Questions and Answers
What are some common side effects when taking antihypertensive medications?
Patients with hypertension can stop taking their medication when they feel no symptoms.
False
What is the recommended rate for reducing systolic blood pressure in adults without a compelling condition?
No more than 25% within the first hour; then to 160/100 mm Hg within the next 2 to 6 hours.
A ______________ is a device that can be used at home for monitoring blood pressure.
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Match the following terms related to hypertension with their descriptions:
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What is one method to encourage adherence to an antihypertensive treatment plan?
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Patients are encouraged to monitor their weight for managing hypertension.
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Which of the following strategies are recommended to aid in controlling hypertension? (Select all that apply)
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What is the recommended blood pressure (BP) goal according to the American College of Cardiology (ACC) and American Heart Association (AHA)?
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Hypertension is only a concern for older adults.
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What are the pathophysiological systems that maintain blood pressure?
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The most common type of hypertension is called __________ hypertension.
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What condition is classified as a medical emergency due to severely elevated blood pressure?
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What common lifestyle change can help reduce hypertension?
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The use of diuretics is the first-line treatment for managing hypertension.
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Match the following types of antihypertensive drugs with their actions:
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Study Notes
Perfusion Concept Exemplar: Hypertension
- Hypertension, or high blood pressure (BP), is the most common health problem seen in primary care settings and can cause stroke, myocardial infarction (heart attack), kidney failure, and death if not treated early and effectively.
- Current guidelines from the American College of Cardiology (ACC) and the American Heart Association (AHA) recommend a BP below 130/80 mm Hg in all people.
- The Eighth Joint National Committee (JNC 8) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends:
- BP below 150/90 mm Hg in people 60 years and older
- BP below 140/90 mm Hg in people younger than 60 years
- Patients with a BP above these goals should be treated with medication.
- The ACC/AHA guidelines suggest that patients with BP above the goal should be treated with drug therapy and lifestyle modifications.
Mechanisms That Influence Blood Pressure
- The systemic arterial BP is a product of cardiac output (CO) and total peripheral vascular resistance (PVR).
- CO is determined by the stroke volume (SV) multiplied by heart rate (HR).
- Control of PVR is maintained by the autonomic nervous system and circulating hormones, such as norepinephrine and epinephrine.
- Any factor that increases PVR, HR, or SV increases the systemic arterial pressure, and conversely, any factor that decreases PVR, HR, or SV decreases the systemic arterial pressure and can cause decreased perfusion to body tissues.
Classification of Hypertension
- Blood pressure is categorized into four levels: normal, elevated (or prehypertension), and stage 1 or 2 hypertension.
- Hypertension can be classified as either essential (primary) or secondary.
- Essential hypertension is the most common type and is not caused by an existing health problem.
- Secondary hypertension is caused by underlying health problems, such as kidney disease, renovascular hypertension, adrenal-mediated hypertension, and Cushing syndrome.
Etiology and Genetic Risk
- Essential hypertension can develop when a patient has one or more risk factors, including:
- Kidney disease
- Obesity
- Physical inactivity
- Smoking
- Aging
- Family history of hypertension
- African American race
- Renovascular hypertension is associated with narrowing of one or more of the main arteries carrying blood directly to the kidneys, known as renal artery stenosis (RAS).
Incidence and Prevalence
- Hypertension is a worldwide epidemic.
- In the United States, it is estimated that 85.7 million adults 20 years of age and older have high blood pressure.
- The disease can shorten life expectancy.
Health Promotion and Maintenance
- Control of hypertension has resulted in major decreases in cardiovascular morbidity and mortality.
- The U.S. Healthy People 2020 campaign includes a number of objectives related to hypertension to decrease cardiovascular mortality.
- Evidence-based dietary and exercise practices that can help lower blood pressure include:
- Achieve weight reduction through lifestyle changes using a combination of reduced caloric intake and increased physical activity.
- Implement Dietary Approaches to Stop Hypertension (DASH), a diet that is high in fruits, vegetables, and low-fat dairy products.
- Reduce the intake of dietary sodium.
- Increase physical activity that includes aerobic exercise, resistance training, and static isometric exercise.### Hypertension Management
- Recommended classes of drugs for hypertension: thiazide-type diuretics, calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACEIs), and angiotensin II receptor blockers (ARBs)
- Avoid using ACEI, ARB, and renin inhibitor simultaneously due to potential harm
- Patients not responding to first-line drugs may be prescribed other diuretics, aldosterone receptor antagonists, beta-adrenergic blockers, or renin inhibitors
Diuretics
- Types of diuretics:
- Thiazide (low-ceiling) diuretics (e.g., hydrochlorothiazide)
- Inhibit sodium, chloride, and water reabsorption in distal tubules
- Promote potassium, bicarbonate, and magnesium excretion
- Decrease calcium excretion, preventing kidney stones and bone loss
- Loop (high-ceiling) diuretics (e.g., furosemide and torsemide)
- Inhibit sodium, chloride, and water reabsorption in ascending loop of Henle
- Promote potassium excretion
- Potassium-sparing diuretics (e.g., spironolactone, triamterene, and amiloride)
- Act on distal renal tubule to inhibit reabsorption of sodium ions in exchange for potassium
- Retain potassium in the body
- Thiazide (low-ceiling) diuretics (e.g., hydrochlorothiazide)
- Side effects of diuretics:
- Hypokalemia (low potassium level) and hyperkalemia (high potassium level)
- Weakness, irregular pulse, and cardiac dysrhythmias
- Muscle spasms in legs
- Dehydration and orthostatic hypotension in older adults
- Nursing considerations:
- Monitor serum potassium levels and assess for irregular pulse, dysrhythmias, and muscle weakness
- Teach patients to eat foods high in potassium and consider potassium supplements
- Avoid nocturia by taking diuretics in the morning
Calcium Channel Blockers (CCBs)
- Mechanism of action:
- Interfere with transmembrane flux of calcium ions
- Result in vasodilation, decreasing blood pressure
- Side effects:
- Headache and nausea
- Neurologic symptoms, visual changes, and symptoms of heart failure
- Grapefruit juice interaction (e.g., felodipine and nifedipine)
- Nursing considerations:
- Monitor for neurologic symptoms, visual changes, and heart failure
- Teach patients to avoid grapefruit juice
Angiotensin-Converting Enzyme Inhibitors (ACEIs)
- Mechanism of action:
- Block the action of angiotensin-converting enzyme (ACE)
- Decrease sodium and water retention, lowering peripheral vascular resistance (PVR) and blood pressure
- Side effects:
- Dry, nagging cough
- Orthostatic hypotension
- Fatigue, weakness, and dizziness
- Hyperkalemia (high potassium level)
- Nursing considerations:
- Teach patients to report cough and orthostatic hypotension
- Instruct patients to rise slowly from bed to avoid severe hypotensive effect
Angiotensin II Receptor Blockers (ARBs)
- Mechanism of action:
- Selectively block the binding of angiotensin II to receptor sites in vascular smooth muscle and adrenal tissues
- Compete directly with angiotensin II, but do not inhibit ACE
- Side effects:
- Fatigue, weakness, and dizziness
- Impurities in certain ARBs (e.g., valsartan) may cause safety concerns
- Nursing considerations:
- Teach patients about potential side effects and impurities in certain ARBs
Beta-Adrenergic Blockers
- Mechanism of action:
- Block beta receptors in the heart and peripheral vessels
- Decrease heart rate (HR) and myocardial contractility
- Side effects:
- Fatigue, weakness, and depression
- Sexual dysfunction
- Cold extremities
- Bradycardia (low heart rate)
- Nursing considerations:
- Teach patients about potential side effects
- Monitor for bradycardia and cold extremities
Hypertensive Crisis
- Definition:
- Systolic blood pressure >180 mm Hg or diastolic blood pressure >120 mm Hg
- Treatment:
- IV antihypertensive therapy (e.g., nitroprusside, nicardipine, fenoldopam, or labetalol)
- Gradual reduction in blood pressure to prevent cerebral ischemia, MI, and renal failure
- Monitor oxygen saturation levels and provide oxygen as needed
- Assess for neurologic or cardiovascular complications
Adherence to the Plan of Care
- Importance of patient involvement in the collaborative plan of care
- Identify ways to encourage adherence to the plan of care
- Develop a plan with the patient and family to manage hypertension
- Health teaching:
- Indications, dosage, times of administration, side effects, and drug interactions for antihypertensives
- Importance of medication adherence and potential consequences of nonadherence
- Lifestyle changes (e.g., sodium restriction, weight maintenance or reduction, alcohol restriction, stress management, and exercise)
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Description
This quiz covers the priority concepts of perfusion and closing, with exemplars on hypertension and venous thromboembolism, as well as the interrelated concept of inflammation in healthcare.
