Antihypertensive Drugs

- Affect different areas of blood pressure control.

Hypertension/Elevated Blood Pressure

- Serious medical condition that significantly increases the risks of heart, brain, kidney, and other
diseases.

1. Essential Hypotension
– elevated total peripheral resistance. Organs are perfused effectively hence it is asymptomatic,
the reason why it is dubbed as “silent killer.”

2. Secondary Hypotension
– elevated blood pressure due to a known cause.

Categories:

Normal: S – less than 120 mmHg D – less than 80 mmHg

Elevated: S – 120-129 mmHg D – less than 80 mmHg
Stage 1: S – S130-139 mmHg D – 80-89 mmHg
Stage 2: S – higher or equal to 140 mmHg D – higher or equal to 90 mmHg
Stage 3: S – higher than 140 mmHg D – higher than 90 mmHg

Hypertensive crisis – sudden increase of blood pressure higher than the normal value which is 120/80
mmHg.

Systole – contraction
Diastole – ventricular filling (resting)

Hypertension is usually asymptomatic so checking the BP is important when monitoring the condition.

Other manifestations/signs and symptoms of HPN

1. Flushing
2. Palpitations
3. Epistaxis
4. Headache
5. Dizziness
6. Fatigue
7. Diuresis

Non-pharmacological nursing interventions

1. Avoid caffeine.
2. Weight reduction
3. DASH diet
4. Smoking and alcohol cessation
Pharmacological

1. Beta-blockers – SNS blockers – blocks the effect of epinephrine/adrenaline, causing the heart to
beat more slowly and with less force.
- (-LOL, -OLOL)
- ATENOLOL, BISOPROLOL, METOPROLOL, NEBIVOLOL, PROPANOLOL, CARVEDILOL
2. ACE inhibitors (Angiotensin Converting Enzyme Inhibitors) – prevents an enzyme from
producing angiotensin 2 which is a substance that narrows the blood vessels.
- (-PRIL) (A-PRIL)
- CAPTOPRIL, LISINOPRIL, ENALAPRIL, BENAZEPRIL, FOSINOPRIL

3. ARBs (Angiotensin 2 Receptor Blockers) - prevents an enzyme from producing angiotensin 2

which is a substance that narrows the blood vessels. It relaxes the blood vessels, lowering blood
pressure.
- (-SARTAN) LOSARTAN, VALSARTAN, IRBESARTAN, CANDESARTAN

4. Calcium Channel Inhibitors – prevents calcium from entering the cells of the heart and arteries.
- (-PINE) (except Diltiazem, Verapamil)
- AMLODIPINE, FELODIPINE, NICARDIPINE, NIFEDIPINE

5. Vasodilators – used when aforementioned drugs no longer take effect. Indicated for severe
hypertension and hypertensive emergencies. Causes muscle relaxation and vasodilation by acting
directly on smooth muscles.
- NITROPUSSIDE – surgical, IV
- HYDRALAZINE – oral, IV, IM
- MINOXIDIL – oral.

Nursing Interventions

1. Check BP – avoid fistula in dialysis PT.

2. Monitor daily HR.
3. Dizziness – report to PHC
4. Slowly rise – prevents orthostatic hypotension.

Baroreflex – short term response to sudden changes in BP.

RAAS – RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM

- Controls blood reflex.

- Long term regulation.
 - In the juxtaglomerular cells in the walls of afferent arterioles in the kidney producing prorenin.
- When there is a drop in blood pressure, prorenin is split to form renin which is released into the
blood.
- Renin converts angiotensinogen (produced by the liver) into angiotensin I that is then further
converted into angiotensin II by ACE (present in lungs and kidneys.)
- Angiotensin II is a hormone that binds to angiotensin II receptors in tissues to produce effects
such as systemic vasoconstriction, sodium/water retention and induces the release of aldosterone
from the adrenal cortex which also promotes sodium/water retention in the kidneys.
- Angiotensin II acts on hypothalamus to stimulate thirst and encourage water intake. It induces
PP to release ADH, which promotes water retention by the kidneys.
- Angiotensin II reduces sensitivity of baroreceptor response to increased blood pressure so this
response would not counteract the effect of RAAS.
- All of these results in increase of blood volume and BP.
- Angiotensin II has a half-life of 1-2 minutes that is then degraded into angiotensin III and IV,
which have lesser effects.
- Overactivated or inappropriately activated RAAS causes hypertension.

Antianginal

Cardiotonic-inotropic drugs – useful for patients whose hearts are not able to effective pump blood
towards different body organs resulting oxygen and nutrient deprivation among the cells of the body.

Cardiotonic agents – increase the contractility of the heart.

Vein – unoxygenated – towards heart – e.g., pulmonary vein

Arteries – oxygenated – away from heart – e.g., pulmonary artery

Unoxygenated blood > Superior Vena Cava > Inferior Vena Cava > Right Atrium > Tricuspid Valve >
Right Ventricle > Pulmonic Valve > Pulmonary Trunk > Pulmonary Artery > Lungs (becomes
oxygenated blood) > Pulmonary Vein > Left Atrium > Bicuspid Valve > Left Ventricle > Aortic Valve >
Aorta > Body.

Heart failure (HF) – dysfunction of cardiac muscles. Can be brought by a number of heart conditions that
can overwork the heart muscles such as:
1. Coronary artery disease (CAD) – leads to insufficient blood supply for the myocardium, also the
most common cause of HF.
2. Cardiomyopathy – leads to enlargement of the heart and myocardial fatigue.
3. Valvular heart disease – causes reflux and overloading of blood to ventricles which overstretches
the myocardium.
- Clinical manifestations depend on the affected side of the heart.

Left Sided Heart Failure (LHF)

- Pulmonary manifestations d/t left ventricle not being able to push blood towards peripheral
systems.
- There is engorgement of pulmonary veins, leading to DOB.
S/Sx:
- Pulmonary edema, adventitious breath sounds, cough, tachypnea, dyspnea, orthopnea, and
hemoptysis.

Right Sided Heart Failure (RHF)

- Right side of the heart has the need to exert more force in order to push blood towards the
pulmonary circulation.
- There is low pressure system on this side so when RHF occurs the pressure rises on this side,
preventing entering of venous return.
- Systemic swelling as manifestation.
S/sx:
- Peripheral edema, splenomegaly, distended neck vein d/t increase in central venous pressure,
problems in hepatic system and spleen, dependent areas like limbs develop pitting edema d/t fluid
pooling in these areas.

Beta Adrenergic Agonist – primary treatment for Congestive Heart Failure.

Diuretics – (Loop – management and treatment of fluid overload, e.g., FUROSEMIDE, BUMETAMIDE,
TORSEMIDE) (Osmotic – inhibit water reabsorption and increase production of urine, e.g., MANNITOL)

Nursing Intervention for Diuretics:

1. Check for K in urine for K wasting – risk for hypokalemia. (Normal value: 135-145 mEq/L.)