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Chapter 23
Drugs Used to Treat Hypertension
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Chapter 23
Lesson 23.1
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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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 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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 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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 Target organ damage
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Heart
Brain
Kidneys
Blood vessels
Eyes
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 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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 Lifestyle modifications
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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Chapter 23
Lesson 23.2
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Identify specific factors the hypertensive
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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 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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Lifestyle modifications are initial therapy
If no significant effect, drug therapy is
introduced
Start with diuretics for stage 1 hypertension
Add beta blockers(lol), ACE inhibitors(pril),
calcium channel blockers(dipine), and
angiotensin receptor blockers(ARBs) as
tolerated
Start with two-drug combination for stage 2
hypertension
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Diuretics; beta-adrenergic blocking (lol)
agents
ACE inhibitors (pril); angiotensin II receptor
blockers (ARBs)
Direct renin inhibitors; aldosterone
receptor antagonist
Calcium channel blockers (dipine); alpha-1
adrenergic blocking agents
Central-acting alpha-2 agonists;
peripheral-acting adrenergic antagonists;
direct vasodilators
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 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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 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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 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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 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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 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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 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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 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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 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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 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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 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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