STAGES OF BLOOD PRESSURE ● Obesity affects the sympathetic and

cardiovascular systems by increasing cardiac

1. Normal <120 over </ 80 output, stroke volume, and left ventricular
2. Prehypertension 120 or >/ 80 filling.

3. Hypertension 140/90 NONPHRAMACOLOGIC CONTROL OF HYPERTENSION

4. Stage 1-140-159/90-99 ● stress-reduction techniques

● exercise
5. Stage 2-160 or >/100or > ● salt restriction
6. Malignant Hypertension or Hypertensive Crisis- ● decreased alcohol ingestion
● Smoking cessation
sustained 200 or >/110 or >

CLASSIFICATION OF HYPERSTENSION THE “OLOL’S”

The Beta-Blockers (B1)
Hypertension can also be defined by its cause ● These agents are antagonist of the
beta-receptors of the sympathetic nervous
● Unknown Cause
system.
o Essential, or Primary Hypertension
● They reduce cardiac output by diminishing the
o 90-95% of cases sympathetic nervous system response and
● Known cause sympathetic tone.
● Secondary hypertension
● Approximately 10% of cases

RENIN-ANGIONTENSIN ALDOSTERONE SYSTEM

• Kidneys and blood vessels

o strive to regulate and maintaín a "normal"

blood pressure
o The kidneys regulate blood pressure by control
of fluid volume and via the reninangiotensin
aldosterone system (RAAS)
o Renin from the renal cells stimulates production
of angiotensin Il.
The Beta-Blockers
• Angiotension II
● Vascular resistance and heart rate decrease
o causes the release of aldosterone an adrenal causing reduced blood pressure. Beta-blockers
hormone that promotes socīum retention and can either blocthe beta- receptor, beta 2 k
thereby water retention. receptor or BOTH.
o Retention of sodium and water causes fluid ● The selective beta-blockers (B1) are specific to
one type of receptor only.
volume to increase, elevating blood pressure.

PHYSIOLOGIC RISK FACTORS The following are the common beta-blockers-

the -OLOL'
Risk factors contribute to hypertension. NON SELECTIVE (B1 AND B2)
● Propranolol
● A diet high in saturated fat and simple ● Carteolol
carbohydrates can increase blood pressure. ● Carvediolol
● Carbohydrate intake can affect sympathetic ● Nadolol
nervous activity. ● Penbutalol
● Alcohol increases renin secretions, causing the ● Pindalol
production of angiotensin II. ● Timolol
● Sotalol
 ● Others- insomnia, depression,
nightmares, constipation
SELECTIVE AND SPECIFIC (B1) ● Impaired ability of the liver to convert
glycogen to glucose causing
● Acebutolol HYPOGLYCEMIA!
● Atenolol
● Betaxolol Implementation
● Bisoprolol ● Monitor patient's vital signs. Take the
● Metoprolol heart rate before giving the drug
● Esmolol ● Instruct the patient to take the drug as
prescribed. Warn not to abruplly stop the
B-BLOCKERS: medication
● Suggest to avoid over-the-counter
Action - Blocks Beta Receptors in medications
The Heart Causing: ● Give health teaching as to name of
o Heart Rate drug, dosages and side effects.
o Force of Contraction SIDE EFFECTS OF ADRENERGIC
o Rate of A-V Conduction ANTAGONISTS B-BLOCKERS

Side Effects: ● Hypertension

o Bradycardia ● Symptoms of CHF
o Lethargy ● Bradycardia
o GI Disturbance ● Drowsiness/ depression
o CHF Example:
o Low BP
● Propranolol (Inderal)
o Depression ● Atenolol (Tenormin)
● Metoprolol (Lopressor)
THE OLOLS CONT’ IMPLEMENTATION
Pharmacodynamics: the mechanism of
action of the beta-blockers. ● Remind client NOT to change position
● These agents block the beta-adrenergic abruptly as to avoid orthostatic
receptors in the body, thereby Hypotension
decreasing the heart rate and in turn, ● Alert diabetic clients of the possible
the blood pressure. hypoglycemic effect
● The non-selective agents block both ● Inform that this can cause sexual
Beta1 and 2 receptors causing bronchial dysfunction
constriction. ● Advise client to utilize other means to
● The onset of action is 30 minutes and control blood pressure such as diet
the duration may range from 6-12 hours. modification, exercise, lifestyle changes,
etc
Clinical Indications of the beta-blockers ● Advise to eat high fiber foods to counter-
o Hypertension act constipation
o Angina pectoris THE PRILS
o Myocardial infarction
The Angiotensin Converting Enzyme
● Pharmacodynamics- Side effects and Inhibitors
adverse effects ● These are commonly called ACE
● CVS- Bradycardia, Hypotension, reboun inhibitors because the agents BLOCK
hypertension when abruptly stopped the conversion of Al to All in the
● Respi- Bronchoconstriction, LUNGS.
bronchospasm
 ● These agents alter one of the ● Others-rash, photosensitivity, dermatitis
mechanisms of blood pressure control- and alopecia, sodium excretion and
the RAAS or renin potassium.
angiotensin-aldosterone system. retention, fatal pancytopenia.
● Angiotensin II is a very powerful ● COUGH- this cough is really unrelenting
vasoconstrictor and stimulus for the and bothersome.
release of aldosterone.
Implementation
The Angiotensin Converting Enzyme ● The nurse should encourage the patient
Inhibitors to implement lifestyle changes such as
"-Pril" weight reduction, smoking cessation,
● Benazepril decreased intake of alcohol, dietary
● Captopril-prototype restriction of salt/fats and increased
● Enalapril exercise.
● Enalaprilat ● Give the drug on an empty stomach,
● Fosinopril either 1 hour before or 2 hours after
● Lisinopril meals to ensure proper drug absorption
● Moexipril ● Monitor the patient who is at risk of
● Quinapril developing fluid volume alteration
● Ramipril ● Provide comfort measures like safety
● Trandorapril Precaution, environmental control, skin
care, oral care and symptomatic relief of
Pharmacodynamics: The mechanism of cough.
action of the ACE inhibitors ● Provide patient teaching including the
● The effect of lowering the blood name of drug, dosage, measure to
pressure is attributed to the decrease in handle adverse effects and the warning
cardiac workload and decrease signs to report. Stress the importance of
peripheral resistance and blood volume. NOT abruptly stopping the medication if
symptoms are improving.
Contraindications and Precautions in the ● Caution the patient to change position
Use of ACE inhibitors slowly and to avoid hazardous or
● Presence of allergy is a clear delicate tasks and driving if drowsiness
contraindication. is a problem
● The ACE inhibitors are NOT given to
patients with renal dysfunction because THE SARTAN’S
these drugs may cause further decrease The Angiotensin II Receptor Blockers
in renal blood flow. ● These are SELECTIVE agents that
● If given to pregnant women, the drugs specifically bind to the angiotensin II
cross the placenta and produce renal receptors in the blood vessels and
abnormalities in the fetus. adrenal cortex to prevent the release of
aldosterone and to prevent
ACE INHIBITORS vasoconstriction.
Pharmacodynamics: the adverse effects The Sartans
● CVS-reflex tachycardia, chest pain,
angina, cardiac arrhythmias ● Prototype: Losartan
● CNS- dizziness, drowsiness, and ● Candesartan
lightheadedness ● Irbesartan
● GIT-GI irritation, nausea, vomiting, ● Losartan
peptic ulcer, constipation and liver ● Telmisartan
damage ● Valsartan
● Renal- renal insufficiency, proteinuria Pharmacodynamics- The mechanism of
action of the A-R-B
 ● These agents work by attaching to the
Angiotensin II receptors in the vascular smooth
muscles and in the adrenal gland.
● The action results in VASODILATION
because All action (constriction) is
inhibited and BLOCKAGE of
aldosterone release
Clinical Use of the A-R-B
● Hypertension, either alone or in
combination.
● These agents are also used if the
patient cannot tolerate the unrelenting
cough associated with ACE inhibitors.
Contraindications and precautions
associated with the A-R-B
● These agents are contraindicated in the
presence of allergy.
● It is NOT GIVEN to pregnant mothers
because of the associated FETAL
DEATH and severe fetal abnormalities.
Lactating women should also avoid
these drugs because they can affect the
neonate.
Pharmacodynamics: the adverse effects.
● CNS- headache, dizziness, weakness,
syncope and orthostatic Hypotension
● GIT-Diarrhea, abdominal pain, nausea,
dry mouth and tooth pain
● Respiratory- mild cough Skin- rash, dry
skin and alopecia.
● Ensure that the patient is not pregnant
before beginning therapy and suggest
the use of barrier contraceptives while
on this drug to avert potential fetal death
or abnormalities that have been
associated the these drugs.
● Find an alternative method of feeding
the baby if patient is nursing to prevent
the potentially danger- block of the
renin- angiotensin system in the
neonate.
● Monitor the patient carefully in any
situation that might lead to a drop in fluid
volume (e. g., excessive eating, and
vomiting diarrhea, dehydration) to detect
treat excessive hypotension that may
occur.
● Provide comfort measures to help the
patient tolerate drug effects (e.g., small,
frequent meals; access to bathroom
facilities; safety precautions if CNS
effects occur environmental control;
appropriate skin care needed;
analgesics as needed).

IMPLEMENTATION
● Encourage the patient to implement
lifestyle changes, including weight loss,
smoking cessation, decrease in alcohol
and salt in the diet, and increased
exercise, to increase the effectiveness
of anti-hypertensive therapy.
● Administer without regard to meals; give
with food to decrease Gl distress if
needed.
● Alert the surgeon and mark the patient's
chart prominently if the patient is to
undergo surgery to alert medical
personnel that the blockage of
compensatory angiotensin II could result
in hypotension following surgery that
needs to be reversed with volume
expansion.