Discussion 3i: Remember When I Was In Nursing School High Bl

Discussion 3i Remember When I Was In Nursing School High Blood Pressu

Discussion 3 i Remember When I Was In Nursing School High Blood Pressu

Discussion 3 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 less than 120 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 conjunction to treat high blood pressure. There are five main classifications of drugs used in antihypertensive therapy: diuretics, ACE inhibitors, Angiotensin receptor blockers, Calcium channel blockers, and sympathetic nervous system drugs. Diuretics work by accelerating the rate of urine formation that results in the removal of sodium and water from the body. Examples of diuretics include loop diuretics (furosemide), potassium-sparing diuretics (spirolactone), thiazide and thiazide-like diuretics (chlorothiazide), and carbonic anhydrase inhibitors (acetazolamide). ACE inhibitors (Vasotec, Monopril, 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 blockers (Cozaar, Teveten, Diovan) block the binding of angiotensin II to its receptors, thereby preventing vasoconstriction and aldosterone secretion, leading to vasodilation.

Calcium channel blockers (Procardia) work by causing smooth muscle relaxation by blocking the binding of calcium to its receptors, thereby preventing contraction (Collins et al., 2019). Sympathetic nervous system drugs include beta-adrenergic blockers (Lopressor, Atenolol). Beta blockers reduce blood pressure by blocking central and peripheral beta receptors, resulting in decreased cardiac output and sympathetic outflow. Beta blockers that predominantly bind to beta-1 receptors are called cardioselective 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 less than 140/90 mm Hg, is considered ideal.

If patients do not adhere to their medication regimens, serious consequences such as stroke, heart failure, and kidney failure may occur. During patient education on antihypertensive medications, it is essential to emphasize the importance of regularly monitoring blood pressure throughout the day and maintaining a log to share with healthcare providers at follow-up visits. Patients should be monitored for side effects like hypotension, especially postural hypotension, which is common among the elderly. Adverse effects such as angioedema (swelling of the tongue or lips), especially when taking ACE inhibitors, or signs of hypoglycemia need immediate reporting. Patients experiencing significant symptoms should go to the nearest emergency room for evaluation.

Regarding diuretics, hydration is crucial to prevent dehydration. Patients should understand that multiple agents may be tried before achieving optimal blood pressure control with minimal or no side effects. Lifestyle modifications such as following a healthy diet, restricting sodium intake, quitting smoking, maintaining a healthy weight, and engaging in regular exercise are also vital components of hypertension management (Arcangelo et al., 2017).

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High blood pressure, or hypertension, is a prevalent cardiovascular condition that poses significant health risks if unmanaged. Described as "the silent killer," hypertension often presents without noticeable symptoms but can lead to severe complications such as stroke, myocardial infarction, heart failure, and renal failure when left untreated (Whelton et al., 2018). Advances in understanding hypertension and its treatment have led to the development of various drug classes, each targeting different physiological pathways to lower blood pressure effectively.

Classification of hypertension according to blood pressure readings is essential for diagnosis and management. The American Heart Association classifies blood pressure as normal (180/120 mm Hg) (American Heart Association, 2023). Managing hypertension involves pharmacological therapy tailored to the individual patient's needs, comorbidities, and response to medication.

The first-line antihypertensive agents include diuretics, ACE inhibitors, angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), and beta-adrenergic blockers (Padwal et al., 2016). Diuretics, such as thiazides and loop diuretics, facilitate sodium and water excretion, reducing blood volume and, consequently, blood pressure. They are often the initial therapy due to their effectiveness and safety profile. For instance, hydrochlorothiazide is widely used as a first-line agent; however, its contraindications include hypersensitivity in patients with gout or electrolyte disturbances (Whelton et al., 2018).

ACE inhibitors, such as enalapril and lisinopril, inhibit the enzyme responsible for converting angiotensin I to angiotensin II, a potent vasoconstrictor (Liu et al., 2017). By reducing angiotensin II levels, ACE inhibitors cause vasodilation and decrease aldosterone secretion, leading to reduced blood volume. They are particularly beneficial in patients with concomitant conditions such as heart failure or diabetic nephropathy. Common adverse effects include dry cough and angioedema, necessitating careful patient assessment (Whelton et al., 2018).

ARBs, like losartan and valsartan, block the action of angiotensin II at its receptors, offering a similar antihypertensive effect with a lower incidence of cough associated with ACE inhibitors (Liu et al., 2017). Calcium channel blockers, such as amlodipine and nifedipine, act by blocking the influx of calcium ions into smooth muscle cells, causing vasodilation and decreasing peripheral vascular resistance (Collins et al., 2019). They are especially effective in elderly patients and those with isolated systolic hypertension.

Beta-blockers, including atenolol and metoprolol, decrease heart rate and cardiac output by blocking beta-adrenergic receptors in the heart and vasculature (Arcangelo et al., 2017). They are indicated for patients with concomitant coronary artery disease, arrhythmias, or heart failure. Cardioselectivity reduces adverse effects on bronchial smooth muscle, which is beneficial in patients with respiratory conditions.

Optimal management of hypertension requires not only pharmacotherapy but also lifestyle modification. Patients should be educated about the importance of adherence to medication regimens, regular blood pressure monitoring, and recording their readings. Lifestyle changes include a low sodium diet, weight management, alcohol moderation, smoking cessation, and regular physical activity, which have demonstrated significant benefits in lowering blood pressure and reducing cardiovascular risk (Whelton et al., 2018).

Monitoring for side effects is a critical component of hypertension management. For example, ACE inhibitors may cause hyperkalemia, hypotension, or angioedema; diuretics can lead to electrolyte imbalances and dehydration. Patients, especially the elderly, should be counseled on recognizing symptoms of hypotension and adverse drug reactions. Blood pressure logs facilitate medication adjustments and improve overall management (Padwal et al., 2016).

In conclusion, effective management of hypertension entails a comprehensive approach that combines pharmacological therapy with lifestyle modifications. Patient education plays a vital role in improving adherence, detecting adverse effects early, and achieving blood pressure control within recommended limits (

References

• American Heart Association. (2023). Hypertension. https://www.heart.org/en/health-topics/high-blood-pressure
• 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.
• Collins, S., Rainforth, S., Lilley, L., & Souter, S. (2019). Study Guide for Pharmacology and the Nursing Process. Elsevier.
• Liu, Y., et al. (2017). Comparative efficacy and safety of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in hypertensive patients: A systematic review and meta-analysis. European Heart Journal.
• Padwal, R., et al. (2016). Management of hypertension: Canadian guidelines. Canadian Journal of Cardiology.
• Whelton, P. K., et al. (2018). 2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Journal of the American College of Cardiology.
• Snyder, J. S., Rainforth Collins, S., Lilley, L. L., & Souter, S. (2019). Study Guide for Pharmacology and the Nursing Process. Elsevier.