FINALS ‘22 1.

Primary HPT
- Unknown cause
CH31 HYPERTENSION
- 90% to 95%
About: 2. Secondary HPT

- Blood Pressure is determined by - Identified cause

cardiac output - 5-10%

- Peripheral vascular resistance is the Common causes:

ability of the vessels to stretch.
- CKD
- Increased viscosity leads to a sluggish
- Cushing’s syndrome
blood flow
- Hyperaldosteronism (mineralocorticoid
- SBP n=>130
HPT)
- DBP n=>85
- OSP
- 58.6% among African American men
- Pheochromocytoma
- 56% among African American women
- Renal artery stenosis
- 46.4% among Asian men
3. Isolated systolic HPT
- 36.4% among Asian women
- Abnormal high systolic pressure,
Correct BP cuff: normal diastolic pressure.

Child W: 10-12 cm L: 18-24 cm - Common in older people

Adult 12-13 23-25 4. White coat HPT

Large adult 12-16 35-40 - Clinical setting; increase bp

Adult tight 20 42 5. Masked HPT

cuff - Other setting; normal bp

- Too large; low bp S&Sx:

- Too small; high bp
- Headache
- Korotkoff sound
- Blurred vision
Classification of BP: - Fatigue

120-129/<80 = pre-HPT - Numbing sensation

- Retinal hemorrhages
130-139/<80 = pre-HPT
- Facial flushing
140-159/90-99 = Stage 1 HPT

>160/>100 = Stage 2 HPT

Target organs
Types of HPT:
 - Heart - Retinal hemorrhage
- Kidney - Cotton wool spots (white spots); small
- Brain infarctions.
- Eyes
Medication:
Complications:
First Line Agents
1. Coronary artery disease
1. THIAZIDE
- Left ventricular hypertrophy
- Decrease of blood volume, renal blood
- Heart failure
flow, and cardiac output
2. Cerebrovascular disease
- Monitor for electrolyte imbalance
- Thromboembolism travels to the brain
- Hydrochlorothiazide,
causing brain damage.
- Aldactone (potassium sparing diuretic)
3. Peripheral vascular disease
2. ACE inhibitors (-PRIL)
- Aortic aneurysm
- Decreases peripheral vascular
- Aortic dissection
resistance
Do not palpate: APAW - Dry cough, hyperkalemia
- Captopril, lisinopril, enapril
- Abdominal aortic aneurysm
- Pheochromocytoma Side note Covid 19
- Appendicitis Causative agent SARS-COV-2
- Wilm’s tumor Target ACE 2 receptor;
4. Nephrosclerosis abundant in the
- End stage renal disease lungs.
- Ischemia; death of nephron (Type II
5. Retinal damage pneumocytes
- Indicates damage in the heart, brain, produces surfactant)
and kidney. 3. ARBS (-SARTAN)
- Loss of vision - Reduce vascular resistance
- Retinal hemorrhage - Monitor for hyperkalemia
- Losartan, valsartan, eprosartan
Assessment:

- Changes in BP
- Pulse rate
- Bruits
4. CALCIUM CHANNEL BLOCKER –
- Truncal obesity
DIHYDROPYRIDINES (-DIPINE)
- Mental status changes
 - Decrease cardiac work and energy
consumption
- Administer on empty stomach
- Muscle cramps, joint stiffness
- May cause dizziness
- Can cause pedal edema
- Contraindicated in HFrEF
- Amlodipine, nifedipine SR/LA
5. CALCIUM CHANNEL BLOCKER –
NONDIHYDROPYRIDINE
(-PAMIL/AMIL)
- Reduce cardiac afterload
- Observe for hypotension
- Monitor heart rate/ for irregular
heartbeat.
- Verapamil, diltiazem
Second Line Agents
1. LOOP DIURETICS (-MIDE)
- Blocks reabsorption of sodium,
chloride, and water in renal tubules.
- Monitor for electrolyte imbalance
- Risk for orthostatic hypotension
- Furosemide, bumetanide
2. POTASSIUM SPARING DIURETIC
- Blocks sodium reabsorption
- Drowsiness, lethargy
- Monitor for hyperkalemia if given with
ACE
- After meals meds
- Amiloride, Aldactone
3. ALDOSTERONE ANTAGONIST
DIURETIC
- Inhibits aldosterone binding
- Indicated for primary aldosteronism
and resistant hypertension.
- GI disturbance
- Avoid potassium supplements
- May cause gynecomastia
- Spironolactone
4. BETA BLOCKERS –
CARDIOSELECTIVE (-OLOL)
- Blocks beta 1 adrenergic receptors of
the SNS, slowing the HR and
decreasing the BP.
- Nausea and vomiting
- Epigastric distress
- Insomnia
- Metoprolol tartrate and succinate
- HFrEF; bisoprolol and metoprolol
succinate
5. BETA BLOCKER -NON
CARDIOSELECTIVE
- Propranolol, timolol, nadolol
6. BETA BLOCKET WITH
VASODILATOR
- Induces nitric oxide dilation
- Nebivolol
7. BETA BLOCKER – INSTRINSIC
SYMPATHOMIMETIC ACTIVITY
(-BUTOLOL)
- Blocks both beta 1 & 2
- Antiarrhythmic activity by slowing AV
conduction.
- Acebutolol
8. BETA BLOCKER – combines Alpha and
Beta receptor blockers
- Cause peripheral dilation and decrease Disease 1st line HPT 2nd line HPT
peripheral vascular resistance. agent agent
- Contraindicated in patients with Coronary Carvedilol, Amlodipine,
asthma, COPD, heart block. artery metoprolol Nifedipine,
- Carvedilol; preferred agent for HErEF disease tartrate and
9. DIRECT RENIN INHIBITOR without succinate.
- Blocks the conversion of HF Captopril.
angiotensinogen to angiotensin 1 HFrEF Captopril, Nondihyropy
- Cannot be given with ACE and ARB’s Lisinopril. ridine is not
- Monitor for hyperkalemia Carvedilol, recommende
- Aliskiren Bisoprolol. d
10. ALPHA 1 BLOCKER (-ZOSIN) HFpEF Diuretics Nondihyropyr

- Peripheral dilator Aldactone, idine is not

- Orthostasis Lasix, recommended

- Prazosin, doxazosin, terazosin Furosemide

11. CENTRAL ALPHA 2 -AGONISTS CKD Captopril,
(-INE/OPA) Enapril,
- Clonidine Lisinopril.
- Guanfacine; stimulate alpha2 Diabetes Aldactone,
adrenergic receptor Amlodipine
- Methylodopa; displaces norepinephrine Captopril,
from storage site. Drug of choice in Losartan.
pregnancy Pregnant Nifedipine Calcium
- Dry mouth, sedation, rebound Methylodopa. channel
hypertension blocker
- Hypertensive crisis is common with superior
withdrawal of clonidine option in
- Monitor BP carefully preventing
12. DIRECT VASODILATORS pre-
- Used in pregnancy-induced HPT eclampsia.
- Sodium and fluid retention and reflex
tachycardia are common effects
NURSING INTERVENTION
- Hydralazine may cause SLE like
symptoms - GOAL: decrease and control BP

- Minoxidil may cause hirsutism. - Regular BP measurement is essential.

Lifestyle modification: Physical activity 90 – 150 min brisk
walking/week and
Diet Reduce sodium
regular exercise
intake.
3x/week
Diet rich in fruits,
veggies, protein, K,
Ca.
Regular physical 30 mins
activity activity/exercise
5x/week
Weight reduction For overweight and
obese
Smoking cessation
Stress management Non-pharmacologic
HYPERTENSIVE CRISIS
strategies
SBP exceeds 180 mmHg
Limit alcohol Men: 2 drinks/day
consumption Women: 1 drink/day DBP exceeds 120 mmHg

Hypertensive
DASH DIET (Dietary Approaches to Stop Emergency
Hypertension) Progressive target Intracerebral
organ dysfunction hemorrhage, AMI,
- 2000 calories/day
pulmonary edema,
Lean meat, fish, and Less than or equal to
unstable angina
poultry 2 servings/day
pectoris, dissecting
Low fat/fat free dairy 2-3 servings/day
aortic aneurysm,
food
eclampsia
Fruits, veggies, nuts, 4-5 servings/day
S&Sx SOB, chest pain,
seeds, dry beans
numbness, change in
Grains and grain 7-8 servings/day
vision, back pain,
products
and difficulty
speaking
Weight reduction Maintain normal Nitroprusside Constant infusion.
BMI; 18.5 -24.9kg/m2 Most effective and
Sodium reduction 1000 mg/day almost always lowers
Potassium increase 3500-5000 mg/day the pressure to the
 desired level
IV Furosemide Often needed to
lower BP further and
prevent retention of
sodium and water
Clonidine Poor choice of drug.

Hypertensive Emergency Drugs