I remember when I was in nursing school; high blood pressure was referred to as “the silent killer”. A person with high blood pressure may or may not display any symptoms therefore the person is at increased risk for a stroke, heart failure, and many other conditions that affect other organs in the body. Ten years ago, normal blood pressure was considered to be systolic of 120 mm Hg and diastolic of 80 mm Hg. According to the American Heart Association, blood pressure readings are grouped in categories including the following;
Normal Blood pressure: systolic less than 120 mm Hg and diastolic less than 80 mm Hg
Elevated blood pressure: systolic 120-129 mm Hg and diastolic less than 80 mm Hg
High blood pressure (Hypertension Stage 1): Systolic 130-139 mm Hg and diastolic 80-89 mm Hg
High Blood pressure (Hypertension Stage 2.): Systolic 140 MM Hg or higher and diastolic 90 mm hg or higher
Hypertensive Crisis: Higher than 180 mm Hg and/or diastolic higher than 120 mm Hg
There are many drugs used alone or in adjunction to treat high blood pressure. There are five main classifications of drugs used in antihypertensive therapy which includes diuretics, ACE inhibitors, Angiotensin receptor blockers, Calcium channel blockers, and sympathetic nervous system drugs. Diuretics work by accelerating the rate of urine formation that result in the removal of sodium and water from the body. Some examples of diuretics are loop diuretics (furosemide), Potassium sparing diuretics (spirolactone), thiazide and thiazide-like diuretics (chlorothiazide), and Carbonic anhydrase inhibitors (acetazolamide). ACE inhibitors (vasotec, menopril, lisinopril) inhibit angiotensin converting enzyme, which is responsible for converting angiotensin I to angiotensin II. Angiotensin II is a potent vasoconstrictor and induces aldosterone secretion by the adrenal glands. Aldosterone stimulates sodium and water reabsorption, which can raise blood pressure. This process is known as the renin-angiotensin-aldosterone system (RAAS). The primary effects of ACE inhibitors are cardiovascular and renal. ACE inhibitors can be used alone or in combination for treatment in hypertension and heart failure. Angiotensin receptor (cozaar, teveten, diovan) blockers block the binding of angiotensin II to angiotensin I, therefore blocking vasoconstriction and the secretion of aldosterone, leading to vasodilation. Calcium channel blockers (Procardia,) work by causing smooth muscle relaxation by blocking the binding of calcium to its receptors, which thereby prevents contraction (Collins et al., 2019). Sympathetic Nervous system drugs are drugs that include beta adrenergic blockers (Lopressor, atenolol). Beta blockers reduce blood pressure by blocking central and peripheral beta receptors, which results in decreased cardiac output and sympathetic outflow. Beta blockers that mostly bind to beta 1 receptors, are referred to as cardio selective because they do not significantly block beta 2 receptors (Arcangelo et al., 2017)
The goal of therapy should always be discussed with the patient. A blood pressure within normal limits, or a pressure that is less than 140/90 mm Hg should be ideal. The consequences that can occur if the patient is not compliant with the medication regime in controlling blood pressure such as having a stroke, heart failure, kidney failure and etc. Important points that should be discussed during patient education on anti-hypertensive medications is to always check blood pressure throughout the day and keep a log of the blood pressure to show to the provider on the next visit. Monitor for side effects of hypotension, especially postural hypotension, which is common among the geriatric population. Adverse effects like angioedema (for ex. Swelling of the tongue or lips) when taking ACE inhibitors, or signs and symptoms of hypoglycemia, need to be reported immediately or patient is to go to the nearest Emergency room to get evaluated. When taking diuretics, patients must remember to hydrate to keep from getting dehydrated. The patient also need to know that several different agents may be tried before finding the one that best controls his or her blood pressure with minimal or no side effects. Patient should also be educated on following a healthy diet, restrict sodium, quit smoking, maintain a healthy weight, and exercise regularly. (Arcangelo et al., 2017)
Snyder, J. S., Rainforth Collins, S., Lilley, L. L., Souter, S. (2019). Study Guide for Pharmacology and the Nursing Process. United Kingdom: Elsevier – Health Sciences Division.
Arcangelo, P. V., Peterson, M. A., Wilbur, V., & Reinhold, A. J. (2017). Pharmacotherapeutics for Advanced Practice: A Practical Approach (4th Ed.). Wolters Kluwer/Lippincott Williams & Wilkins.