Hypertension is known as a silent killer. Why?
It commonly has no signs or symptoms and yet is the major cause of premature death, heart failure, CVA, renal disease, and MI
What is an elevated level of hypertension?
120-129/<80
What is a stage 1 level of hypertension?
130-139/80-89
What is a stage 2 level of hypertension?
140+/90+
What level is considered a hypertensive crisis?
>180/>120
What is hypertension based off of?
cardiac output and peripheral resistance
What are the types of hypertension? Which one is the most common?
Primary and Secondary. Primary is the most common.
What are some RISKFACTORs of primary hypertension?
- R - race
- I - increased sodium/alcohol intake
- S - smoking/stress
- K - K+ is low
- F - family history
- A - aging
- C - cholesterol is high
- T - too much caffeine
- O - obesity
- R - renal artery atenosis
What is secondary hypertension?
Hypertension resulting from another underlying disease, medications, or other drugs. It will resolve once the disease is dealt with, the pt stops taking the medication, or stops doing drugs.
What are some signs of hypertension?
CHIEF
- C - change in vision/chest pain
- H - headache
- I - Irritability
- E - Epitaxis
- F - forgets fullness
What are some lifestyle modifications to treat hypertension?
weight loss, DASH diet, reduce intake of sodium, increase intake of potassium, exercise, and use alcohol moderately.
What are the ABCDs for hypertension drug therapy?
ACEI/ARBS
Beta (adrenergic) Blockers
Calcium channel blockers
Diuretics
What is the prototype drug for ACE?
captopril
What do all ACE drugs end in?
"-pril"
What are some other drugs in the ACE drug class?
lisinopril and benzapril
What is a fun way to know what a common ACE drug symptom is?
"coughing prils"
How do ACE drugs work?
they block the enzyme that converts angiotensin l to ll. It also inhibits the breakdown of bradykinin, prolonging vasodilating effects (thus lowering BP)
What kind of patients would you expect to be prescribed ACE inhibitors?
pts w hypertension, DM, post MI, and to prevent/reverse heart remodeling with HF.
What else do ACE inhibitors do in the body?
decreases pressure in kidneys (thus protecting it), decreases peripheral vascular resistance and O2 demand for the heart (thus lowering the workload for the heart).
What are some effects of ACE inhibitors?
CAPTOPRIL
- C - cough
- A - angioedema
- P - pregnancy contraindication
- T - taste change
- O - orthostatic hypertension/other (rash/fatigue)
- P - proteinuria
- R - renal insufficiency contraindication
- I - increases K
- L - lowers BP/leukopenia
ACE inhibitors have a BBW. What is it?
do NOT give if the pt is pregnant or trying to become pregnant. If they are in their child bearing years, make sure they use birth control.
What are some nursing considerations when it comes to ACE inhibitors?
monitor labs/electrolytes, consult provider if pt's cough is bothersome (affecting ADLs), AVOID salt substitutes in foods already rich in K.
What should you ABSOLUTELY NOT DO when it comes to giving ACE inhibitors?
administer with ARBS. DO NOT GIVE PTS TAKING ACE INHIBITORS ARBS.
What kind of diuretic is also helpful in lowering hypertension?
Thiazide diuretics
What is the prototype drug for thiazides?
hydrochlorothiazide
How would you use hydrochlorothiazide for the treatment of hypertension?
in combination with other drugs
How does hydrochlorothiazide work?
it decreases reabsorption of Na/Cl by inhibiting the Na/Cl channel in the distal convoluted tube. It is considered the "middle ground" for diuretics. For hypertension, the mechanism of action is unknown, but has been shown to cause vasodilation.
What are some advantages of using thiazide diuretics?
it's cheap, relatively well tolerated, and is useful in patients with kidney stones and osteopenia.
What are some possible side effects of thiazide diuretics?
orthostatic hypertension, HYPOnatremia, HYPERcalcemia, HYPOkalemia, HYPERuricemia, and HYPERglycemia. (aka increases Ca (in urine/blood) and glucose while decreasing Na/K)
What are some nursing considerations when using thiazide diuretics?
monitor I/O, weight, and labs.
What would you tell a patient for educating reasons when it comes to thiazide diuretics?
Take the medications during the day (so that pt doesn't go up to pee throughout the night), change positions frequently, get up slowly, and eat more K rich foods (like bananas, dark leafy greens like kale, spinach, etc.)
What kind of patients would make you question the provider if they had prescribed thiazide to?
pts with a sulfa allergy and have gout