ANTIHYPERTENSIVES
Hypertension
● Selected regulators of blood pressure
● Kidneys via renin–angiotensin system
○ Renin - (angiotensinogenASE) an enzyme that causes the release of angiotensin from the liver, converts
angiotensinogen into Angiotensin I
○ ACE - converts Angiotensin I into II
○ Angiotensin II - increases sympathetic activity (baroreceptors), H20 retention, Na and Cl reabsorption, and K
excretion, makes adrenal gland release aldosterone, arterial constriction increase BP, pituitary gland to release
ADH
○ Antidiuretic Hormone (ADH) - water retention; released from the pituitary
○ Aldosterone - salt and water retention; released from the adrenal cortex
Regulators of Blood Pressure
● Baroreceptors - located in the aorta and carotid sinus; sense BP and relay info to the brain
● Vasomotor center - in the medulla; stimulated when there is low BP and inhibited with low BP
● Hormones
○ Antidiuretic hormone (ADH) - increase water retention; released from pituitary
○ Atrial natriuretic peptide (ANP) - decreased BP, vasodilation, decrease angiotensin II and aldosterone,
increase GFR
○ Brain natriuretic peptide (BNP) - decreases BP, vasodilation, decrease angiotensin II and aldosterone,
increase GFR
,
, ● Physiologic Risk Factor
○ Physiologic risk factors
■ Excess saturated fat and simple carbohydrates (arteries become small and hard → increase BP and
HR)
■ Alcohol increases renin secretions (activates RAAS → also inhibits ADH)
■ Obesity increases cardiac output, stroke volume, and left ventricular filling.
○ Cultural responses to antihypertensive agents → Increased
■ African Americans
■ Asian Americans
○ Hypertension in older adults
● Nonpharmacologic Control of Hypertension
○ Nonpharmacologic control
■ Stress-reduction techniques
■ Exercise
■ Salt restriction
■ Decrease alcohol ingestion
■ Smoking cessation
Guidelines for Determining Hypertension
Category Systolic pressure Diastolic pressure
, Normal Less than 120 mm Hg Less than 80 mm Hg
Prehypertension 120 to 139 mm Hg 80 to 89 mm Hg
Stage 1 hypertension 140 to 159 mm Hg 90 to 99 mm Hg
Stage 2 hypertension Greater than 160 mm Hg Greater than 100 mm Hg
Antihypertensive Drugs
● Diuretics - excrete fluid
○ Thiazides → prevent salt reabsorption in distal convoluted tubule
■ Hydrochlorothiazide
○ Loop diuretics → prevent salt reabsorption in the loop of henle
■ Furosemide
○ Combination of thiazide with potassium-sparing diuretics
○ Combination of thiazide with other antihypertensive drugs
■ ACE inhibitors (which converts angiotensin which constricts vessels)
■ Beta blockers
■ Angiotensin II Receptor Blockers (ARBs)
● Qs
○ The nurse should instruct a patient to not suddenly stop taking antihypertensives in order to avoid?
■ Rebound Hypertension → hypertension caused by stopping the use of antihypertensive medication
○ An African-American patient is to be treated with initial monotherapy to control hypertension. The nurse
expects the patient to receive?
■ Diuretic
Sympatholytics → prevents sympathetic nervous system response
● 1. Beta-adrenergic blockers
○ Nonselective beta blockers
■ Inhibit beta 1 (normally increases cardiac contractility, heart rate, renin secretion, BP)
■ Inhibit beta 2 (normally decreases GI motility, increases bronchodilation, blood flow to muscles, liver
glycogenolysis, and relaxes uterus)
■ Medications
● Propranolol and Carvedilol
○ Cardioselective beta blockers
■ Block beta 1 receptors (normally increases cardiac contractility, heart rate, renin secretion, BP)
■ Medications
● Acebutolol, atenolol, betaxolol, bisoprolol, and metoprolol
○ Side effects
■ Hypotension, dizziness, fatigue
■ Insomnia, nightmares
■ Depression, sexual dysfunction
○ Nursing Process: Beta-Adrenergic Blockers
■ (Have monitor BP but tell them not to focus on it → they can become obsessed)
■ Assessment
● Obtain a medication and herbal history from the patient.
● Obtain vital signs.
■ Nursing diagnoses
● Cardiac output, decreased related to variations in blood pressure readings
Hypertension
● Selected regulators of blood pressure
● Kidneys via renin–angiotensin system
○ Renin - (angiotensinogenASE) an enzyme that causes the release of angiotensin from the liver, converts
angiotensinogen into Angiotensin I
○ ACE - converts Angiotensin I into II
○ Angiotensin II - increases sympathetic activity (baroreceptors), H20 retention, Na and Cl reabsorption, and K
excretion, makes adrenal gland release aldosterone, arterial constriction increase BP, pituitary gland to release
ADH
○ Antidiuretic Hormone (ADH) - water retention; released from the pituitary
○ Aldosterone - salt and water retention; released from the adrenal cortex
Regulators of Blood Pressure
● Baroreceptors - located in the aorta and carotid sinus; sense BP and relay info to the brain
● Vasomotor center - in the medulla; stimulated when there is low BP and inhibited with low BP
● Hormones
○ Antidiuretic hormone (ADH) - increase water retention; released from pituitary
○ Atrial natriuretic peptide (ANP) - decreased BP, vasodilation, decrease angiotensin II and aldosterone,
increase GFR
○ Brain natriuretic peptide (BNP) - decreases BP, vasodilation, decrease angiotensin II and aldosterone,
increase GFR
,
, ● Physiologic Risk Factor
○ Physiologic risk factors
■ Excess saturated fat and simple carbohydrates (arteries become small and hard → increase BP and
HR)
■ Alcohol increases renin secretions (activates RAAS → also inhibits ADH)
■ Obesity increases cardiac output, stroke volume, and left ventricular filling.
○ Cultural responses to antihypertensive agents → Increased
■ African Americans
■ Asian Americans
○ Hypertension in older adults
● Nonpharmacologic Control of Hypertension
○ Nonpharmacologic control
■ Stress-reduction techniques
■ Exercise
■ Salt restriction
■ Decrease alcohol ingestion
■ Smoking cessation
Guidelines for Determining Hypertension
Category Systolic pressure Diastolic pressure
, Normal Less than 120 mm Hg Less than 80 mm Hg
Prehypertension 120 to 139 mm Hg 80 to 89 mm Hg
Stage 1 hypertension 140 to 159 mm Hg 90 to 99 mm Hg
Stage 2 hypertension Greater than 160 mm Hg Greater than 100 mm Hg
Antihypertensive Drugs
● Diuretics - excrete fluid
○ Thiazides → prevent salt reabsorption in distal convoluted tubule
■ Hydrochlorothiazide
○ Loop diuretics → prevent salt reabsorption in the loop of henle
■ Furosemide
○ Combination of thiazide with potassium-sparing diuretics
○ Combination of thiazide with other antihypertensive drugs
■ ACE inhibitors (which converts angiotensin which constricts vessels)
■ Beta blockers
■ Angiotensin II Receptor Blockers (ARBs)
● Qs
○ The nurse should instruct a patient to not suddenly stop taking antihypertensives in order to avoid?
■ Rebound Hypertension → hypertension caused by stopping the use of antihypertensive medication
○ An African-American patient is to be treated with initial monotherapy to control hypertension. The nurse
expects the patient to receive?
■ Diuretic
Sympatholytics → prevents sympathetic nervous system response
● 1. Beta-adrenergic blockers
○ Nonselective beta blockers
■ Inhibit beta 1 (normally increases cardiac contractility, heart rate, renin secretion, BP)
■ Inhibit beta 2 (normally decreases GI motility, increases bronchodilation, blood flow to muscles, liver
glycogenolysis, and relaxes uterus)
■ Medications
● Propranolol and Carvedilol
○ Cardioselective beta blockers
■ Block beta 1 receptors (normally increases cardiac contractility, heart rate, renin secretion, BP)
■ Medications
● Acebutolol, atenolol, betaxolol, bisoprolol, and metoprolol
○ Side effects
■ Hypotension, dizziness, fatigue
■ Insomnia, nightmares
■ Depression, sexual dysfunction
○ Nursing Process: Beta-Adrenergic Blockers
■ (Have monitor BP but tell them not to focus on it → they can become obsessed)
■ Assessment
● Obtain a medication and herbal history from the patient.
● Obtain vital signs.
■ Nursing diagnoses
● Cardiac output, decreased related to variations in blood pressure readings
