Chapter 23 Hypertension (Bb)

Front 1

Hypertension (the silent killer)

Back 1

sustained elevation of blood pressure
early stages no signs or symptoms, Incidence is higher in blacks by 2X
25% of people are undiagnosed

Front 2

Systolic Blood pressure

Back 2

(arterial BP) – systole
highest pressure exerted on blood vessels

Front 3

Diastolic Blood Pressure

Back 3

diastole
resting or lowest pressure exerted on the vessel walls between contractions

Front 4

Pulse pressure

Back 4

difference between systolic and diastolic blood pressure

Front 5

MAP- Mean arterial blood pressure

Back 5

average pressure throughout each cycle of heart beat
It is the pressure that pushes blood through the circulatory system to perfuse the tissue

Front 6

how to calculate MAP

Back 6

(systolic BP- diastolic BP/3) +diastolic pressure

Front 7

co(Cardiac output)

Back 7

primary determinant of systolic BP

Front 8

Peripheral Vascular Resistance determines

Back 8

diastolic BP

Front 9

Arterial Blood Pressure

Back 9

Cardiac output (CO) x PVR

Front 10

(cardiac output) CO

Back 10

Heart rate x stroke volume

Front 11

Types of hypertension

Back 11

1. Primary= 90% of all cases are idiopathic
2.secondary=associated with another disorder; renal, head trauma, cushing syndrome, thyroid disease, drugs ect.

Front 12

risk factors of hypertension

Back 12

smoking,diabetes, sex, family history, sedentary lifestyle, stress, race, obesity(BMI above 30),

Front 13

diagnosis of HTN(Hypertension)

Back 13

2 or more high readings on seperate occasions, 2 minutes apart: seated, supine, standing( in both arms)

* remember proper cuff size!!!

Front 14

normal blood pressure reading

Back 14

120/80

Front 15

Prehypertension reading

Back 15

120-139/80-89

Front 16

Stage 1

Back 16

140-159/90-99

Front 17

stage 2

Back 17

above 160/ above 100

Front 18

Identifiable causes of hypertension

Back 18

Sleep apnea, renal or Renovascular disease(chronic kidney disease, renal artery stenosis), Drug induced or related problems, primary aldosteronism, pheochromocytoma, coarctation of the aorota , thyroid or para thyroid disease

Front 19

hypertension causes damage to these organs:

Back 19

Heart:LVH, Angina or Mi, prior coronary, revascularization, heart failure; Brain: Stroke, TIA; Kidneys: high GFR; Peripheral blood vessels:PAD(Peripheral arterial diseases, PVD(peripheral vascular disease); Metabolic syndrome components; Eyes: retinopathy

Front 20

signs and symptoms of Hypertension

Back 20

waking headache, N&V, blurred vision, Nocturia, Edema, Nosebleeds

Front 21

hypertension treatment goals

Back 21

lower CV disease, morbidity, and mortality, lower blood pressure under 140/90

Front 22

lifestyle changes for people with hypertension

Back 22

Smoking cessation
Weight loss
Routine Exercise
Adequate sleep
Stress management
Decreased ETOH & decreasedcaffeine
Sodium control
DASH dietary approaches to stop HTN

Front 23

preferred hypertension medications

Back 23

diurectics and beta blockers

Front 24

alternatives meds (used alone or in combo)

Back 24

ACE
ARBs
CCB
Alpha adrenergic Receptor Blockers

Front 25

Adjunctive agents (only used in combo)

Back 25

Central acting alpha 2 agonists
Peripheral acting adrenergic antagonists
Direct vasodilators

Front 26

Older adults with isolated systolic HTN

Back 26

diuretics with or without beta blocker or dihydropyridine CCB alone

Front 27

HTN + DM, hyperlipidemia &/or chronic kidney disease

Back 27

ACE or ARB

Front 28

diuretic uses

Back 28

Most common Rx (decrease morbidity & mortality),
Used in all stages of HTN,
Potentiate hypotensive actions of other anti-hypertensive agents,
low incidence of adverse effects, and
Inexpensive

Front 29

diurectic actions

Back 29

decrease fluid volume, decrease sodium, and its a vasoodilation

Front 30

diurectic classes

Back 30

Thiazide & thiazide –like diuretics
Used if adequate renal function
Loop Diuretics(Strongest)
Carbonic Anhydrase Inhibitors
(Wimpy)
Potassium-sparing diuretics
Usually used in combo c thiazide & loop diuretics

Front 31

Types of Diuretics

Back 31

Lasix (furosemide) - Loop

hydrochlorothiazide (HCTZ) – thiazide

Side Effects:
electrolyte depletion (K+ & Na+)
dehydration

check electrolytes and input and output while on the medicine

Front 32

Beta adrenergic blockers (olol)- uses

Back 32

hypertension, Angina, prevent Mi, atrial fib/Flutter, hypertrophic subaortic stenosis; migraine HA

Front 33

Beta adrenergic blockers (olol)- Actions

Back 33

inhibits cardiac response to sympathetic nerve stimulation by block beta receptors, decreases heart rate thus it decreases CO&BP
inhibits renin release from kidneys altering the renin-angiotensin-aldosterone cascade that induces vasoconstriction and sodium+ reabsorption that worsen hypertension

Front 34

Beta adrenergic blockers (olol)-advantages

Back 34

miniamal postural hypotension, most administered 1x daily, good for clients with migraines

Front 35

Beta adrenergic blockers (olol)-side effects

Back 35

bradycardia, fatigue, impotence, vasoconstriction(mottled skin), bronchospasm, angina if d/c suddenly

Front 36

Beta adrenergic blockers (olol)- nursing implications

Back 36

DO NOT USE: Asthma Hx, DM type 1, heart failure caused by systolic dysfunction, and PVD
Safety: teach not to discontinue suddenly, use with caution patients with DM may mask signs and symptoms of hypoglycemia
check interactions
NSAIDS MAY DECREASE effectiveness of beta blockers
NOT As EFFECTIVE FOR AFRICAN AMERICANS

Front 37

ACE inhibitors "pril"- actions

Back 37

inhibits angiotensin I-converting enzyme, preventing conversion of angiotensin I to angiotensin II (prevents vasoconstriction)

Front 38

ACE inhibitors "pril"- use

Back 38

stage 1 and 2 hypertension, Heart Failure, lower blood pressure, preserves cardiac output (CO), increases renal blood flow

Front 39

ACE inhibitors "pril"- advantages

Back 39

good for DM, slows progression of diabetic nephropathy, heart failure, post-MI
no sexual or CNS side effects

Front 40

ACE inhibitors "pril"- side effects

Back 40

cough in 1/3 of patients, possible hyperkalemia, inhibits aldosterone, angioedema: swelling of face, tongue, and lips

Front 41

ACE inhibitors "pril"- Nursing implications

Back 41

check electrolytes, Safety, if developing angioedema,discontinue and notify physician immediately
NOT AS effective in AFRICAN AMERICANS unless combined with a diuretic
Contraindicated in Pregnancy

Front 42

Angiotensin II Receptor Blockers ARBs - “sartan”

Back 42

ARBs works by binding to the Angiotensin II (the a POTENT vasocontstrictor) receptor sites (AT1 receptor)
blocking angiotensin II in the vascular smooth muscle, brain, heart, kidneys & adrenal glands.
ARBs have NO effect on renal function, prostaglandin levels, triglycerides, cholesterol, or blood glucose levels or bradykinin so NO COUGH.

Front 43

Angiotensin II Receptor Blockers ARBs - “sartan”- action

Back 43

bind to angiotensin II receptor sites (prevents vasoconstriction)

Front 44

Angiotensin II Receptor Blockers ARBs - “sartan”- uses

Back 44

HTN; Heart Failure; Post MI Lt Ventricular Dysfunction

Front 45

Angiotensin II Receptor Blockers ARBs - “sartan- advantages, side effects, Nursing implications

Back 45

advan: NO COUGH, Side effects: hyperkalemia, orthostasis, nursing implications: check electrolytes especially potassium, safety and check for pregnancy
NOT AS effective in AFRICAN AMERICANS

Front 46

Calcium Channel Blockers CCBs -ACTIONS

Back 46

Inhibits Ca++ ions movement across cell membrane,decreases conduction (fewer dysrhythmias), decreases heart rate,Relax smooth muscles of blood vessels (vasodilation)

Front 47

Calcium Channel Blockers CCBs - drugs

Back 47

Diphenylalkylamine - Calan, Isoptin (verapamil)
Benzothiazelines - Cardizem (diltiazem)
Dihydropyridine – dipines

Front 48

Calcium Channel Blockers CCBs

Back 48

very effective in AFRICAN AMERICANS and OLDER PATIENTS

Front 49

Calcium Channel Blockers CCBs -Uses

Back 49

hypertension, Angina; Alternative to Beta blockers for pts with asthma & DM; patients with higher pretreatment HTN

Front 50

CCB's side effects, advantages, and nursing implications

Back 50

check edema, and sodium levels, check daily weights
side effect: edema
advan:Better peripheral vasodilation,decreased afterload, increased renal sodium plus secretion, and well tolerated

Front 51

Direct Renin Inhibitor -Tekturna (aliskiren)

Back 51

action:inhibits the 1st step of the renin-angiotensin-aldosterone system, prevents angiotensin II from activating its receptors
Uses: stage 1 and 2 hypertension; lowers blood pressure

Front 52

Aldosterone Receptor Antagonists- Inspra (eplerenone)

Back 52

Action:
blocks aldosterone which causes Na+ retention by stimulating mineralcorticoid receptors in the adrenal cortex , blood vessels, & brain ; prevents Na+ reabsorption

Front 53

Aldosterone Receptor Antagonists- Inspra (eplerenone)

Back 53

uses:Stage 1 & 2 hypertension; heart failure

Front 54

Aldosterone Receptor Antagonists- Inspra (eplerenone)

Back 54

Side effects:Hypertriglyceridemia (1-15%)

Nursing Implications
Interactions with strong metabolic inhibitors
CYP34A inhibitors (azoles, emycin)
Grapefruit juice increase med 25%
√ Electrolytes
NSAIDs decrease effectiveness

Front 55

alpha-1 Blocking Agents – “zosin”

Back 55

doxazosin Cardura
prazosin Minipress
terozosin Hytrin

Front 56

alpha-1 Blocking Agents – “zosin”

Back 56

Action:
blocks post-synaptic alpha-1 adrenergic receptors to produce arteriolar & venous vasodilation
decrease PVR without decreasing CO or inducing reflex tachycardia
Small decrease total cholesterol, LDL, & triglycerides & increase HDL
DOES NOT increase catecholamine, so Øincrease heart rate or myocardial O2 consumption
No effect on uric acid concentrations
Doxazosin (Cardura) & terozosin (Hytrin) decrease urinary outflow resistance with BPH
Prostate& areas of the bladder have alpha-1 receptors

Front 57

alpha-1 Blocking Agents – “zosin”

Back 57

uses: hypertension, high blood pressure
side effects: drowsiness; dizziness (self-limiting)
Nursing Implications
Administer with food to decrease side effects
Avoid ETOH (additive effects)
Give Minipress with diuretic (2 Na+ & H2O retention)

Front 58

Central-Acting alpha-2 Agonists

Back 58

clonidine Catapres
guanabenz Wytensin
guanfacine Tenex
methyldopa Aldomet

Action:
stimulate lpha-adrenergic receptors in brain stem →
Decrease sympathetic outflow from brain
Decrese HR
Decrese PVR (peripheral vascular resistance)

Front 59

Central-Acting alpha-2 Agonists

Back 59

Use:
Adjunct
When other drugs fail
Elderly

Off Label Uses:
Heroine or nicotine withdrawal; ethanol dependence
Severe pain
Menopause Sx; Vasomotor sx (hot flashes)
Migraine prophylaxis
Glaucoma
ADHD; impulse control disorder

Front 60

Central-Acting alpha-2 Agonists

Back 60

Side effects:
Sedation & fatigue (25-35%)
Dizziness
Dry mouth (40%)
Depression
Sexual dysfunction

Nursing Implications
Assess mental status
Teach: do not d/c suddenly
profound rebound HTN
Patch: √ rash

Front 61

Peripheral-Acting Adrenergic Antagonists

Back 61

Direct Vasodilators:
Hydralaxine (Apresoline)
Po, IM, IV
Minoxidil (Loniten)
PO, topical (rarely used for HTN)
Nitroprusside Sodium (Nipride)
IV only

Front 62

Hydralazine (Apresoline)

Back 62

Actions:
Arterial smooth muscle dilator
Decrease PVD peripheral resistance
Causes reflex tachycardia, increaseCO, & renin release with Na+ & H2O retention

Front 63

Hydralazine (Apresoline)

Back 63

Use:
Severe HTN (Stage II)
Renal disease
Toxemia of Pregnancy
Heart failure (by decrese afterload)
Combined with beta blocker (to decrease reflex tachycardia) & diuretic