Pharmacology
- First line drug choices
- Thiazide diuretics - increase sodium excretion
- Long-acting CCBs - relaxes and dilated arteries - increases vasodilation - no with
grapefruit juice
- ACE inhibitors - cough
- ARBS -
- Second line drug choices
- Beta blockers
- Alpha 1 blocker
- Alpha 3 agonist
- Loop diuretic - pee a lot
- Potassium sparing diuretic
Gerontologic Considerations
- Start with lifestyle modifications
- Isolated systolic hypertension is the most common type of hypertension in adults older
than 50
- Medication is only prescribed if needed to achieve less than 150/90
- Older adults tend to have comorbidities, be aware of drug interactions
- Increased risk for side effects of hyperkalemia and orthostatic hypotension
Considerations
- Most patients with hypertension will require more than one drug
- The degree of blood pressure reduction, not the choice of medication is the main
determining factor in reducing cardiovascular risk in patients with hypertension
- Fixed dose, single pill combination medications should be used whenever possible to
reduce the burden on patients and increase medication adherence
- After medication therapy is initiated, patients should be evaluated monthly to ensure
adequate blood pressure is achieved
- The optimal management plan is one that is inexpensive, simple, and causes the least
disruption in the patient’s life
Nursing Process - Assessment
- Accurate BP readings
- Cuff size based on size of patient
- Get two readings 1-2 minutes apart
- Assessment based on average of at least two readings
- Position patient’s arm at heart level
- History
- assess for other CV risk factors
- Look for other signs/symptoms of target organ damage
- Angina
- SOB
- First line drug choices
- Thiazide diuretics - increase sodium excretion
- Long-acting CCBs - relaxes and dilated arteries - increases vasodilation - no with
grapefruit juice
- ACE inhibitors - cough
- ARBS -
- Second line drug choices
- Beta blockers
- Alpha 1 blocker
- Alpha 3 agonist
- Loop diuretic - pee a lot
- Potassium sparing diuretic
Gerontologic Considerations
- Start with lifestyle modifications
- Isolated systolic hypertension is the most common type of hypertension in adults older
than 50
- Medication is only prescribed if needed to achieve less than 150/90
- Older adults tend to have comorbidities, be aware of drug interactions
- Increased risk for side effects of hyperkalemia and orthostatic hypotension
Considerations
- Most patients with hypertension will require more than one drug
- The degree of blood pressure reduction, not the choice of medication is the main
determining factor in reducing cardiovascular risk in patients with hypertension
- Fixed dose, single pill combination medications should be used whenever possible to
reduce the burden on patients and increase medication adherence
- After medication therapy is initiated, patients should be evaluated monthly to ensure
adequate blood pressure is achieved
- The optimal management plan is one that is inexpensive, simple, and causes the least
disruption in the patient’s life
Nursing Process - Assessment
- Accurate BP readings
- Cuff size based on size of patient
- Get two readings 1-2 minutes apart
- Assessment based on average of at least two readings
- Position patient’s arm at heart level
- History
- assess for other CV risk factors
- Look for other signs/symptoms of target organ damage
- Angina
- SOB
