Transcript Hypertension Medications

Chapter 23
Drugs Used to Treat Hypertension
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Chapter 23
Lesson 23.1
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Slide 2
Objectives
• Discuss blood pressure and its measurement
• Define hypertension
• Differentiate between primary and secondary
hypertension
• Summarize nursing assessments and
interventions used for the treatment of
hypertension
• State recommended lifestyle modifications for
a diagnosis of hypertension
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Slide 3
Hypertension
• Characterized by an elevation of systolic blood
pressure (sbp), diastolic blood pressure (dbp) or
both
 Primary hypertension: 90% of cases, unknown
cause
 Secondary hypertension: occurs after another
disorder
• Normal BP: less than 120 sbp, less than 80 dbp
• Prehypertension: 120 to 139 sbp, or 80 to 89
dbp
• Stage I: 140 to 159 sbp or 90 to 99 dbp
• Stage 2: greater than or equal to160 sbp or
greater than or equal to 100 dbp
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Slide 4
Major Risk Factors of Hypertension
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Smoking
Obesity
Physical inactivity
Dyslipidemia
Diabetes mellitus
Microalbuminuria or estimated glomerular
filtration rate (GRF) less than 60 mL/min
• Age (older than 55 for men, older than 65 for
women)
• Family history of premature cardiovascular
disease
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Slide 5
Major Risk Factors
of Hypertension (cont’d)
• Target organ damage
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Heart
Brain
Kidneys
Blood vessels
Eyes
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Slide 6
Nursing Assessments
for Patients with Hypertension
• Blood pressure sitting for 5 minutes quietly;
no recent caffeine products
• Family history and risk factors present
• Laboratory data for lipids, triglycerides,
cholesterol, renal function studies
• BMI
• Peripheral pulses
• Patient education focuses on lifestyle
modifications
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Slide 7
Patient Education
and Health Promotion
• Lifestyle modifications
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Smoking cessation
Weight reduction
DASH diet
Physical activity
Restriction in alcohol intake
Stress reduction
Regular sleep pattern of at least 7 hours each
night
 Sodium control
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Slide 8
Chapter 23
Lesson 23.2
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Slide 9
Objectives
• Identify specific factors the hypertensive
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patient can use to assist in managing the
disease
Identify 10 classes of drugs used to treat
hypertension
Review Figure 23-2 to identify options and
progression of treatment for hypertension
Develop patient education objectives for
individuals with hypertension
Summarize the action of each drug class
used to treat hypertension
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Slide 10
Options and Progression
of Treatment for Hypertension
• Long-term success depends on patients
understanding the characteristics and
diseases that contribute to the issue
 Demographic characteristics – age, gender,
race
 Coexisting diseases and risk factors –
migraine headaches, dysrhythmias, angina,
diabetes mellitus, previous therapy used,
concurrent therapy, cost of treatment
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Slide 11
Management of
Hypertension
• Lifestyle modifications are initial therapy
• If no significant effect, drug therapy is
introduced
• Start with diuretics for stage 1 hypertension
• Add beta blockers, ACE inhibitors, calcium
channel blockers, and angiotensin receptor
blockers as tolerated
• Start with two-drug combination for stage 2
hypertension
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Slide 12
Drug Classes Used
for Hypertension Management
• Diuretics; beta-adrenergic blocking agents
• ACE inhibitors; angiotensin II receptor
blockers (ARBs)
• Direct renin inhibitors; aldosterone receptor
antagonist
• Calcium channel blockers; alpha-1 adrenergic
blocking agents
• Central-acting alpha-2 agonists; peripheralacting adrenergic antagonists; direct
vasodilators
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Slide 13
Drug Class: Diuretics
• Actions
 Cause volume depletion, sodium excretion,
vasodilation of peripheral arterioles
• Uses
 Most commonly prescribed antihypertensives
 In combination with other antihypertensive
agents
 Discussed further in Chapter 29
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Slide 14
Drug Class:
Beta-Adrenergic Blocking Agents
• Actions
 Inhibit cardiac response to sympathetic nerve
stimulation
 Inhibit renin release from kidneys
• Uses
 Initial therapy for stage 1 and 2 hypertension
• Common adverse effects
 Bradycardia, peripheral vasoconstriction
(purple mottled skin); heart failure;
bronchospasm, wheezing; masks
hypoglycemia in diabetic patients
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Slide 15
Drug Class: ACE Inhibitors
• Actions
 Inhibit angiotensin I converting enzyme (ACE),
disrupting the conversion of angiotensin I to
angiotensin II
• Uses
 Single therapy for stage 1 or 2 hypertension
• Common adverse effects
 Nausea, fatigue, headache, diarrhea;
orthostatic hypotension
• Serious adverse effects
 Angioedema; neutropenia; hyperkalemia;
chronic cough; birth defects
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Slide 16
Drug Class: ARBs
• Actions
 Bind to angiotensin II receptor sites and block
the vasoconstrictor from binding to receptor
sites in target organs
• Uses
 Alone or in combination with other
antihypertensives to reduce blood pressure
• Common adverse effects
 Dyspepsia, cramps, diarrhea; headache;
orthostatic hypotension
• Serious adverse effects
 Birth defects; hyperkalemia
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Slide 17
Drug Class: Direct Renin Inhibitors
• Drug: aliskiren (Tekturna)
• Actions
 Block the first step in the RAAS cascade
preventing release of aldosterone
• Uses
 Alone or in combination with other
antihypertensives to reduce blood pressure
• Common adverse effects
 Dyspepsia, cramps, diarrhea; headache;
orthostatic hypotension
• Serious adverse effects
 Altered fluid and electrolytes, birth defects
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Slide 18
Drug Class:
Aldosterone Receptor Antagonist
• Drug: eplerenone (Inspra)
• Actions
 Block stimulation of aldosterone at receptor
sites, preventing sodium reabsorption
• Uses
 Alone or in combination with other
antihypertensives to reduce blood pressure
• Common adverse effects
 Nausea, diarrhea; fatigue, headache;
orthostatic hypotension
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Slide 19
Drug Class:
Calcium Channel Blockers
• Actions
 Inhibit movement of calcium ions across cell
membranes
• Uses
 Ideal for first- or second-line drug therapy for
hypertension
• Serious adverse effects
 Hypotension and syncope
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Slide 20
Drug Class: Alpha-1 Adrenergic
Blocking Agents
• Actions
 Block postsynaptic alpha-1 adrenergic
receptors to produce vasodilation, decrease
peripheral vascular resistance
• Uses
 Alone or in combination with other
antihypertensives to reduce blood pressure
 Reduce mild to moderate urinary obstruction
• Common adverse effects
 Drowsiness, headache, weakness, lethargy;
dizziness, tachycardia, fainting
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Slide 21
Drug Class: Central-Acting
Alpha-2 Agonists
• Actions
 Stimulate alpha-adrenergic receptors in the
brainstem, reducing sympathetic outflow from
CNS
• Uses
 Considered adjunctive therapy; used only in
combination with other antihypertensives
• Common adverse effects
 Drowsiness, dry mouth, dizziness, altered
urine color, altered rest results
• Serious adverse effects
 Depression; rash
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Slide 22
Drug Class: Direct Vasodilators
• Actions
 Relax arterial smooth muscle, reducing
peripheral vascular resistance
• Uses
 Treatment of stage 2 hypertension, renal
disease hypertension, toxemia of pregnancy
• Common adverse effects
 Dizziness, numbness, tingling in legs; orthostatic
hypotension, palpitations, tachycardia; nasal
congestion; hair growth
• Serious adverse effects
 Fever, chills, joint and muscle pain, skin
eruptions; gynecomastia
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Slide 23