HYPERTENSION

Hypertension

•BP >140/90 mmHg taken at

rest
•Blood Pressure (BP)
pressure exerted by the
blood against the arterial
wall
 Hypertension
Types:
➢PRIMARY/ ESSENTIAL
No known cause; Idiopathic (90%)

➢SECONDARY
Medical conditions (10%)
Cardiovascular, renal, endocrine, pregnancy and drugs
HYPERTENSION
Risk Factors:

Non-Modifiable Modifiable
Age Diet: ↑ Fat, ↓ Na
Gender Obesity
Family history Smoking
Race Alcohol
Stress
Lifestyle
HYPERTENSION
Assessment:
✓ASYMPTOMATIC (majority)
✓Headache; dizziness
✓Nape pain
✓Blurring of vision
✓Nausea and vomiting
✓Chest pain
✓Weakness
 HYPERTENSION
Nursing Diagnosis:
✓Altered tissue perfusion
✓Pain
✓Activity intolerance
 HYPERTENSION
Diagnostics:
•BP apparatus

Organ Damage:
• Brain
• Eyes
• Heart
• Kidney
 VASODILATORS/
ANTI-ANGINAL
•Vasodilation → ↓BP
•Nitrates, ISMN (Imdur), ISDN (Isordil)
•Hydralazine

Nursing care:
✓IV, SL, PO, trandermal/ topical
✓Assess for HEADACHE, dizziness, ↓ BP
 ANGINA
• Anti-anginal drugs
– Nitroglycerin, nitrodur, nitrites, Isosorbide dinitrate (Isordil)
• Dilates peripheral vascular smooth muscles
• Decreases preload and afterload
• Decreases myocardial oxygen needs
• Dilates large coronary arteries
• Used to treat angina, CHF, hypertension
• Can develop tolerance to drug
• HA, flushing, hypotension are SE
• Store in dark light protected container
• Cardiac glycoside
– Lanoxin (Digoxin)
• Increase force of contraction and decreases rate of conduction
• Has diuretic effect
• Used in CHF, dysrhythmias (A-fib)
• Can become toxic, especially with low K+
• Hold drug if apical rate < 60 bpm
• Monitor K+ levels
• Digi-bind is an antidote
 CARDIAC DRUGS
• DIRECT-ACTING ADRENERGICS ( alpha and beta)
agonists
– Epinephrine- same actions as sympathetic nervous
system
– Increases force of contraction
– Increases systolic blood pressure, cardiac rate, output
– Relaxes bronchial smooth muscle
 ALPHA ADRENERGIC BLOCKERS

↓ vasoconstriction→ ↓BP
•Clonidine (Catapres)
•Methyldopa (Aldomet)
•Prazocin
 BETA ADRENERGIC BLOCKERS
↓ CR→ ↓BP
• Metoprolol (Neobloc)
• Propanolol (Inderal)
• Esmolol (Brevibloc)
• Atenolol (Tenormin)
Nursing care:
✓Monitor VS; CR
✓Hold if CR < 60/min
✓CI: Asthma, DM and bradycardia
SE: bronchospasm, hypoglycemia, ↓CR
 ANTI-DYSRHYTHMICS
• Beta-adrenergic blocking
• Block sympathetic stimulating reduces heart rate,
contractility, slows electrical impulse
• Used to treat dysrhythmias
• Also used for hypertension, angina
• Can promote CHF
• Inderal causes bronchoconstriction
• Brevibloc is cardio-selective
 Ca Channel Blockers

↓ Contraction; Vasodilation→ ↓BP

•Nifedipine (Calcibloc)
•Felodipine
•Verapamil
•Diltiazem
 ANTI-DYSRHYTHMICS
• Calcium channel antagonists
• Reduce influx of calcium into cell
• Produces smooth muscle relaxation
• Lowers BP
• Dilate coronary arteries
• Reduce myocardial oxygen consumption
• Slow electrical impulse
• May cause hypotension, peripheral edema, HA, bradycardia, possible CHF
 ACE INHIBITORS

Blocks RAA system→ ↓BP

•Captopril (Capoten)
•Enalapril
•Imidapril

Nursing care:
✓Assess for cough
 ANTI-DYSRHYTHMICS
• Antidysrhythmics
– Procainamide (Pronestyl, Procan SR); disopyramide
(Norpace)
• Used to treat ventricular dysrhythmias, A-fib
• May cause GI upset, tachycardia, hypotension
• Norpace has lower incidence of adverse effects
– Usually reserved for those who do not tolerate other drugs
 ANTI-DYSRHYTHMICS
• Anti-dysrhythmics
– Lidocaine
• Rapid acting dysrhythmic and brief action
• Less likely to become toxic
• Does not depress cardiac contractility or electrical conduction
• May cause lightheadedness, bradycardia
• Not effective when administered orally
 ANTI-DYSRHYTHMICS
• Anti-dysrhythmics
– Tocainide (tonocard)
• Similar to lidocaine
• Is administered orally
• Serious SE: paresthesia, restlessness, tremors
 ANTI-DYSRHYTHMICS
• Anti-dysrhythmics
– Mexiletine HCL (mexitil)
• Similar to lidocaine
• Administered orally
• Same SE as lidocaine
 ANTI-DYSRHYTHMICS
• Anti-dysrhythmics
– Flecanide acetate (tambocor) Encainide HCL ( Enkaid)
• Decrease cardiac impulse conduction
• Used orally
• May cause worse dysrhythmias
• May cause worsening of CHF
• Usually reserved for use in life-threatening dysrhythmias
 ANTI-DYSRHYTHMICS
• Anti-dysrhythmics
– Amiodarone HCL (Cordarone)
• May be given orally or IV
• Able to treat dysrhythmias resistant to other drugs
• But has significant adverse reactions:
– Pulmonary toxicity- cough, dyspnea, chest pain
– Requires immediate medical treatment
– May increase activity of digoxin and coumadin
– May develop yellow-brown spots on cornea
 ANTI-DYSRHYTHMICS
• Anti-dysrhythmics
– Adenosine (adenocard)
• One of most effective drugs for cardioversion
• Naturally occurring substance in body
• Slows electrical conduction thru AV node
• Caffeine and theophylline may inhibit effects
 DIURETICS
Na and water excretion→ ↓BP
➢Thiazide Diuretics
Chlorothiazide
(SE: ↑ Uric Acid, ↑ Ca)

➢Loop Diuretic
Furosemide (Lasix)
SE: ↓BP

➢Osmotic Diuretics
Mannitol→ ↓ ICP
 DIURETICS
➢Carbonic Anhydrase Inhibitor
Acetazolamide
SE: Metabolic Acidosis

➢K- Sparing Diuretics

Spirinolactone
SE: ↑ K

Nursing care:
✓Monitor VS; BP
✓Monitor I and O accurately
 HYPERTENSION
Management:
✓Take anti-hypertensive drugs regularly
not symptomatically
✓Diet: ↓ Na (2 gm/day); ↓ Fat
✓Weight control
✓No alcohol, smoking
✓Avoid stress
✓Regular exercise and rest
 HYPERTENSIVE CRISIS
•Systolic BP > 180 mmHg
•Diastolic BP >120mmHg

•With target organ damage

Management:
✓Airway, Breathing and Circulation
✓Control BP in minutes to few hours
✓Antihypertensive drugs (IV, SL)
THANK YOU