NURS 403 PATHOPHYSIOLOGY|PHARMACOLOGY 1 HYPERTENSION FINAL EXAM REVIEW LATEST AND ACCURATE PACE UNIVERSITY.

NURS 403
PATHOPHYSIOLOGY|PHARMACOLOGY 1
HYPERTENSION FINAL EXAM REVIEW
LATEST AND ACCURATE PACE UNIVERSITY.

, HYPERTENSION
1. BP Classification, When to Initiate Pharmacotherapy, BP
Targets BP Classification:
• Normal:
o Systolic BP (SBP) < 120 mmHg and Diastolic BP (DBP) < 80
mmHg
o This is the optimal range, where no intervention is needed
if the patient is asymptomatic.
• Elevated:
o SBP 120-129 mmHg and DBP < 80 mmHg
o Patients in this range may not require medication but
should be advised on lifestyle modifications (diet,
exercise).
• Hypertension Stage 1:
o SBP 130-139 mmHg or DBP 80-89 mmHg
o Pharmacotherapy should be initiated in patients with a
history of cardiovascular disease (CVD), chronic kidney
disease (CKD), or diabetes.
• Hypertension Stage 2:
o SBP ≥ 140 mmHg or DBP ≥ 90 mmHg
o Pharmacotherapy is typically initiated in these patients
regardless of comorbidities, as this stage carries an
increased risk of complications like stroke, heart attack,
and renal failure.
When to Initiate Pharmacotherapy:
• Stage 1 HTN:
o Initiate pharmacotherapy if there is evidence of CVD (e.g., heart
failure, coronary artery disease) or high-risk conditions such as
diabetes, CKD, or a history of stroke.
• Stage 2 HTN:
o Immediate initiation of pharmacotherapy is indicated due to the
high cardiovascular risk associated with elevated BP.
BP Targets:
• General Targets:
o SBP < 130 mmHg and DBP < 80 mmHg is the goal for most
adult patients with hypertension.
• Specific Populations:
o Older Adults: A more relaxed target (SBP < 140 mmHg) might
be appropriate, especially in those over 80 years old, to
balance risks and benefits.
o Diabetes: BP should be controlled to reduce the risk
of microvascular complications, aiming for < 130/80
mmHg.

,o Chronic Kidney Disease: For patients with proteinuric
kidney disease, ACE inhibitors or ARBs are preferred to
preserve kidney function.

, 2. Compelling Indications and Appropriate Drugs for Each
• Heart Failure with Reduced Ejection Fraction (HFrEF):
o Preferred classes: ACE inhibitors, Beta-blockers,
Aldosterone antagonists, ARNIs.
o ACE Inhibitors (e.g., Lisinopril): Reduce the work of the
heart, prevent angiotensin II-mediated vasoconstriction,
and help prevent remodeling of the heart.
o Beta-blockers (e.g., Carvedilol, Metoprolol
succinate): Reduce heart rate, improve systolic
function, and improve survival in heart failure.
o Aldosterone antagonists (e.g., Spironolactone,
Eplerenone): Prevent fluid overload and have heart-
protective benefits in severe heart failure.
o ARNIs (e.g., Sacubitril/valsartan): Combination of an
angiotensin receptor blocker (ARB) and a neprilysin inhibitor
that improves heart failure outcomes.
• Chronic Kidney Disease (CKD):
o Preferred: ACE inhibitors or ARBs for their renal protective
effects, particularly in patients with albuminuria or
declining renal function.
o These agents help reduce glomerular hypertension,
prevent further kidney damage, and can improve long-
term renal outcomes.
• Post-Myocardial Infarction (MI):
o Beta-blockers, ACE inhibitors/ARBs, and Aspirin are used to
prevent further infarction, stabilize plaque, and improve survival.
• Diabetes:
o ACE inhibitors/ARBs: Protect against diabetic nephropathy.
o Thiazide diuretics and Calcium channel blockers
(e.g., Amlodipine) are safe and effective in diabetic
patients but require monitoring for electrolyte
imbalances.
• Stroke:
o Thiazide diuretics (e.g., Chlorthalidone) and ACE inhibitors
are commonly used for secondary stroke prevention.

3. ACE Inhibitors: Drugs, Mechanism of Action,
ADE Drugs:
• Lisinopril, Ramipril, Enalapril, Benazepril, Captopril,
Fosinopril. Mechanism of Action:
• Angiotensin-Converting Enzyme (ACE) converts angiotensin I
into angiotensin II, which has potent vasoconstrictor effects.