Hypertension, commonly referred to as high blood pressure, causes the blood vessels’ pressure to remain elevated
Hypertension, commonly referred to as high blood pressure, causes the blood vessels’ pressure to remain elevated
should be at least 200 words each, formatted and in-text cited in current APA style with support from at least 1cacademic sources per question Question 1:
Hypertension, commonly referred to as high blood pressure, causes the blood vessels’ pressure to remain elevated. Hypertension is common is a significant risk factor for the development of other cardiovascular diseases and should be adequately controlled, and the patient is given the necessary education. Antihypertensives lower blood pressure and come in a wide variety of forms with a different mechanisms of action. Some drugs remove surplus salt and fluid from their bodies, while others lower the heartbeat or relax and broaden the blood vessels. This essay will focus on the therapeutic actions of drugs affecting blood pressure and discuss essential teaching points for patients receiving antihypertensive drugs.
According to the Joint National Committee on High Blood Pressure, there are different categories of high blood pressure drugs. Diuretics work primarily by inhibiting sodium reabsorption at four key locations in the nephron. Three types of diuretics is thiazides, loop, and potassium-sparing diuretics. In the ascending limb of Henle’s loop, furosemide, ethacrynic acid, and potentially organomercurial drugs are helpful. The main substances influencing the early distal tubule are thiazides. Spironolactone and triamterene are effective in the late distal tubule and collecting duct, particularly when combined with diuretics that act more proximally. Angiotensin-converting enzyme (ACE) inhibitors aid in blood pressure reduction by relaxing the veins and arteries (Llorens-Cortes, 2020). An enzyme in the body that produces angiotensin II, a chemical that constricts blood arteries, is prevented from doing so by ACE inhibitors.
Angiotensin receptor blockers (ARBs) obstruct the hormone receptors, specifically the AT1 receptors in the kidneys, blood arteries, and heart. Angiotensin II blockade lowers blood pressure and helps to protect the heart and kidneys from harm. They include irbesartan, valsartan, losartan and candesartan. Calcium channel blockers reduce blood pressure by inhibiting the entry of calcium into the heart and artery cells allowing blood vessels to open and relax (Bain, 2019). Some calcium channel blockers can also lower blood pressure by lowering heart rate. There are short-acting and long-acting calcium channel blockers. They include amlodipine, diltiazem, felodipine and isradipine. The sympathetic nervous system drugs act centrally or peripherally. The two alpha-blockers now available, prazosin and terazosin, successfully lower blood pressure when taken alone or in conjunction with other antihypertensive medications. The alpha-blockers reduce total peripheral resistance at rest and do not inhibit the normal vasodilatory responses to exercise since they specifically block peripheral alpha-receptor-mediated vasoconstriction.
Patients receiving antihypertensive require extensive education on the medications and lifestyle changes necessary to lead a healthy lifestyle. In order to maximize the effects of antihypertensive therapy, the patient should know about the necessity of making healthy lifestyle choices, such as regular exercise, weight loss, quitting smoking, and a low-sodium diet (Bain, 2019). To achieve optimal drug absorption, the patient should take the medication on an empty stomach one hour before or two hours after a meal. Patients on antihypertensive medications should be reminded to keep appointments with the doctor even if they feel fine because renal function needs to be checked. The patient should understand that the medication cannot be stopped abruptly and that they need evaluation.
In conclusion, hypertension is a common major risk factor for developing other cardiovascular diseases and should be adequately controlled, and the patient should be given the necessary education. According to the Joint National Committee on High Blood Pressure, there are different categories of high blood pressure drugs. These categories are Diuretics, Beta-blockers, ACE inhibitors, Angiotensin II receptor blockers, Calcium channel blockers, and sympathetic nervous system drugs. Proper patient assessment and monitoring are crucial.
References
Bain, A. (2019). Use of calcium channel blockers in cardiovascular disease. British Journal of Cardiac Nursing, 14(2), 64–70. https://doi.org/10.12968/bjca.2019.14.2.64 Links to an external site.;
Llorens-Cortes, C., & Touyz, R. M. (2020). Evolution of a new class of antihypertensive drugs: targeting the brain renin-angiotensin system. Hypertension, 75(1), 6-15. https://doi.org/10.1161/HYPERTENSIONAHA.119.12675Links to an external site.
Question 2:
Diuretics are used to decrease blood pressure by causing diuresis, which results in decreased plasma volume, stroke volume, and cardiac output, causing the blood pressure to decrease. Diuretics are grouped into the following 5 classes: carbonic anhydrase inhibitors, thiazides, thiazide-like diuretics, loop diuretics, and potassium-sparing diuretics (Arcange et al., 2017). Diuretics reduce peripheral vascular resistance. Due to the diuretic effects that these drugs produce, they can also cause adverse effects such as hypokalemia and hypomagnesemia, which can lead to cardiac arrhythmia. Angiotensin-Converting Enzyme Inhibitors (ACEIs) are antihypertensives that prevent the conversion of angiotensin 1 to the potent vasoconstrictor angiotensin 2. In addition, ACEIs prevent the waste of bradykinin and increase the synthesis of vasodilating prostaglandins. ACEIs decrease morbidity and mortality in patients with congestive heart failure (CHF), systolic function, and post-myocardial infarction (MI). Angiotensin II Receptor Blockers (ARBs) block the vasoconstriction and aldosterone-secreting effects of angiotensin II by blocking the binding effects of angiotensin II to the angiotensin II receptor found in tissues, causing a reduction of end-organ responses to angiotensin II, and decreased afterload and preload. Calcium Channel Blockers (CCBs) inhibit the movement of calcium ions across the cell membrane. CCBs relax the cardiovascular muscle, causing vasodilation, decreased heart rate, and slow cardiac conduction in the AV node. Sympathetic nervous system drugs are that stimulate presynaptic alphas-2 androgenic receptors in the central nervous system by dilating peripheral blood vessels, decreasing sympathetic outflow, which lowers peripheral resistance and reduces blood pressure, decreases cardiac output.
Patients that are receiving antihypertensive therapy should be educated on their proper usage. Patient education is a key factor in enhancing medication adherence in hypertensive patients. Several factors are attributed to poor adherence to antihypertensive medication regimes. Poor knowledge of the disease and ignorance of long-term treatment, the prohibitive cost of medications, adverse drug reactions, cultural beliefs, and lack of access to medical care and facilities, can all contribute to poor adherence to a medication regime. The reported high incidence of complications even among those on treatment is attributable to poor adherence (Ayodapo, AO et al., 2020). Patient education aims to train patients in the skill and self-management of their chronic disease by adapting to the treatment or lifestyle changes, and healthcare providers have the responsibility to provide such information (Tan, 2020). Providing patients with information and educating them about the treatment could enhance their empowerment and medication adherence.
As a practitioner, the first step in educating a hypertensive patient is to explain what hypertension is, on the patient’s level of understanding. Some of the important teaching points would include explaining hypertension. Hypertension is also referred to as high blood pressure, and when the force of blood that presses against the walls of the arteries is too strong, it causes the heart to work harder to pump blood from the heart throughout the body, and this may cause the arteries to become hard and stiff. Managing hypertension is important, because, over time, uncontrolled hypertension can damage the arteries, and decrease blood flow to body parts, including the brain, heart, and kidneys. Having untreated or uncontrolled hypertension can lead to a heart attack, stroke, weakened blood vessels, heart failure, kidney damage, eye damage, memory and concentration problems, and vascular dementia.
Diet, exercise, and maintaining a healthy body weight are important in controlling blood pressure. A diet high in fiber, and potassium, low in salt- less than 1500 mg per day, and low in added sugar, and fat, along with plenty of fresh fruits and vegetables, whole grains, beans, eggs, low-fat dairy products fish, and skinless chicken. Fatty meats and processed foods should be avoided. The patient should be instructed on smoking cessation, and to limit alcohol if they use tobacco products or drink alcohol. The patient can be offered the Dietary Approaches to Stop Hypertension (DASH) eating plan diet. Sources of stress should be identified and the practitioner should encourage the patient to find ways to manage stress. This may include meditation, deep breathing, or being available for fun activities. Hypertension can be managed by lifestyle changes, like exercising for 30 minutes 3 times per week.
Patients should also be taught how to take and record their blood pressure. The blood pressure reading includes a higher number over a lower number. The top number is called the systolic pressure and represents the pressure in your arteries as your heart beats. The diastolic pressure is represented by the bottom number and is the pressure in your arteries as the heart relaxes. The patient should be instructed not to smoke, drink caffeinated beverages, or exercise within 30 minutes of taking their blood pressure. They should also use the bathroom and empty their bladder, as well as sit quietly for at least 5 minutes before taking measurements. Patients should be instructed not to cross their legs while taking their blood pressure. Sitting with your back straight and supported, with feet flat on the floor, with the arm supported on a flat surface, such as a table, ensures that the upper arm is at heart level. The patient should be taught to take two or three readings one minute apart and record the results. The practitioner should give the patient their target blood pressure.
Before prescribing any medications, the practitioner should review all the patient’s current medications, because there may be side effects or interactions with the new medications. Instruct the patient to take all medicines as instructed. Medication does not work as well when doses are skipped. Skipping doses also puts you at risk of problems. The patient needs to be instructed to keep all follow-up visits. The patient should be instructed to contact their practitioner if they think they are reacting to the medication(s), for example, repeated headaches, dizziness, ankle swelling, or vision disturbance. They should be instructed to call 911 if they develop a severe headache or confusion, have unusual weakness or numbness, severe pain in their chest or abdomen, frequent vomiting, or difficulty breathing.
References
Arcangelo, V. P., Peterson, A. M., & Wilbur, V. (2017). Pharmacotherapeutics for advanced practice: A practical approach (5th ed.). LWW.
Ayodapo AO, Elegbede OT, Omosanya OE, & Monsudi KF. (2020). Patient education and medication adherence among hypertensives in a tertiary hospital, south western Nigeria. Ethiopian Journal of Health Sciences, 30(2). https://doi.org/10.4314/ejhs.v30i2.12Links to an external site.
Tan, >. S. (2020). The-need-of-patient-education-to-improve-medication-adherence-among-hypertensive-patients. Malaysian Journal of Pharmacy, 6(1), 1-5. https://doi.org/10.52494/moel1486Links to an external site.
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