1-adrenergic blockers
Physiologic Risk Factors
that Contribute to Hypertension
Internal Regulators of Blood Pressure
Hypertension is an increase in blood pressure such that the systolic pressure is greater than 140 mmHg and the diastolic is greater than 90 mmHg.
The kidneys and blood vessels strive to regulate and maintain a 'normal' blood pressure. The kidneys regulate blood pressure via the renin-angiotensin-aldosterone system.
Renal System: If the kidneys decrease in blood flow, or the pressure decreases, the kidney will retain water and sodium. BP will increase because of the fluid being retained (where ever sodium goes…water follows)….this will activate the renin-angiotensin-aldosterone mechanism.
Renin (from the renal cells) stimulates production of angiotensin II (a potent vaso-constrictor), which causes a release of aldosterone (adrenal hormone that promotes sodium retention & water retention). This retention of sodium & water causes fluid volume to increase, elevating blood pressure.
Sensory receptors are located in various tissues and act in different ways to try to maintain the body’s balance and meet the different needs it has to do so with HR, BP, fluid control, hormones.
Baroreceptors: These are located in the arch of the aorta at the origin of the internal carotids. These baroreceptors are stimulated when the arterial walls are stretched by increase BP…stimulation of the baroreceptors causes them to send a message to inhibit the effects of the vasomotor center (located in the pons and medulla) and BP starts to go back down.
Peripheral Chemoreceptors: these are receptors that are sensitive to hypoxemia (decreased partial pressure of arterial oxygen PaO2). When stimulated, these receptors will send impulses along the vagus nerves to activate vasoconstriction to elevated BP.
ADH (Antidiuretic Hormone), ANP (atrial natriuretic hormone) & BNP (brain natriuretic hormone) also assist with blood pressure regulation. ADH stimulates the kidneys to conserve and retain water when there is a fluid volume deficit. When there is an overload, ADH secretion is inhibited, and the kidneys excrete more water.
Emotional behaviors, limited physical activity, hypothermia (decreased metabolic demand), hyperthermia (increased metabolic demand), family history of hypertension, hyperlipidemia, African-American background, diabetes, obesity, aging, stress, excessive smoking, excessive sodium intake, and lack of non-pharmacologic control of hypertension.
Guidelines for Determining Hypertension
Pharmacologic Control of Hypertension
Angiotensin II receptor blockers
Calcium channel blockers
Promotes sodium depletion, which decreases extra cellular fluid volume.
Blocks the alpha-adrenergic receptors, resulting in vasodilation and decreased blood pressure.
Helps maintain renal blood flow. They also decrease LDL and increase HDL.
Beta Blockers reduce cardiac output by diminishing the sympathetic nervous system response.
With continued use, vascular resistance is diminished, and blood pressure is lowered.
Beta blockers block beta1 receptors, decreasing heart rate, contractility, and renin release; lowering blood pressure.
Take baseline vital signs (BP & Pulse)
Check all lab values
Check blood sugar levels
Teach client nonpharmocologic measures to decrease BP
Instruct client on medication side effects (sexual dysfunction, orthostatic hypotension, GI upset, dizziness, BP changes)
Instruct client how to take blood pressure & pulse readings at home
Teach medication compliance
Teach client not to abruptly stop taking beta blockers, as rebound hypertension may occur.
Decrease the sympathetic response from the brain stem to the peripheral vessels & stimulate the Alpha 2 receptors, which decreases sympathetic activity. This decreases cardiac output, serum epinephrine, norepinephirine, and renin release. This all leads to reduced peripheral vascular resistance and increased vasodilation.
Methyldopa, Clonidine, Guanabenz & Guanfacine
Check baseline vital signs
Check urinary output (30 ml/hr)
Teach medication side effects
Instruct client to limit
Watch for peripheral edema
Inhibits the formation of angiotens II (vasoconstrictor) and blocks the release of aldosterone (allowing for sodium & water excretion, sparing potassium).
Calcium Channel Blockers
Avoid ingestion of grapefruit juice; could intensify drug effect. Obtain baseline vital signs, watch for peripheral edema, monitor O2 levels, and teach client side effects of medication.
Calcium is found in the myocardium (heart muscle) and vascular smooth muscle. Calcium increases muscle contractility, peripheral resistance, and blood pressure. Calcium channel blockers decrease the calcium levels and promote vasodilation.
NCLEX Practice Questions
NCLEX Practice Question 1
A client's blood pressure (BP)is 145/90. According to the guidelines for determining hypertension, the realizes that the client's BP is at which stage?
Question 1 Answer
C. Stage 1 hypertension
Rationale: Stage 1 hypertension is 140-159 systolic & 90-99 diastolic
c. Stage 1 hypertension
d. Stage 2 hypertension
NCLEX Practice Question 2
Captopril (Capoten) has been ordered for a client. The nurse teaches the client that ACE inhibitors have which common side effects?
D Constant, irritating cough.
a. Nausea & vomiting
b. Dizziness & headaches
c. Upset stomach
d. Constant, irritating cough
Question 2 Answer
Rationale: A constant irritating cough is a primary side effect of ACE inhibitors.