HYPERTENSION (HPN)

 Abnormal elevation of blood pressure systolic pressure above 140mmHg and or diastolic pressure
above 90mmHg for at least 2 reading.

CLASSIFICATIONOF HYPERTENSION

 ESSENTIAL/IDIOPATHIC/PRIMARY HYPERTENSION
 90-95% of all cases of hypertension- CAUSES unknown
 SECONDARY HYPERTENSION
 Due to known causes EXAMPLE: Renal failure, hyperthyroidism
 MALIGNANT HYPERTENSION
 Is a severe rapidly progressive elevation in blood pressure that causes rapid onset target organ
complications
 LABILE HYPERTENSION
 Is intermittently elevated blood pressure

STEPPED – CARE APPROACH

STEP I Diuretics, beta blocker, calcium blocker, ace inhibitor

STEP II Diuretics with beta blocker, sympatholytic

STEP III Diuretics acting vasodilator, sympatholytic with diuretics

STEP IV Adrenergic neuron blocker combinations from step I, II and III.

STEPPED CARE APPROACH

 Proved effective for management of hypertension for majority of hypertensive patients.

 The use of diuretics as first step therapy produces normotensive levels in a high percentage of
patients as any of the second step

DIURETICS

 Are easy to dilute and relatively inexpensive and side effects are not generally serious.

BETA BLOCKERS

 May be preferred in a certain patients without special testing.

 The use of diuretics in small doses and a second step agent such as beta blocker may prove more
efficacious and causes fewer side effects than larger doses of single agent.

DIURETICS

 First line of drugs for treating mild hypertension

HYDRODIURIL (HYDROCHORTHIAZIDES)

 Most frequently prescribed diuretics

 DIURETICS

Promote sodium and water exertion which decreases extracellular fluid volume. This in turn lowers
blood pressure.

A. POTASSIUM
 Wasting diuretics
 DIURIL – Chlorothiazide
 HYDRODIURIL – Hydrochlorothiazide

THIAZIDE LIKE

 HYGROTON – Chlosthalidone
 LOZOL – Indapamide

DROP – high ceiling

BUMEX – Bumetanide

LASIX – Furosemide

B. POTASSIUM – sparing
 ALDACTONE – Spironolactone
C. THIAZIDE with POTASSIUM SPARING DIURETICS – combination diuretics
 ALDACTAZIDE – Spironolactone and hydrochlorothiazide

THIAZIDE AND THIAZIDE LIKE DIURETICS

 Promote sodium chloride, potassium and water excretion

 Hypovolemia may occur
 Cause vasodilation which lowers blood pressure
 Promote calcium absorption – hypercalcemia may result
 Hyperglycemia can also occur – should be used cautiously in clients with diabetes mellitus.

FUROSEMIDE

 Is contraindicated if the client has hypersensitivity to sulfonamides

NSG INTERVENTIONS IN DIURETIC THERAPY

 Monitor vital signs and serum electrolytes especially potassium, uric acid and cholesterol levels.
 Check clients daily weight a vitamin gain of 2.2 -2.5 is equals to an excess liter of body fluids
 Monitor urine output to determine fluid loss or retention
 Administer medication in early morning, to avoid sleep disturbance resulting from nocturia.
 Instruct client to take and record blood pressure daily
 Advise pre diabetic patient to have blood sugar checked periodically because large doses of
hydrochlorothiazide increase blood sugar.

LOOP DIURETICS
  Assess vital signs serum electrolytes, weight and urine output for baseline levels.
A. If furosemide is given IV, the urine output should increase in 5-20 mins. If not increases notify
physician monitor urinary output.

ADMINISTER IV FUROSEMIDE
 Slowly hearing less may occur if rapidly injected

POTASSIUM

 Sparing diuretics

 SPIRONOLACTINE, AMILORIDE TRIAMTERENE

 Should not be taken with ace inhibitor because both can increase SERUM POTASSIUM
levels.

SYMPHATOLYTICS

1. BETA ADRENERGIC BLOCKERS

 BETA BLOCKERS
 Reduce cardiac output by diminishing SNS response, lower blood pressure by diminishing
vascular resistance
 Reduce heart rate, contractility and renin release

INDERAL (Propranolol)

 Should not be given to a client with COPD because it may cause Broncho constriction
 Should not be given to a client with diabetes mellitus
 May cause hypo glycaemia.
EXAMPLES OF BETA BLOCKER “OLOL DRUGS”
Tenormin – Atenolol
Kerlone – Betanolol HcL
Zebeta – Bisoprololol fumarate
Lopressor – Metropolol
Inderal – Propanolol

ONSET OF ACTION

 Oral BETA BLOCKERS

 30 mins or less

DURATION OF ACTION

 6-12 hrs.

IV ADMINISTRATION

 Immediate
 DURATION OF ACTION

 4-10 hrs.

SNS

 Sympathetic nervous system

2. CENTRALLY ACTING SYMPATHOLYTICS

 Adrenergic blockers
 Decrease SNS response from the brainstem to the peripheral vessels
 Stimulate ALPHA 2 receptors. Increase vagus activity and decrease serum, epinephrine,
Norepinephrine, and renin release.

METHYLDOPA (aldomet) AND OLONIDINE (catapress)

 Should be administer with diuretics because it can cause H2O and Na retention

BETA BLOCKERS

 Are not given with centrally acting sympatholytic.

 To prevent bradycardia
 To prevent rebound hypertension upon discontinue of drug therapy.

EXAMPLES OF CENTRALLY ACTING SYMPATHOLYTICS

1. CATAPRESS

 Clonidine HCL

2. ALDOMET

 Methyldopa
 Decrease VLDL and LDL
 Responsible for atherosclerosis (buildup of fatty plagues in the arteries)
 Increase HDL – friendly lipoprotein.

 These drugs can cause sodium and water retention with edema.
 Diuretics are frequently given to lower fluid accumulation in the extremities.

EXAMPLES

I. MINIPRESS

 Prazosin HCL

II. HYTRIN

 Terazosin HCL
III. PEBENZYLONE

 Penoxybenzamine HCL

IV. REGITINE

 Phentolamine

4. ADRENERGIC BIC NEURON BLOCKERS

 Peripherally acting sympatholytic

 Block norepinephrine release from the SNS.
 Results in lowering of blood pressure
 Decrease both in cardiac output and peripheral vascular resitance.

5. ALPHA 1 AND BETA 1 ADRENERGIC BLOCKERS

 Block the alpha-1 receptor

 Dilation of the arterioles and veins occurs.
 Block the cardiac beta -1 receptor.
 The HR and atrioventricular contractility are decreased.

EXAMPLES

 Cartrol ocupress – Cartedol HCL

 Trasdate, nonodyme – Labetalol HCL

DIRECT ACTING VASODILATORS

 Relax smooth muscles of the blood vessels mainly the arteries causing vasodilation and lower
blood pressure.

EXAMPLES:

 APRESOLINE HCL – hydralazine HCL

 LONITEN – Rogaine minoxide
 HYPERSTAT PROGLYCEM DIAZOXIDE
 Can cause hyperglycemia
 It inhibits release of insulin from because of the pancreas

ANGIOTENSIN ANTAGONISTS

 Angiotensin – converting enzyme inhibitors.

 Inhibit angiotensin converting enzyme which turn inhibits the formation of angiotensin II
(vasoconstriction) and blocks the release of aldosterone
 Promotes Na and H2o retention and potassium excretion when aldeterone is blocked Na and H2o
are excreted and potassium is retained.
 Ace inhibitors should not be given during pregnancy
 Can reduce blood flow
EXAMPLES:

CAPOTEN – captopril

VASOTEC – Enalapril maleate

MONOPRIL – fosinopril

ACCUPRIL – quinapril HCL

ALTACE – Ramipril

ANGIOSTENSIN II RECEPTOR ANTAGONIST BLOCKERS (arb’s)

 Block the angiotensin II absorption by the receptors found in many tissues.

 Prevent the release of aldosterone cause vasodilation and decrease peripheral resistance.

COUGH

 Is the common side effect of ace inhibitor

EXAMPLES SARTAN DRUGS

 ATACAND – candesartan
 TEVETEN – eprosartan
 AVAPRO – irbesartan
 COZAAR – losartan
 MICARDIS – telmisartan
 DIOVAN – valsartan

CALCIUM CHANNEL BLOCKERS 9ccb’s calcium antagonist calcium blockers)

 Decreases calcium levels and promote vasodilation

Examples of calcium channel blockers

 Calan SR, Isoptin SR – VERAPAMIL

 Cardizem, Cardizem CD or SR – DILTIAZEM HCL
 Norvasc – AMPLODIPINE
 Plendil – FELODIPINE
 Dynacirc – ISRADIPINE
 Cardene, cardene SR – NICARDIPINE HCL
 Procardia - NIPEDIPINE