Hypertension & Teaching of antihypertension Drugs
QUESTION
The advanced practice nurse is updating the plan of care of nursing home patients with hypertension.
Briefly describe the therapeutic actions of drugs affecting blood pressure (diuretics, ACE inhibitors, ARBs, CCB, sympathetic nervous system drugs).
What important teaching points should be addressed for patients receiving antihypertensive drugs?
Hypertension & Teaching of antihypertension Drugs
ANSWER
Hypertension & Teaching of antihypertension drugs
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Hypertension & Teaching of antihypertension Drugs
Therapeutic actions of;
a) Diuretics
Thiazides are the commonly used diuretics for hypertension. Thiazides and the related agents act by inhibiting an electroneutral sodium chloride transport pathway at the distal convoluted tubule (Sarafidis, et al., 2010). It aids in the reabsorption of sodium ions at the renal tubules hence increasing osmolality, so water reabsorption is suppressed.
b) Angiotensin-Converting Enzyme inhibitors (ACEs)
These drugs lower high blood pressure by inhibiting the angiotensin-converting enzyme responsible for converting angiotensin I to angiotensin II. These inhibitors prevent the progression of the renal disease by causing a reduction in angiotensin II-mediated intra-glomerular pressure (Arora & Chauhan, 2013)
c) Angiotensin Receptor Blockers (ARBs)
The renin-angiotensin-aldosterone system protects against cardiovascular collapse during hypertension. ARBs inhibit angiotensin II type 1 receptor for the treatment of hypertension due to renal injuries and other organ-related injuries. They are primarily used for a patient who cannot tolerate ACE inhibitors (Hill & Vaidya, 2022)
d) Calcium Channel Blockers (CCBs)
Their therapeutic use is managing pediatric hypertension. CCBs reduce mesangial cell proliferation, decreasing receptor sites for angiotensin II (Pasko & Flynn, 2001). In patients with hypertension, CCBs cause the glomerular filtration rate, renal plasma flow increases, and vascular resistance decreases. They affect the afferent arteriole in the glomerulus without affecting the efferent arteriole. Pressure is reduced when afferent arteriole is dilatated. During therapy of patients with hypertension, the glomerular filtration rate and renal plasma rate increases while the vascular resistance decreases.
e) Sympathetic nervous system drugs
They alter the balance of the postsynaptic adrenergic receptors in the cardiovascular tissues through the sympathetic CNS. As hypersensitivity develops and evolves drugs affecting the CNS, attenuate the pre- or postsynaptic tone by improving the sympathetic function (de Champlain. 1999).
Drug protocols for patients receiving antihypertensive therapy should be followed strictly; these include either initiation of not using a single-pill combination or a single-pill initiation, depending on preoccupying condition.
References
Arora, P., Chauhan, A. (2013). ACE Inhibitors: A Comprehensive Review. International Journal
of Pharmaceutical Sciences and Research. 4. 532-548.
de Champlain, J., Karas, M., Toal, C., Nadeau, R., & Larochelle, P. (1999). Effects of
antihypertensive therapies on the sympathetic nervous system. The Canadian journal of
cardiology, 15 Suppl A, 8A–14A.
Flynn, J., Pasko, D. (2001). Calcium channel blockers: Pharmacology and place in
therapy of pediatric hypertension. Pediatric nephrology (Berlin, Germany). 15. 302-16.
10.1007/s004670000480.
Hill, R, D., Vaidya, P, N. (2022). Angiotensin II Receptor Blockers (ARB). In:
StatPearls . Treasure Island (FL): StatPearls Publishing; 2022 Jan-.
https://www.ncbi.nlm.nih.gov/books/NBK537027/
Sarafidis, P., Georgianos, P., Lasaridis, A. (2010). Diuretics in clinical practice. Part I:
Mechanisms of action, pharmacological effects and clinical indications of diuretic
compounds. Expert opinion on drug safety. 9. 243-57. 10.1517/14740330903499240.
Hypertension & Teaching of antihypertension Drugs