Drugs for Hypertension

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

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

Target Organs Affected by Untreated Hypertension Heart Brain Kidneys Retina 4

Primary factors affecting blood pressure

Blood Pressure

Hormonal and nervous factors influencing blood pressure .

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

Mechanism of Action of Antihypertensive Drugs

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

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

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

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

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

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

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) .

The renin–angiotensin–aldosterone pathway

Drugs for Chronic Hypertension Page 506 Table 47-2