Hypertension Drug Therapy

Drug Therapy for Hypertension

• Chapter 19 and 22 contains key information.
• Objectives include discussing how antihypertensive drugs lower blood pressure.
• Objectives also include discussing different drugs classes, adverse effects, nursing considerations, and patient teaching.

General Teaching Points

• Take medications on a regular schedule.
• Check blood pressure weekly.
• Change positions slowly.
• Dizziness may occur.
• Follow non-pharmacological recommendations for hypertension.
• Inform the provider about pregnancy or intent to become pregnant.

Classes of Antihypertensive Drugs

• Diuretics
• Angiotensin-Converting Enzyme (ACE) Inhibitors
• Angiotensin II Receptor Blockers (ARBS)
• Calcium Channel Blockers
• Beta Blockers
• Alpha Blockers
• Alpha-Beta Blockers
• Central Acting Adrenergic
• Direct Vasodilators

Diuretics

• Examples include bumetanide, furosemide, hydrochlorothiazide and spironolactone.
• Hydrochlorothiazide is commonly used.

Renin-Angiotensin-Aldosterone System (RAAS)

• Angiotensinogen converts to Angiotensin I via renin.
• Angiotensin I converts to Angiotensin II via ACE.
• Angiotensin II leads to sodium reabsorption, vasoconstriction, and norepinephrine release.

Angiotensin-converting Enzyme (ACE) Inhibitors

• Examples include benazepril, captopril, enalapril, lisinopril, and ramipril.
• Mode of action involves blocking the conversion of angiotensin I to angiotensin II.
• Adverse effects include cough, hyperkalemia, and angioedema.
• Angioedema is swelling in the deep layers of the skin and other tissues.
• Eyes, lips, mouth, tongue, genitals, hands, and feet may be affected.

Angiotensin II Receptor Blockers (ARBS)

• Valsartan is an example.
• They block the effects of angiotensin II.
• Renal dysfunction and hyperkalemia are adverse effects.

Calcium Channel Blockers

• Non-dihydropyridines include diltiazem and verapamil.
• Dihydropyridines include amlodipine, felodipine and nifedipine.
• Mode of action includes slowing calcium movement in the heart and blood vessels.
• Dizziness is an adverse effect.
• Bradycardia occurs with non-dihydropyridines.
• Peripheral edema occurs with dihydropyridines.

Beta Blockers

• Atenolol, bisoprolol, metoprolol and propranolol are examples.
• Mode of action involves blocking epinephrine and norepinephrine in the sympathetic nervous system.
• Adverse effects include bradycardia, bronchospasm, fatigue and depression.
• Beta1 blockers mainly affect the heart.
• Beta2 blockers mainly affect the lungs.

Alpha Blockers

• Examples include doxazosin, prazosin and terazosin.
• Mode of action is to prevent stimulation of alpha-1 receptors on arteries and smooth muscle.
• Adverse effects include orthostatic hypotension, reflex tachycardia, and nasal congestion.

Alpha-Beta Blockers

• Examples include carvedilol and labetalol.
• Adverse effects are similar to alpha and beta blockers.

Central-Acting Adrenergics

• Examples include clonidine and methyldopa.
• They block sympathetic responses within the brainstem.
• Adverse effects include sedation and drowsiness.
• Dry mouth and rebound hypertension can occur.

Direct Vasodilators

• Hydralazine and nitroprusside are examples.
• They directly cause peripheral vasodilation.
• Adverse effects include reflex tachycardia, edema, and lupus-like syndrome.

Lifespan Considerations

• Safety is unknown for most drug classes in pediatrics.
• Generally, methyldopa and labetalol are safe during pregnancy and breastfeeding.
• Labetalol, hydralazine and nifedipine are first line for preeclampsia.
• Older adults are more sensitive to side effects.

This lesson covers drug therapy for hypertension, including different drug classes such as diuretics, ACE inhibitors, ARBs, calcium channel blockers, and beta blockers. It also discusses adverse effects, nursing considerations, and patient teaching. General teaching points such as taking medications regularly and checking blood pressure weekly are also discussed.