1. Drugs for Hypertension

2. Cardiovascular Disease (CVD)
Includes conditions of heart and blood vessels
Hypertension is most common form of CVD
Most frequent causes of death in U.S
HTN = > 140/90 in ages 18 to 59 years old.
> 50 yrs old elevated systolic BP is of greatest risk 2

3. Consequences of Hypertension
Heart disease
Kidney disease
Stroke
Visual Impairment and blindness

4. Target Organs Affected by Untreated Hypertension
Heart
Brain
Kidneys
Retina 4

5. Primary factors affecting blood pressure

6. Blood Pressure

7. Hormonal and nervous factors influencing blood pressure.

8. Non-Pharmacologic Management of HTN
Therapeutic lifestyle changes
Weight management
Limit alcohol intake
Dietary sodium restriction but maintain K and Ca intake (DASH diet)
Decrease saturated fat and cholesterol
Increase fruits and vegetables
Increase aerobic activity
Smoking cessation
Reduce stress through coping strategies

9. Mechanism of Action of Antihypertensive Drugs

10. Primary Antihypertensive Agents
Diuretics
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin II receptor blockers
Beta-adrenergic antagonists
Calcium channel blockers 10

11. Secondary Antihypertensive Agents
Alpha1-adrenergic antagonist
Alpha2-adrenergic agonists
Direct-acting vasodilators
Peripheral adrenergic antagonists 11

12. Role of Nurse Obtain complete health history Obtain vital signs
Do physical examination
Obtain blood and urine specimens for analysis 12

13. Diuretics (Chapter 41)
MOA: reduces blood volume & lowers arterial resistance
Potassium Sparing Diuretic
Thiazide & Thiazide Like Diuretic
Loop High Ceiling Diuretic
spirololactone, triamterene, eplerenone
hydrochlorothiazide
Indapamide, metolazone
furosemide, torsemide, bumetanide
Adverse Effects
Hyperkalemia, dehydration, hyponatremia, , agranulocytosis
Significant hypokalemia, electrolyte depletion, hypotension, hyponatremia, hyperglycemia
Significant hypokalemia, ototoxicity, electrolyte imbalance, circulatory collapse, dehydration

14. Key Assessment and Monitoring Points for Potassium-Sparing Diuretics
Use of salt substitutes and potassium-rich foods
Use in pregnant and lactating women
History of gout and kidney stones
Uric-acid levels
Gynecomastia and hirsutism for spironolactone (Aldactone) 14

15. Orthostatic hypotension
Key Assessment and Monitoring Points for Nonpotassium-Sparing Diuretics
Orthostatic hypotension
Laboratory electrolyte values, especially potassium level, and daily weights
Intake and output assessment of edema and signs of fluid overload 15

16. Calcium Channel Blockers (CCBs) MOA: decrease peripheral resistance by relaxing smooth muscle, limits muscle contraction
Dihydropyridines (acts on the blood vessels)
Non-dihydropyridines (acts on the blood vessels and the heart)
Verapamil
Diltiazem
(Chapter 45, Table 45-1, pg. 487) .

17. The renin–angiotensin–aldosterone pathway

18. Drugs for Chronic Hypertension
Page 506
Table 47-2