1. Well Aware Health Improvement Program HYPERTENSION High Blood Pressure
OMC Wellness Center
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2. Authors of information:
Cindy Floyd MSN, FNP-BC
Director of Wellness and Well Aware Health Coach
Marla Rabalais RD
Registered dietician
Don Lusk RPH, Pharm D.
OMC Pharmacist

3. Well Aware Benefit Plan Review of Goals
Purpose and Mission of the Well Aware Program:
To empower Oconee Medical Center employees and their families to reach their best state of health.
How will this program benefit the employees, their spouse and OMC?
Health Coaches will be available to assist you in decreasing risk factors and improving lifestyle choices which will lead to better health.
Better health leads to the following:
Improves your outlook on life
Increases your energy level
Increases employee productivity
Decreases absenteeism
Decreases your personal medical cost
Saves OMC money allowing cost savings to be reinvested into additional benefits for all employees

4. Compliance with the 2012 Risk Management Focus: Hypertension
Complete Hypertension Assessment
Complete online educational session and post test
Drop-in blood pressure check in the Wellness Center during the month of March
1:1 Health Coach visits based on level of control and severity but not mandatory unless warranted
This is a review of the 5 main steps you should follow to ensure you are in compliance with Well Aware Hypertension.
This is step is not mandatory unless warranted by the current condition of your blood pressure.
Again, as stated in your introduction letter, this program is mandatory for all those currently being treated for hypertension or identified as falling into Stage 2 Hypertension based on the 2011 KYN assessment, but anyone interested in learning more about hypertension is welcome to use this resource. A review of this information with specific dates is also available in a handout at the end of the presentation.

5. Hypertension Management
Part 1
What is hypertension
How it affects the body
Measurement of blood pressure
Risk and complications
General overview of treatment to lower blood pressure

6. Hypertension What is it?
A dangerous condition where blood pressure is persistently higher than normal
It is mainly due to clogs or blockages in arteries requiring the heart to pump harder to get blood flowing throughout the body
Causes damage in the walls of the arteries over time and ultimately can damage the heart
Your heart beats about 100,000 times a day; if you have hypertension, damage can be done with each beat

7. Blood Pressure Measurements
There are two measurements when determining blood pressure: Systolic/Diastolic
Systolic – top number
The pressure exerted on the arteries when the heart beats/pumps
Diastolic – bottom number
The pressure exerted in between beats (when the heart is at rest)

8. Blood Pressure Measurements
Stage 2 Hypertension: More than 160/100
Stage 1 Hypertension: /90-99
Pre-hypertension: /80-89
Normal: less than 120/80

9. Diagnosis Hypertension
One reading cannot diagnose hypertension
Need 2 or more readings by your doctor or other health professional, 2 minutes apart for 2 or more visits
Verify in the other arm

10. The Correct Way to Measure BP
Best time to check: late AM or early afternoon
Best not to check in early AM as will be higher than later times due to high Cortisol levels in blood stream.
Do not test during time of increased pain or stress
Measure at least 30 minutes after last meal, caffeine or nicotine.
Bladder should be empty
Should rest at least 5 minutes (sitting) prior to test
There are several steps to ensure you get the most accurate reading of your blood pressure.
First, the best time to check is late morning or early afternoon.

11. The Correct Way to Measure BP
Should be sitting in a chair with a back rest while testing
Cuff should be at level of heart, so place arm on a table. Do not hold arm out mid-air for test or rest in lap.
Relax arm and shoulder muscle while testing
Use instrument that is routinely calibrated for accuracy.
Finger measurements have been found to be inaccurate.
Use correct cuff size
Take your personal cuff in to physician’s office so comparison testing can be done.
There should be information with your blood pressure monitor that will help you determine which cuff size is right for you.
There is a handout provided for printing at the end of the session with all of these techniques.

12. Record keeping Purchase a home measurement cuff
Blood pressure machines available at:
OMC Ambulatory Pharmacy
Tony Chapman – Pharmacist
Phone: (864)
See handout for more information
Always record your measurements with date and time.
Take record with you to physician’s office so trends can be seen from readings.
An at-home blood pressure tracking handout is available to print at the end of the presentation

13. Hypertension Risk
High blood pressure is called the “silent killer” because it contributes to deadly health conditions (heart disease) and there are NO symptoms
Of those with hypertension, 1 out of 3 do not even know they have it!
Therefore, to avoid health problems, awareness and early intervention are essential!

14. Complications of Hypertension
Coronary Artery Disease
Atherosclerosis –plaque deposits narrow diameter
Arteriosclerois – Elevated BP causes the inside walls of the vessels harden preventing the vessels to widen as blood pumps through.
Atherosclerosis - Elevated BP causes accelerated accumulation of fatty deposits in and under the lining of the artery walls. Fat build up narrows vessel thereby increasing the pressure within the vessels as blood tries to squeeze by.

15. Complications of Hypertension
Arteriosclerois – hardening of the arteries
Aneurysm – ballooning out in wall of vessel
Hemorrhagic Stroke – blood vessel rupture in part of brain
Ischemic Stroke – lack of oxygen to part of brain

16. Complications of Hypertension
Heart Failure
Dementia
Kidney failure
Impotence
Vision loss
Stroke

17. Treating Hypertension
Lowering blood pressure can greatly reduce risk for serious health problems
Small changes in lifestyle can lower blood pressure:
Dietary management
Weight Loss (even a small amount – 10%)
Smoking Cessation
Regular physical activity
Limit alcohol intake
Increase fruits, vegetables and whole grains
Stress Management
Medication

18. Smoking Increases BP
7 seconds after the first puff, nicotine reaches the brain signaling the release of epinephrine (adrenaline).
Epinephrine narrows blood vessels forcing
the heart to beat harder under higher pressure.
After 2 cigarettes the systolic and diastolic BP
increases about 10 mm Hg and keeps it there
for at least 30 minutes.
Chain smoking keeps the BP higher over longer periods of time.
Smoking and high blood pressure combined increases your risk for a heart attack, heart failure and stroke.
Milimiters of mercury

19. Smoking Cessation classes
American Cancer Society’s “Freshstart” program offered here at OMC Wellness Center.
Classes consist of 3 (1 hour) sessions
Free to anyone, but must register by calling the Wellness Center at
Offered quarterly.

20. Learning Check
Do most individuals have symptoms that alert them that they may have hypertension?
YES NO

21. Hypertension can cause which of the following conditions?
Learning Check
Hypertension can cause which of the following conditions?
Heart Failure
Vision Loss
Kidney Failure
Stroke
ALL OF THE ABOVE
Dementia

22. Normal blood pressure is below…
Learning Check
Normal blood pressure is below…
100/90
130/90
120/80
150/100

23. Learning Check
To diagnose hypertension, you should have your blood pressure taken on more than one visit to your doctor with two readings each visit, at least 2 minutes apart.
TRUE
FALSE

24. Learning Check The best time to take blood pressure is
early morning and late afternoon.
TRUE
FALSE

25. Have your arm hanging straight down
Learning Check
To get the most accurate blood pressure reading you should do which of the following:
Have your arm hanging straight down
Lay down
Drink a cup of coffee
Empty your bladder

26. Learning Check
Blood pressure can be lowered by lifestyle changes such as which of the following.
Eating more fruits, vegetables, & whole grains
Losing Weight
Not smoking & limiting alcohol intake
Regular exercise
All of the above

27. Learning Check
After 2 cigarettes the systolic and diastolic BP increases about 10 mm Hg and keeps it there for at least 30 minutes. T/F
TRUE
FALSE

28. Hypertension Management
Part 2
Dietary Management—DASH DIET
Sodium Reduction
Caffeine Reduction
Food restrictions with Medications

29. DASH = Dietary Approaches to Stop Hypertension
The diet is lower in sodium and higher in potassium, calcium, magnesium and fiber. 
Evidence indicates that the DASH diet creates a synergy between nutrients that helps lower blood pressure, potentially as much as one prescription medication.
EVIDENCE HAS SHOWN THE DASH EATING STYLE TO BE LOWER IN SODIUM AND HIGHER IN POTASSIUM, CALCIUM, MAGNESIUM, AND FIBER.  DASH CREATES A SYNERGY BETWEEN NUTRIENTS THAT HELPS LOWER BLOOD PRESSURE, POTENIALLY AS MUCH AS ONE PRESCRIPTION MEDICATION.  WHAT'S MORE, THE BENEFITS OF DASH EXTEND BEYOND HYPERTENSION TO A DECREASED RISK OF DEVELOPING CERTAIN CANCERS, DIABETES, AND OSTEOPOROSIS.

30. DASH Diet
Dash has been called a “Diet for all Diseases” because the benefits of DASH extend beyond hypertension to a decreased risk of developing certain cancers, diabetes and osteoporosis.
Dash can benefit everyone! Making a few simple changes, one step at a time, can lead you down a path of good health. 

31. DASH Diet recommendations
Fruits
Daily Goal: 2-2 1/2 cups
Examples of a ½ cup portion include:
1 medium fresh fruit, 16 grapes, ½ cup fresh, canned or frozen, ¼ cup dried, or 4 oz 100% juice
If you don't eat fruit now or have only juice at breakfast, add a serving to your meals or have it as a snack.
Call the last bullet….TIPS

32. DASH Diet recommendations
Vegetables
Daily Goal: 2-2 1/2 cups
Examples of a ½ cup portion include:
1 cup leafy greens, ½ cup raw, canned* or frozen, or 4 oz 100% juice
* when purchasing canned foods choose “low sodium” option
If you now eat one or two vegetables a day, add a serving at lunch and another at dinner.

33. DASH Diet recommendations
Fat-free or Lowfat Milk and Dairy
Daily Goal: 2-3 cups
Examples of a 1 cup portion include:
8 oz milk, 8 oz yogurt
Gradually increase dairy products to three servings per day.
For example, drink milk with lunch or dinner, instead of soda, alcohol, or sugar-sweetened tea. Choose low-fat (1 percent) or fat free (skim) dairy products to reduce total fat intake.

34. DASH Diet recommendations
Whole Grains
Daily Goal: 6-8 ounces
Examples of a 1 oz portion:
1 oz slice of bread, ½ cup cooked rice or pasta, ½ - 1 ¼ cup dry cereal*
* Always check the nutrition fact label on cereal before buying.

35. DASH Diet recommendations
Lean Meat, Fish, Poultry
Daily Goal: 6 ounces or less
Note: a 3 oz portion roughly equals the size of a deck of cards
Treat meat as one part of the whole meal, instead of the focus.

36. DASH Diet recommendations
Nuts, Seeds, and Legumes
Daily Goal: 4-5 portions per week
Examples of a portion:
1/3 cup or 1 ½ oz. nuts, 2 Tbsp peanut butter, ½ oz. seeds, ½ cup cooked dry beans, peas or lentils.
Note: These portions can count as a 2 oz. portion of lean meat, fish, or poultry.
Include two or more vegetarian-style (meatless) meals each week.

37. DASH Diet recommendations
Oils and Fats
Use sparingly
Examples of a 1 teaspoon portion:
1 tsp soft margarine, 1 Tbsp low-fat mayo, 2 Tbsp low-fat salad dressing or 1 tsp. olive oil or canola oil
Use only half the butter, margarine, or salad dressing you do now
Try low-fat or fat free condiments, such as fat free salad dressings

38. DASH Diet recommendations
Added Sugar
Use sparingly
Examples of one serving:
1 Tbsp. sugar, 1 Tbsp jelly or jam, ½ cup sorbet and ices or 1 cup lemonade, 1 cup sweet tea

39. DASH Diet recommendations
Alcohol
One drink is equivalent to:
12 oz beer, 5 oz wine, 1.5 oz spirits
Men: 2 or less drinks per day
Women: 1 or less drinks per day

40. DASH Diet recommendations
Sodium
1 teaspoon of salt = 2,300 mg of sodium
Dietary sodium comes primarily in the form of salt or sodium-chloride. 
Sodium is found naturally in some foods. However, it is the sodium from added salt, especially in many processed foods, restaurant meals, and shaken on that really adds up.

41. Sodium (“Salt”) Intake
The average American gets about 3,400 mg of sodium a day — twice what is recommended.

42. Recommended Sodium Intake
Age 51 years or older: < 1500 mg/day
African American : < 1500 mg/day
If have Hypertension: < 1500 mg/day
If have Hypertension & Kidney Disease: < 1500 mg/day
Everyone else: < 2300 mg/day

43. Lowering Sodium To lower sodium, be aware of sodium content in foods :
1 teaspoon table salt: 2300mg
1 teaspoon of sea salt: 2250mg
1 packet of salt, single serving: 400mg
1 oz cheddar cheese: 170 mg
1 dill pickle 2.5 oz : 900 mg
1 average Lean Cuisine: 700 mg
1 cup tomato sauce: 1200 mg
2 slices of a pepperoni & cheese pizza: mg
½ cup chicken noodle soup: 890 mg
1 instant noodle lunch: 1,240 mg

44. Caffeine Increases BP Caffeine increases blood pressure by:
Narrowing blood vessels. This “vasoconstriction” or narrowing is a result of caffeine blocking the hormone adenosine release. Adenosine helps keep the vessels widened.
Raising heart rate. Caffeine causes the adrenal glands to release more cortisol and adrenaline which both increase heart rate.
***May want to add return to quiz to push button

45. Limit Caffeine Found in coffee, tea, soft drinks and chocolate
Limit to about 200 mg /day
Amount of Caffeine in:
Coffee , ¾ cup or 6 oz = 103 mg
Tea, ¾ cup or 6 oz = 100 mg
Soft Drink, 12 oz = 70 mg
1 chocolate bar, 1 ½ oz = 10 mg
2 to 3 cups of coffee has been shown to raise systolic BP 14 mm Hg and diastolic BP 13 mm Hg
It is also advised to avoid caffeine right before activities that naturally increase BP, such as exercise or hard physical labor.

46. Food/Drinks that interfere with medications
If on a Calcium Channel Blocker avoid
Grapefruit and grapefruit juice
Seville (sour) oranges
Natural Licorice often added to chewing tobacco and some cough drops
It increases BP by making your kidneys retain sodium and fluid
High doses of calcium can interfere with some BP medications

47. Learning Check
For men, the DASH diet recommends limiting alcohol intake to 4 or less drinks per day. T/F
TRUE
FALSE

48. Learning Check
Following the DASH Diet (Dietary Approaches to Stopping Hypertension), can also help lower your risk for developing diabetes, certain cancers, and osteoporosis.
TRUE
FALSE

49. Hypertension Management
Part 3
Medication Management
Physician driven
Classifications
Actions
Dosing regimens
Side effects
Monitoring (liver and renal function) recommendations
Guidelines for adding medications
OTC and other medications that increase BP
Taking medications correctly
Financial support

50. Classifications of Hypertension Medications
There are several different types of medicines the physician may prescribe to help control high blood pressure.
Each type works differently (different sites in the circulatory system, different mechanisms, etc.).
Sometimes, multiple medications from different classes may be needed for appropriate blood pressure control. The physician and you will make these decisions.

51. Drug Classes Diuretics Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin-II receptor blockers (ARBs)
Beta blockers
Calcium channel blockers
Renin inhibitors
Alpha blockers
Central agonists
Vasodilators
Combination medications
There are 10 classes of hypertension drugs.

52. Medications that INCREASE BP
Over-the-Counter Meds:
Cold remedies
Nasal decongestants
Appetite suppressants
Non-steroidal anti-inflammatory drugs (NSAIDS) such as adult aspirin, Advil, Motrin, and Aleve
Prescription Meds:
Steroids (Medrol dose paks, Deltasone)
Tricyclic antidepressants (Elavil, Asendin, others)
Cyclosporine (Neoral, Sandimmune, others)
Epoetin alpha (Procrit, Epogen)
COX-2 inhibitors (Celebrex)

53. Medications to Lower BP
Needed if lifestyle changes are not effective
Most can control BP on one medication, others may need a combination of two or three drugs
A diuretic, beta blocker or ACE inhibitor is often prescribed for uncomplicated cases
Most have minimal side effects
Finding the right drug or combination may require time and patience
Read the handouts given at the pharmacy when you have your prescription filled
Talk to your pharmacist and physician if you have questions

54. Take Your Medications Correctly
Take as prescribed and at the same approximate time each day
Too early, can produce overdose symptoms and side effect symptoms such as nausea and diarrhea
Too late or forget to take, allows BP to increase, sometimes to higher levels than at start of treatment
Know the names of your medications
Tell your doctor about other medication (including OTC and nutritional supplements)
Take medications with water

55. Learning Check
Over the counter medications such as cold remedies, appetite suppressants, NSAIDS (such as aspirin, Advil and Aleve) can increase blood pressure.
TRUE
FALSE

56. There will be no post test questions on the following medication information.
Please scroll forward through the following slides to find your current medication and learn more about how it works and possible side effects. You are not required to know all information about all of these medications.

57. Diuretics
Help the body get rid of excess sodium (salt) and water by allowing more to be passed into the urine by the kidneys.
This reduces the amount of fluid in the bloodstream leading to lower pressure.
Usually taken once or twice a day – or as directed by the physician.
Unless otherwise directed, try not to take med too late in the evening so as not to be awakened during the night for urination.

58. Diuretics
There are 3 basic types of diuretics that work in different parts of the kidney:
Thiazide diuretics
Hydrochlorothiazide (HCTZ), Chlorthalidone (Hygroton),
Clorothiazide (Diuril), Indapamide (Lozol), Metolazone (Zaroxolyn)
Loop diuretics
Furosemide (Lasix), Bumetanide (Bumex), Torsemide (Demadex)
Potassium-sparing diuretics
Spironolactone (Aldactone), Amiloride (Midamor), Triamterene (Dyrenium)
Combinations diuretics are also available:
Triamterene + HCTZ (Maxzide, Dyazide), Amiloride + HCTZ (Moduretic),
Spironolactone + HCTZ (Aldactazide)

59. Diuretics Side Effects/Monitoring
May decrease the body’s supply of Potassium.
Watch for symptoms such as weakness, leg cramps, or tiredness.
Dietary changes or a potassium supplement may be suggested by the physician to help replenish potassium.
Also, the physician may change the drug to a Potassium-sparing diuretic. This may decrease the amount of potassium lost in the urine.
Increases urination. Try not to take too late in the evening or too close to bedtime.
Low blood pressure.
Because of the change in blood volume, blood sugar levels may increase. Notify the physician if this is significant.
Prolonged use may trigger an attack in someone who suffers from gout.
A small percentage of men may experience erectile dysfunction.
Try to take Metolazone (Zaroxolyn) about 30 minutes BEFORE a dose of a loop diuretic (Lasix, Bumex, Demadex). This will increase the amount of fluid excreted.

60. Angiotensin Converting Enzyme (ACE) Inhibitors
Angiotensin is a chemical that causes the arteries throughout the body to become more narrow – especially in the kidneys.
These medications help to prevent the production of Angiotensin by blocking the enzyme that is needed for its conversion to an active form.
This in turn helps the blood vessels relax and open up, which helps to lower blood pressure
These are usually taken once or twice a day or as directed by the physician.
The progression of kidney disease or dysfunction due to high blood pressure or diabetes may be slowed.

61. ACE Inhibitors Medications in this class include:
Benazepril (Lotensin) Moexipril (Univasc)
Captopril (Capoten) Perindopril (Aceon)
Enalapril (Vasotec) Quinapril (Accupril)
Fosinopril (Monopril) Ramipril (Altace)
Lisinopril (Prinivil, Zestril) Trandolapril (Mavik)
(Notice the generic names of these medications end
with the letters “PRIL”)

62. ACE Inhibitors Side Effects/Monitoring
Watch for a chronic dry or hacking cough. If this becomes severe or a nuisance, notify the physician.
Low blood pressure
Loss of taste
Skin rashes
Potassium imbalance
In rare instances – kidney damage
Women who are pregnant or considering pregnacy should see their physician immediately. These drugs could potentially harm the fetus.

63. Angiotensin-II Recptor Blockers (ARBs)
These drugs are somewhat similar to ACE Inhibitors.
ARBs block the effects of Angiotensin on the body, a chemical which causes the arteries to become narrow.
Angiotensin needs a receptor (like a “key fits into a lock”) in order to constrict blood vessels.
ARBs block these receptors, resulting in blood vessels staying relaxed and open. This helps to lower blood pressure.
SO– Whereas ACE inhibitors help prevent Angiotensin from becoming active, ARBs help block the receptors so that however much Angiotensin is already active is less likely to work.
The progression of kidney disease or dysfunction due to high blood pressure or diabetes may slowed.

64. Angiotensin Receptor Blockers
Drugs in this class include:
Candesartan (Atacand) Losartan (Cozaar)
Eprosartan (Teveten) Telmisartan (Micardis)
Irbesartan (Avapro) Valsartan (Diovan)
(Notice that the generic names for these drugs
end with the letters “SARTAN”)

65. Angiotensin Receptor Blockers
Side Effects/Monitoring
Chronic dry or hacking cough – but not as prevalent as ACE inhibitors
Low blood pressure
Occasional dizziness
Women who are pregnant or considering pregnancy, should notify their physician immediately. These drugs could potentially harm the fetus.

66. Beta Blockers
Beta Blockers interfere with specific receptors in the body (beta receptors).
These medications reduce the heart rate, reduce the heart’s workload (strength of contractions), and reduce the output of blood (stoke volume).
All of these actions help to lower blood pressure and preserve heart muscle.
Beta blockers may also be useful in patients with heart failure, who have had a heart attack, or have an irregular heart rhythm.
These medications are usually taken once or twice a day or as directed by a physician. Dosing is usually started low, then increased as tolerated. (“Start low…Go slow”)

67. Beta Blockers Medications in this class include:
Acebutolol (Sectral) Metoprolol tartrate (Lopressor)
Atenolol (Tenormin) Metoprolol succinate (Toprol XL)
Betaxolol (Kerlone) Penbutolol (Levatol)
Bisoprolol (Zebeta) Pindolol (Visken)
Carteolol (Cartrol) Propranolol (Inderal)
Carvedilol (Coreg) Sotalol (Betapace)
Nadolol (Corgard) Timolol (Blocadren)
Nebivolol (Bystolic)
Labetolol (Trandate, Normodyne) –has both beta blocker & alpha blocker effects
(Notice that the generic names for these drugs end with the letters “OLOL”)

68. Beta Blockers Side Effects/Monitoring Insomnia Low blood pressure
Nightmares
Tiredness (“washed-out” feeling)
Depression
Slow heartbeat
Symptoms or aggrevation of asthma
Erectile dysfunction may occur.
May affect blood sugar and response to insulin. Monitor blood sugar closely.
Irregular heart rhythms – notify physician immediately.
Consult physician if you are pregnant or considering pregnancy.
Do not suddenly stop beta blockers or skip a number of doses. Can result in heart racing, elevated blood pressure, anxiety, and chest pain.
Beta blockers may not be indicated for patients with emphysema or COPD – discuss usage with physician.

69. Calcium Channel Blockers
Help decrease the amount blood vessels can contract and helps them to dilate.
The vessels narrow when calcium flows through calcium channels in the muscle cells within the arteries. This causes blood pressure to increase.
The medication helps to block calcium entry into these channels allowing the vessels to widen.
These effects lower blood pressure and heart rate.
Usually taken once to three times a day – depending on formulation of the tablet/capsule or as directed by the physician.
Some drugs in this class may also be used to help control heart rate and rhythm.

70. Calcium Channel Blockers
Medications in this class include:
Amlodipine (Norvasc) Felodipine (Plendil)
Isradipine (DynaCirc) Nicardipine (Cardene)
Nifedipine (Procardia) Nisoldipine (Sular)
Diltiazem (Cardizem, Tiazac, Cartia)
Verapamil (Calan, Isoptin, Verelan)
(Note that most of the generic names end in the letters “IPINE” –EXCEPT for Diltiazem and Verapamil)

71. Calcium Channel Blockers
Side Effects/Monitoring
Avoid grapefruit juice while on these medications. The levels of drug in the body may increase and become toxic.
Swelling of feet or legs
Swollen gums
Headache (although may be used for migraines)
Low blood pressure
Low heart rate
Erectile dysfunction may occur.
Monitor for changes in heart rhythm – notify physician immediately if noted.

72. Renin Inhibitors
Renin is an enzyme produced in the kidneys that starts a chain of chemical steps which increase blood pressure.
This chain reaction leads to the steps which include Angiotensin.
This class of medication helps to block the production of Renin. This is turn helps to reduce blood pressure
Usually taken once daily.

73. Renin Inhibitors Medication in this class: Side Effects/Monitoring
Aliskiren (Tekturna)
Side Effects/Monitoring
Low blood pressure
Potassium disturbances
Swelling in legs or feet. If severe or nuisance, or occurs anywhere else in the body, contact the physician.
Use with caution in patients who already have decreased kidney function.
Do not use if pregnant or considering pregnancy. May result in harm to the fetus. Consult the physician.

74. Alpha Blockers
Reduce the resistance within arteries by blocking alpha receptors.
This relaxes the muscle tone in the walls of the blood vessels.
This results in helping to lower blood pressure.
Usually taken once daily.
May also be used in men to help with symptoms associated with enlarged prostate.

75. Alpha Blockers Medications in this class include:
Doxazosin (Cardura), Prazosin (Minipres), Terazosin (Hytrin),
Labetolol (Normadyne, Trandate) –has both alpha blocker and beta blocker effects
Side Effects/Monitoring
Low blood pressure
Dizziness
Fast heart rate
Rapid drop in blood pressure upon standing up (orthostatic hypotension). May be directed to take medication at night to “sleep through” this side effect.
Men: this class of medication not usually indicated if taking drugs for erectile dysfunction (Viagra, Cialis, Levitra). Consult physician.

76. Central Agonists
Central agonists help to decrease the ability of the blood vessel to tense up or contract.
These medications follow a different pathway than either alpha blockers or beta blockers.
By decreasing constriction in the blood vessels, the blood pressure within the vessels is decreased.
May be taken once or multiple times a day –as directed by the physician.

77. Central Agonists Medications in this class include:
Clonidine (Catapres), Guanfacine (Tenex), Methyldopa (Aldomet)
Side Effects/Monitoring
Low blood pressure
Erectile dysfunction may occur.
Dry mouth, constipation, blurred vision
Drowsiness/Sluggishness
Fever
Anemia
May produce a greater drop in blood pressure when standing or walking, or feel faint. If this persists or is severe, notify the physician.
Do not stop these medications suddenly because blood pressure may rise very quickly.
Methyldopa may be considered for pregnancy because the adverse effects are infrequent for the pregnant woman or the developing fetus.
Clonidine is available in a once-a-week patch. There are different dosages and absorption through the skin may be variable in different patients.

78. Vasodilators
These drugs act on small arteries through direct effects on the muscle in the walls of the arteries.
This causes the muscles in the walls of the arteries to relax, allowing the vessels to dilate or widen.
Therefore, blood flows easier through the vessels and helps to reduce blood pressure.
Usually taken once or multiple times a day – as directed by the physician.

79. Vasodilators Medications in this class include:
Hydralazine (Apresoline), Minoxidil (Loniten)
Side Effects/Monitoring
Hydralazine – may cause headaches, swelling (especially around the eyes), heart palpitations, low blood pressure, and joint aches/pain. Most side effects will usually go away after a few weeks. If they persist or are severe, inform the physician.
Minoxidil – usually only used in resistant cases of severe high blood pressure or when kidney failure is present. It may cause fluid retention, marked weight gain, or excessive hair growth.

80. Combination Drugs
Combination drugs are 2 or 3 medications contained in the same pill.
Dosages are fixed in the combination pill, so it may be more difficult to adjust dosages.
However, it may be easier to take the medication because the patient is taking fewer pills.
Refer to the previous slides on each medication class for information on the drugs contained in the combination pill.

81. Combination Drugs ACE Inhibitor + Diuretic ARBs + Diuretic
Benazepril + HCTZ (Lotensin HCT)
Captopril + HCTZ (Capozide)
Enalapril + HCTZ (Vaseretic)
Fosinopril + HCTZ (Monopril HCT)
Lisinopril + HCTZ (Prinzide, Zestoretic)
Moexipril + HCTZ (Uniretic)
Quinapril + HCTZ (Accuretic)
ARBs + Diuretic
Candesartan + HCTZ (Atacand HCT)
Eprosartan + HCTZ (Teveten HCT)
Irbesartan + HCTZ (Avalide)
Losartan + HCTZ (Hyzaar)
Olmesartan + HCTZ (Benicar HCT)
Telmisartan + HCTZ (Micardis HCT)
Valsartan + HCTZ (Diovan HCT)
Beta Blocker + Diuretic
Nadolol + Bendroflumethazide (Corzide)
Atenolol + Chlorthalidone (Tenoretic)
Bisoprolol + HCTZ (Ziac)
Metoprolol tartrate+HCTZ (LopressorHCT)
Propranolol + HCTZ (Inderide)
Central Agonist + Diuretic
Clonidine + Chlorthalidone (Clorpres)
Methyldopa + HCTZ (Aldoril)
Renin Antagonist + Diuretic
Aliskiren + HCTZ (Tekturna HCT)

82. Combination Drugs Calcium Channel Blocker + ACE Inhibitor
Amlodipine + Benazepril (Lotrel)
Verapamil + Trandolapril (Tarka)
Felodipine + Enalapril (Lexxel)
Calcium Channel Blocker + ARBs
Amlodipine + Olmesartan (Azor)
Amlodipine + Telmisartan (Twynsta)
Amlodipine + Valsartan (Exforge)
Calcium Channel Blocker
+ Renin Antagonist
Aliskiren + Valsartan (Valturna)
+ ARBs + Diuretic
Amlodipine + Valsartan + HCTZ
(Exforge HCT)

83. Conclusion But remember it is a silent killer,
Hypertension is a serious risk factor for disease; however, it can be prevented and treated through lifestyle changes and proper medication!!
But remember it is a silent killer,
so please take action NOW !!
Your Well Aware Health Coaches are here to help!