A Discussion on Hypertension and Antihypertensive Medications
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Hypertension and Antihypertensive Medications
High blood pressure, often known as hypertension, is a condition whereby a patient exhibits symptoms of elevated blood pressure. Blood pressure fluctuates daily because of activities that we carry out every day. When blood pressure readings exceed the average pressure constantly, an individual is diagnosed with hypertension. Unchecked hypertension increases the chances of developing associated conditions such as cardiovascular diseases (Laurent, 2017). Your medical team can diagnose elevated blood pressure and give multiple treatments discussed herein, followed by teaching points for patients receiving antihypertensive drugs in the nursing home.
Diuretics
Diuretics, often known as water pills, aid in the removal of Sodium (K+) salt/ions and fluid (water) from the body. Medications under the category of diuretics assist the kidneys in releasing more sodium salt into the urine. Due to the differences in osmotic pressure in the urine and the body, more water is drawn to the kidney, which is released as urine. The salt aids in the elimination of water from circulation, reducing the quantity of fluid passing through the blood vessels. As a result, blood pressure is reduced significantly. Examples of commonly used diuretic drugs include Thiazide, Loop, and Potassium-sparing.
Angiotensin-Converting Enzyme (ACE)
ACE inhibitors are hypertension drugs that contribute to dilating the blood vessels (arteries and veins). ACE inhibitors work by hindering the body’s enzymes from making angiotensin II hormone, which constricts the blood vessel's sympathetic nervous system. As a result of constriction, blood pressure can be elevated as the heart exerts more pressure to pump blood to the extremities. Examples of available ACEs include Lotensin, Ramipril, Captopril, and Fosinopril.
Angiotensin Receptor Blockers (ARBs)
ARBs, also known as angiotensin II receptor inhibitors, are medications used to control hypertension (Laurent, 2017). ARBs work by inhibiting the activity of a hormone called angiotensin II. This hormone has a strong narrowing impact on arteries and veins, causing an elevation in blood pressure. Angiotensin II also causes water and sodium salts to be retained in the system, elevating blood pressure and further the sympathetic nervous system. ARBs function by inhibiting the hormone’s receptor sites, primarily AT1 receptors in the heart, blood vessels, and kidneys. Blocking angiotensin II activity assists in lowering hypertension and protect the heart and kidneys from getting damaged sympathetic nervous system. Examples of ARBs include Valsartan, Losartan, Eprosartan, and Azilsartan.
Calcium Channel Blockers (CCBs)
CCBs, often known as calcium antagonists, are drugs used to reduce elevated blood pressure. They block calcium ions (Ca+) from reaching the sympathetic nervous system of the cardiac and artery cells. When calcium ions enter the cells inside the heart and arteries, it causes a tight constriction. Calcium channel antagonists enable the arteries to ease and dilate by hindering calcium (Laurent, 2017). Specific calcium channel inhibitors can also lessen blood pressure by slowing the heartbeat. The medications can also treat chest discomfort and uneven heartbeats by altering the sympathetic nervous system. Approved CCBs include Felodipine, Amlodipine, and Isradipine, among others.
Sympathetic Nervous System Drugs
The sympathetic nervous system is essential in the biological control of the circulatory system and may also influence some elements that generate or maintain clinical high blood pressure. Most sympathetic nervous system drugs work by exerting at least some of their actions by inhibiting actions on sympathetic channels (Laurent, 2017). The most precise sympathetic antagonists now include centrally acting medicines and peripheral alpha-adrenergic inhibitors. When taken alone or with other antihypertensive medication, the alpha-blockers, prazosin, and terazosin, successfully lower elevated blood pressure (Nardin et al., 2019). Phenylephrine is among the most common drug under this category.
Teaching Points for Patients Receiving Antihypertensive Drugs
To enhance the benefit of antihypertensive drugs, teach the patient about the importance of adopting a healthy lifestyle, such as daily exercise, weight management, cessation of smoking, and reduced salt in the diet (Carey et al., 2018). The patient also needs to be informed that, to achieve optimal medication uptake, the medication should be administered on an empty stomach (Gulla et al., 2018). That is one hour beforehand or 2 hours after eating. Also, the patient needs to monitor renal and hepatic functioning testing to alert the clinician to the possibility of renal/hepatic failure and to highlight the need for a lower medication dosage.
Finally, to avoid worsening the drug’s hypotensive impact, keep an eye out for signs of reduced fluid volume (Carey et al., 2018). For example, diarrhea, dehydration, and vomiting can reduce fluid volume. Furthermore, according to Gulla et al. (2018), practitioners should improve patients’ awareness of medication regimen and, increase compliance, teach patients and their relatives about the medication’s effects on the body and symptoms that require notification. Teaching the patient about hypertensive drugs will ensure that they follow prescriptions accordingly. As a result, patient in this particular nursing home will have their blood pressure managed to optimal levels.
References
Carey, R. M., Calhoun, D. A., Bakris, G. L., Brook, R. D., Daugherty, S. L., Dennison-Himmelfarb, C. R., ... & White, W. B. (2018). Resistant hypertension: detection, evaluation, and management: a scientific statement from the American Heart Association. Hypertension, 72(5), e53-e90.
Gulla, C., Flo, E., Kjome, R. L., & Husebo, B. S. (2018). Deprescribing antihypertensive treatment in nursing home patients and the effect on blood pressure. Journal of geriatric cardiology: JGC, 15(4), 275.
Laurent, S. (2017). Antihypertensive drugs. Pharmacological research, 124, 116-125.
Nardin, C., Rattazzi, M., & Pauletto, P. (2019). Blood pressure variability and therapeutic implications in hypertension and cardiovascular diseases. High Blood Pressure & Cardiovascular Prevention, 26(5), 353-359.