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Transcript
TREATMENT OF
HYPERTENSION
PRESENTED BY:
DIONEL VENIGAS
KEN DELA CRUZ
JOAN KHO
LORENZO NARCISO SEVA MARCIAL
AHNA VANESSA
IRENE DACUNO
Vasodilator medication esp. Hydralazine contains
CYCLIC GUANOSINE MONOPHOSPHATE a primary
content which causes vasodilation in the arterioles and
veinules
FACT
CCB are the mainstay
treatment for angina
pectoris, MI, CHF and
Hypertension
BLUFF
Side effects of ACE
inhibitors are Hacking dry
cough and Edema
FACT
Angiotensin II blockers acts in
increasing sodium and
retention of water in the distal
segment of nephron
BLUFF
ARBS prevent Angiotensinogen
II from binding to the
Angiotensinogen II receptor on
blood vessels and other tissue
BLUFF
The only direct Renin Inhibitor
available in the market is
Aliskiren (Tektura)
FACT
PERIPHERAL
VASODILATORS
ARE AGENTS WHICH ACT ON THE MOST DISTAL PARTS OF THE VASCULAR SYSTEM I.E. THE ARTERIOLES
AND VENULES. THEY DILATE THESE DISTAL BLOOD VESSELS AND LOWER THE BLOOD PRESSURE,
THEREFORE MAKES IT EASIER FOR THE HEART TO PUMP BLOOD THROUGH THESE PERIPHERAL BLOOD
VESSELS (AND THEREFORE THE WHOLE BODY).
MECHANISM OF ACTION

are an effective medications that reduces elevated systolic and
diastolic
blood
pressure
by
decreasing
peripheral vascular resistance. blood flow increases while renal
blood flow and glomerular filtration rate are preserved.

Reduction of peripheral arteriolar resistance and the associated fall
in blood pressure trigger sympathetic, vagal inhibitory, and renal
homeostatic mechanisms that lead to increased cardiac rate and
output and salt and water retention.
HYDRALAZINE (APRESOLINE)
hye-DRAL-a-zeen

Severe essential hypertension when the drug cannot be given orally
or when there is an urgent need to lower blood pressure

is used with or without other medications to treat high blood
pressure.
MECHANISM OF ACTION
Relaxes vascular smooth muscles(arteries, arterioles and veins) causing
peripheral vasodilation and decreasing peripheral vascular resistance.
These actions decrease blood pressure and increase heart rate, stroke
volume and cardiac output
Dosage

ADULT DOSING

Max: 300mg/day

Start with 10mg PO QID x 2-4 days,
titrate the dose in 25mg QID x
remainder of the first week. Titrate
the dose upto 50mg QID for the
second and subsequent weeks.

Patients with low response to
hydration use a lower dosafe of
hydralazine combination with a
thiazide and/or reserpine or a
betablocker

PEDIATRIC DOSING

Initial dos: 0.75mg/kg/day in four
divided doses gradually increase
over the next 3-5 weeks to max
7.5mg/kg or 200mg daily
SIDE EFFECTS AND
ADVERSE REACTION

fast or pounding heartbeats;

nausea, vomiting, loss of appetite;

swelling in your face, stomach, hands, or
feet;

constipation;

headache;

dizziness;

anxiety;

muscle or joint pain;

runny or stuffy nose; or

mild itching or skin rash.

numbness, burning, pain, or tingly feeling;

feeling like you might pass out;

confusion, unusual thoughts or behavior;

pale skin, easy bruising;

painful or difficult urination;

dark-colored urine;

urinating less than usual or not at all; or

joint pain or swelling with fever, chest
pain, weakness or tired feeling.
NURSING CARE:

Prior taking this medication, ask for allergy and history of certain
heart condition

Take with or without food

Seek PCP for dose adjustment (if s/sx occurs)

Get up slowly when rising from sitting of lying position

Do not drive, use machinery or do any activity that requires alertness

Limit alcohol intake

Lifestyle changes: stress reduction, exercise and dietary changes

Periodic lab/medical test shall be made; regular monitroring of
blood pressure

Store at room temperature; keep away from children.
MINOXIDIL (LOMITEN)
mə-ˈnäk-sə-ˌdil
 used with other medications to treat high blood pressure (hypertension). Lowering high blood
pressure helps prevent strokes, heart attacks, and kidney problems. Minoxidil works by relaxing
blood vessels so blood can flow more easily.
 It is also used for hair regrowth.
DOSING



Severe or Refractory Hypertension (HTN)

Initial: 5mg PO qDay, increase every 3 days PRN

Maintenance: 2.5-80 mg/day qDay or q12hr; not to exceed 100 mg/day
< 12 years

Initial: 0.1-0.2 mg/kg; not to exceed 5 mg/day PO; titrate to response
every 3 days

0.25-1 mg/kg/day PO qDay or q12hr; not to exceed 50 mg/day
> 12 years

Initial: 5mg PO qDay, increase every 3 days PRN

Maintenance: 2.5-80 mg/day qDay or q12hr; not to exceed 100 mg/day
SIDE EFFECTS/ADVERSE EFFECTS

Tachycardia

Hirsutism

Fluid and sodium retention

Hypotension

Pericarditis

Angina

Cardiac tamponade

Stevens-Johnson syndrome (rare )

Leukopenia (rare)

Thrombocytopenia (rare)
NURSING CONSIDERATION

If excessive hairs is undesired, immediately seek doctor for
replacement.

Inform doctor if chest pain occurs or call 911

Slowly rise from lying or sitting position

Avoid driving or use of machineries which requires alertness

.
CALCIUM CHANNEL BLOCKERS
MECHANISM OF ACTION
NIFEDIPINE (Adalat)
10mg, 20 mg/capsule,
30 mg, 60 mg, 90 mg
sustained release
tablet
NIFEDIPINE (Adalat)
USES

Vasospastic “ variant” or
Prinzmetal’s angina

Chronic stable angina without
vasospasm

Essential hypertension: (extended
release tablet)
MECHANISM OF ACTION

Selectively blocks calcium ion
influx across cell membranes of
cardiac muscle and vascular
smooth muscle without changing
serum calcium concentration
NIFEDIPINE (Adalat)
Adverse effect

Hypotension, Dizziness, Facial
flushing, Palpitations

May precipitate CHF, MI in patient
with cardiac disease

Overdose: nausea, confusion and
slurred speech
Nsg care

Blood pressure

Diabetogenic properties

Gingival Hyperplasia

Withdrawal symptoms

Smoking decreases efficacy
Amlodipine

2.5 mg, 5 mg and 10
mg
Amlodipine
Uses

Treatment of mild to moderate
hypertension and angina
Mechanism of Action

Blocks calcium ion reflux across
cell membranes cardiac and
vascular smooth muscle

Decrease peripheral resistance
Amlodipine
Adverse effect
Nsg care

Postural hypotension

BP (6- 9 hours) therapeutic effect.

Palpitations, flushing tachycardia,
peripheral or facial edema.

Edema not accompanied by
weight gain

urogenital: sexual dysfunction,
nocturia

Postural hypotension

Report: SOB, palpitation and
constipation

Support on mobility
Diltiazem

30, 60,90, 120 mg
tablets: 120 mg, 180
mg 240 mg sustained
release tablet

25 and 50 mg vials
Diltiazem
Uses

Angina

Essential hypertension
Mechanism of Action

Inhibit calcium ion influx through
slow channels into cell of
myocardial and arterial smooth
muscle
Diltiazem
Adverse effect
Nsg care

Headache, fatigue, dizziness

Check BP

Arrhythmia

Manage constipation

Av block

Lab Test

GI: VANDA

S/Sx of CHF

Wt gain

Supervise Ambulation

Rash

FF up appointments
Renin-AngiotensinAldosterone System (RAAS)
IT IS A HORMONE SYSTEM THAT REGULATES BLOOD PRESSURE AND WATER BALANCE.
IF THE RAAS IS ABNORMALLY ACTIVE, BLOOD PRESSURE WILL BE TOO HIGH. THERE ARE
MANY DRUGS THAT INTERRUPT DIFFERENT STEPS IN THIS SYSTEM TO LOWER BLOOD
PRESSURE. THESE DRUGS ARE ONE OF THE MAIN WAYS TO CONTROL HIGH BLOOD
PRESSURE, HEART FAILURE, KIDNEY FAILURE, AND HARMFUL EFFECTS OF DIABETES.]
ANGIOTENSIN-CONVERTING
ENZYME
INHIBITOR
CAPTOPRIL (CAPOTEN)

Used to treat hypertension, congestive heart failure, kidney
problems caused by diabetes, and improve survival after a heart
attack.
MECHANISM OF ACTION

Captopril competitively inhibits the conversion of angiotensin I (ATI)
to angiotensin II (ATII), thus resulting in reduced ATII levels and
aldosterone secretion. It also increases plasma renin activity and
bradykinin levels. Reduction of ATII leads to decreased sodium and
water retention. By these mechanisms, captopril produces a
hypotensive effect and a beneficial effect in congestive heart
failure
DOSING

ACUTE HYPERTENSION



12.5-25 mg PO
HYPERTENSION

Initial:25 mg PO q8-12

Maintenance: 25-150 mg PO q8-12

Max: 450 mg/day
CONGESTIVE HEART FAILURE

Initial: 6.25-12.5mg PO q8
AVAILABILITY
ADVERSE REACTION

Lightheadedness

Dry cough, persistent sore throat

Tachycardia

High potassium blood level

Sign of infection

Hepatotoxic (jaundice, dark urine, abdominal pain, persistent N/V)
SIDE EFFECTS

Gynecomastia

Hyperkalemia

Orthostatic hypotension

Hyponatremia

Anemia

Increase in BUN/Crea

Hyponatremia


Myalgia

Confusion/somnolence
Elevated liver transaminases,
alkaline phosphatase and serum
bilirubin

Rhinitis

Blurred vision

impotence
NURSING CARE

History taking: allergy to medication, angioedema, renal diseases,
CHF, pregnancy and lactation

Physical: Skin color, tumors, vital signs, mucous membranes,
diagnostic findings

Instruct member to take medication one hour before meals

Educate client to monitor blood pressure regularly

Inform PCP if member experiences dry cough, GI upset and the like

Limit activities which requires alertness
Enalapril (Vasotec)

Indications:

Hypertension

CHF

Asymptomatic left
ventricular
dysfunction

Injection Solution:


1.25mg/ml
Tablets:

2.5mg, 5mg, 10mg, 20mg
Lisinopril (Zestril)

Indications:

Hypertension

CHF

Stable pt within 24hrs of
acute MI
Adverse Effects

Reflex tachycardia

Renal Insufficiency

Chest pain

Renal Failure

CHF

Proteinuria

Cardiac arrhythmia

Rash

GI irritation

Dermatitis

Ulcers

Photosensitivity

Constipation

Liver Injury

Cough
Nursing Considerations

Lifestyle changes

Monitor BP

Patient health Teaching

Alert: Breathing problem

Lightheadedness

Pregnancy

Salt substitute
Angiotensin II
Receptor
Antagonist
THE ANGIOTENSIN II RECEPTOR BLOCKERS (ARBS) REPRESENT A
NEWER CLASS OF ANTIHYPERTENSIVE AGENTS. THEIR
MECHANISM OF ACTION DIFFERS FROM THAT OF THE
ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITORS, WHICH
ALSO AFFECT THE RENIN-ANGIOTENSIN SYSTEM.
Mechanism of action:
Losartan (Cozaar)
Losartan is the first Angiotensin
II receptor blocker that was
developed in 1986.
Cozaar is an angiotensin II receptor antagonists.
 Action: Blocks vasoconstrictor, aldosterone-secreting effects of an
angiotensin II, inhibiting binding of angiotensin II to A1 receptors. This
keeps blood vessels from narrowing, which lowers blood pressure and
improves blood flow.
This is a potent vasodilator.
Indication:
Hypertension, stroke with heart disease
Kidney damage with DM2
Appearance : Film-coated tablet form
50 mg – white color with mark 952 in teardrop shape
100 mg – white color with mark 960 in teardrop shape
Hypersensitive to Losartan.
Pregnante women.
Losartan
Losartan
Losartan
Potassium sparing
diuretics or potassium
supplements
Lithium
NSAIDS
Hyperkalemia
Lithium toxicity
Decrease effect of
Losartan
Valsartan (Diovan)
Used to treat high blood pressure in adults and
children who are at least 6 years old.
Used in adults to treat heart failure and to
lower the risk of death after a heart attack.
Used with or without other medications to treat
high blood pressure.
Dosages
40 mg are scored yellow ovaloid tablets with beveled edges,
imprinted NVR/DO (Side 1/Side 2)
80 mg are pale red almond-shaped tablets with beveled edges,
imprinted NVR/DV
160 mg are grey-orange almond-shaped tablets with beveled edges,
imprinted NVR/DX
320 mg are dark grey-violet almond-shaped tablets with beveled
edges, imprinted NVR/DXL
Side effect
Insomnia, fatigue, heartburn, abdominal pain, dizziness, headache, diarrhea, nausea, vomiting,
arthralgia, edema
Adverse effect/ toxic reactions
Overdosage may manifest as hypotension, tachycardia. Bradycardia occurs less often. Viral
infection and URTI (cough, pharyngitis, sinusitis, rhinitis) occur rarely.
Contraindication
 Hypersensitive t o Diovan
 Severe hepatic impairment, biliary cirrhosis and cholestasis
 Second and third trimester of pregnancy
Caution
 Concurrent use of potassium-sparing diuretics or potassium supplements
 Mild to severe hepatic impairment
 Unstented bilateral/unilateral renal artery stenosis
 Renal impairment
 Significant aortic/mitral stenosis
 Heart failure
Therapeutic indications
Hypertension - Treatment of hypertension in children and adolescents 6 to 18 years of age.
Recent myocardial infarction - Treatment of clinically stable adult patients with
symptomatic heart failure or asymptomatic left ventricular systolic dysfunction after a recent
(12 hours-10 days) myocardial infarction
 In clinically stable patients, therapy may be initiated as early as 12 hours after a
myocardial infarction.
After an initial dose of 20 mg twice daily, valsartan should be titrated to 40 mg, 80 mg,
and 160 mg twice daily over the next few weeks.
The starting dose is provided by the 40 mg divisible tablet. The target maximum dose
is 160 mg twice daily.
Heart failure - Treatment of symptomatic heart failure in adult patients when Angiotensin
Converting Enzyme (ACE) inhibitors cannot be used, or as add-on therapy to ACE inhibitors
when beta blockers cannot be used
Heart failure - Treatment of symptomatic heart failure in adult patients when
Angiotensin Converting Enzyme (ACE) inhibitors cannot be used, or as add-on
therapy to ACE inhibitors when beta blockers cannot be used
The recommended starting dose of Diovan is 40 mg twice daily.
Up titration to 80 mg and 160 mg twice daily should be done at intervals of at
least two weeks to the highest dose, as tolerated by the patient.
Consideration should be given to reducing the dose of concomitant diuretics.
The maximum daily dose administered in clinical trials is 320 mg in divided
doses.
Elderly - No dose adjustment is required in elderly patients.
Renal impairment - No dose adjustment is required for patients with a creatinine
clearance > 10ml/min.
Hepatic impairment - Diovan is contraindicated in patients with severe hepatic
impairment, biliary cirrhosis and in patients with cholestasis. In patients with mild to
moderate hepatic impairment without cholestasis, the dose of valsartan should not
exceed 80 mg.
Monitor BP and apical pulse at drug trough (prior to a scheduled
dose), in addition to regular monitoring (be alert of fluctuations)
Monitor BP regularly.
Question for possibility of pregnancy.
Assess medication history. Check for drug interaction and also
diuretics.
Question for history of hepatic/renal impairment, renal artery
stenosis, history of severe CHF.
Maintain hydration. Offer fluids frequently.
Assess for evidence of URTI and cough.
Monitor daily pattern of bowel activity and consistency.
Obtain baseline chemistries and blood counts.
Lab tests: Monitor CBC, electrolytes, liver & kidney function with longterm therapy.
Patient & Family Education
•Instruct to avoid task that requires alertness, motor skills until
response to drug is established. (Dizziness is possible)
•Notify physician immediately of pregnancy. Pt should avoid
pregnancy.
•Do not breast feed while taking this drug.
•Report any signs of infection (sore throat, fever) and chest pain.
•Do not take OTC cold preparations, nasal decongestant.
•Do not stop taking medication abruptly.
•Limit salt intake.
•Report swelling of extremities, chest pain and palpitations.
Antihypertensive Combinations
Valsartan/ Hydrochlorothiazide
(Diovan Hct)

A combination tablet of valsartan (Diovan), an angiotensin II
receptor blocker (ARB) and hydrochlorothiazide (HCTZ), a diuretic.

For treatment of hypertension

Lowering blood pressure reduces the risk of fatal and nonfatal
cardiovascular events, primarily strokes and myocardial infarctions.
Mechanism of Action

Blocks the binding of angiotensin II to receptor sites in vascular
smooth muscle and the adrenal gland, which inhibits the pressor
effects of the renin-angiotensin-aldosterone system

Increases sodium and water excretion by inhibiting sodium and
chloride reabsorption in distal segment of the nephron
Dosages
Side Effects

stomach pain, diarrhea

headache, dizziness

Photosensitivity

 Orthostatic
hypotension
Dry cough
Warnings and Precautions

Impaired Renal Function

Fetal Toxicity

Hypersensitivity Reaction

Systemic Lupus Erythematosus

Acute Myopia and Secondary Angle-Closure Glaucoma

Metabolic Disturbances
Adverse Effects

severe hypotension

hyponatremia (headache, slurred speech, hallucinations, vomiting,
severe weakness, muscle cramps, loss of coordination, feeling
unsteady, seizure, fainting, shallow breathing)

low or high potassium (confusion, slow or uneven heart rate, weak
pulse, tingly feeling, extreme thirst, increased urination, leg
discomfort, muscle weakness or limp feeling)
Adverse Effects

blurred vision, tunnel vision, eye pain, or seeing halos around lights

joint pain or swelling with fever, headaches, chest pain, shortness of
breath

skin sores, butterfly-shaped skin rash on your cheeks and nose
(worsens in sunlight)

numbness, cold feeling, or pale appearance of your fingers or toes
Nursing Considerations

Avoid sudden posture changes to avoid dizziness upon standing
quickly

Encourage member to use a sunblock to prevent photosensitivity
reactions

Watch out for hypotension.

Take drug in the morning
Nursing Considerations

Instruct member to take drug with food to minimize GI upset

Monitor blood pressure and obtain weight daily

In women, avoid pregnancy and breastfeeding while taking the
drug

Maintain hydration by increasing oral fluid intake and adequate
sodium intake of 2gms/day
DIRECT RENIN INHIBITOR
Aliskiren (Tekturna)

150 mg light pink biconvex
round tablet, imprinted NVR/IL

300 mg light red biconvex
ovaloid round tablet,
imprinted NVR/IU
Mechanism of Action
Direct renin inhibitor. Decreases plasma
renin activity (PRA), inhibiting the conversion
of angiotensinogen to angiotensinogen I,
blocking the effects of increased renin
levels.
Therapeutic effect: Reduces B/P.
Contraindications

Tekturna is contraindicated in patients with diabetes who are
receiving ARBs or ACEIs because of the increased risk of renal
impairment, hyperkalemia, and hypotension.
Warning and Precautions

Fetal toxicity

Anaphylactic Reactions and Head and Neck Angioedema

Hypotension

Impaired Renal Function

Hyperkalemia

Cyclosporine or Itraconazole
Adverse Reactions

Injury or death to unborn baby

Severe allergic reactions and angioedema

Renal impairment or failure

Hypotension
Side effects

Diarrhea

Cough

Dizziness

Headache

Flu-like symptoms

Back pain

Tiredness

Hyperkalemia
Nursing Considerations

Pregnancy

Anaphylactic Reactions and Angioedema

Symptomatic hypotension

Potassium Supplements

Relationship to meals
Dosage and Administration

The usual recommended starting dose of Tekturna is 150 mg once
daily.

In patients whose blood pressure is not adequately controlled, the
daily dose may be increased to 300 mg.

The antihypertensive effect of a given dose is substantially attained
(85-90%) by 2 weeks.