Renin-angiotensin-aldosterone system (RAAS) • Psychological factors • Stress and anger ( ↑ BP) • Depression and lethargy ( ↓ BP)
COMPLICATIONS OF HYPERTENSION • Cardiovascular system • Heart failure • Atherosclerosis • Nervous system • Cerebral vascular accident (CVA) • Transient ischemic attack (TIA) • Renal system • Kidney failure • Sensory implications • Visual impairment and blindness
TREATMENT OF HYPERTENSION • Nonpharmacological treatment • Limit alcohol and quit smoking • Limit sodium consumption and fat intake • Increased intake of fresh fruits and veggies • Exercise regularly and reduce stress • Maintain healthy weight • Pharmacological treatment • Individualized regimen (often combo therapy) • Numerous drug therapy • Prototypes
ACE INHIBITORS captopril (Capoten) INDICATIONS Hypertension, heart failure, diabetic neuropathy, left ventricular dysfunction (post-MI) DRUG CLASS ACE inhibitors; includes enalapril (Vasotec), lisinopril (Prinivil) CONTRAINDICATIONS Pregnancy, allergy to ACE inhibitors, hypotension, liver disease MOA Blocks the production of angiotensin II → arterial vasodilation, increased excretion of sodium and water, and potassium retention ADVERSE EFFECTS First-dose hypotension, nonproductive cough (discontinue), angioedema (swelling of the mouth and throat), hyperkalemia, neutropenia (rare) NURSING CONSIDERATIONS • Given orally, usually 2-3x daily • Start low and titrate up, monitor for first-dose hypotension (diuretics and other antihypertensives can increase effect) • Discontinue medication if cough or angioedema develop (IV epinephrine) • Monitor potassium levels (avoid salt substitutes) and renal function (caution) • May cause lithium toxicity
ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs) losartan (Cozaar) INDICATIONS Hypertension, prevents stroke (losartan only), heart failure, migraine headaches, second-line therapy if intolerant of ACE inhibitors DRUG CLASS ARB; includes valsartan (Diovan), irbesartan (Avapro), candesartan (Atacand) CONTRAINDICATIONS Pregnancy, allergy, children < 6 years, caution with renal impairment MOA Blocks angiotensin II receptors → arterial vasodilation, excretion of sodium and water, and potassium retention ADVERSE EFFECTS Angioedema (less common with ARBs), HA, dizziness, hypotension, insomnia NURSING CONSIDERATIONS • Given orally with or without food • Monitor for angioedema (discontinue and treat with IV epinephrine) • Monitor potassium levels
ACE INHIBITORS ARBs
CALCIUM-CHANNEL BLOCKERS verapamil (Calan), nifedipine (Adalat) INDICATIONS Hypertension, angina pectoris, cardiac dysrhythmias (verapamil and diltiazem) DRUG CLASS Calcium-channel blocker; includes diltiazem (Cardizem), amlodipine (Norvasc), nicardipine (Cardene) CONTRAINDICATIONS AV heart block, shock, hypotension, intestinal obstruction MOA Blocks calcium uptake into muscle and cardiac cells → leads to vascular smooth muscle relaxation (vasodilation) and lowers HR ADVERSE EFFECTS Reflex tachycardia, peripheral edema, constipation, dizziness, HA, flushing NURSING CONSIDERATIONS • Given IV (slowly, continuous monitoring) or orally (do not crush or chew) •
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- Fall '19