Hypertension is an ailment characterized by elevated blood pressure that can cause disorders of the cardiovascular and renal systems. The primary purpose of management is to regulate blood pressure and diminish the risk of cardiovascular diseases. Cardiac output and peripheral resistance may be reduced to lower blood pressure. Diuretics, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), and medicines targeting the sympathetic nervous system are the most often prescribed medications in this protocol (Sear, 2019). Diuretics with natriuretic activity are among the most often prescribed medications globally. For example, they work by decreasing salt reabsorption at various points in a kidney and increasing sodium and water excretion.
There is another group of diuretics, referred to as aquaretics, works by inhibiting vasopressin receptors in the connecting duct and collecting tube, preventing the body from reabsorbing water (Sear, 2019). Beta-blockers such as catecholamines, epinephrine, and norepinephrine bind to B1 receptors in the heart, increasing cardiac automaticity and conduction speed. Renin release is also induced by B1 receptors, which raises blood pressure (Sear, 2019). In contrast, binding to B2 receptors results in smooth muscle relaxation and metabolic consequences such as glycogenolysis in the body. Beta-blockers also lower blood pressure through decreasing renin and decreasing cardiac output, among other methods. Blood pressure and pulse rate go up when alpha-1 receptors become overactive, which happens when there is a severe reaction to the receptors signaling. Blood pressure and heart rate fall due to negative chronotropic effects caused by antagonistic interactions at the alpha-1 receptor (Sear, 2019).
Like beta-blockers, ARBs are antihypertensive drugs, but their mode of action is different by blocking the hormone Angiotensin II. Contrast this with angiotensin II inhibitors, which prevent the body from manufacturing an enzyme that produces angiotensin II, narrowing blood arteries. High blood pressure and an increased workload on the heart might result from narrowing the arteries. Blood pressure-raising hormones are also released by angiotensin II. The L-type “long-acting” voltage-gated calcium channels in the pancreas, smooth muscle, and heart are blocked by calcium channel antagonists (Sear, 2019). Because of their inhibitory actions on the sinoatrial and atrioventricular nodes, the non-dihydropyridines reduce cardiac conduction and contractility more than dihydropyridines. In this way, hypertension may be treated, oxygen demand can be reduced, and tachydysrhythmia rates can be controlled more easily (Sear, 2019). Conduction velocity increases and cardiac automaticity improves by B1 receptor-binding catecholamines such as adrenaline and norepinephrine. Renin release is also induced by B1 receptors, which raises blood pressure.
The nurse must advise the patient that diuretics should be given in the morning to prevent nocturnal diuresis and frequent nocturnal urination. To minimize rebound tachycardia and hypertension, the patient should be informed that their prescriptions must be continued (Benetos et al., 2019). If a patient has adverse effects, the nurse or physician should report them. Patients should report dizziness and other manifestations of an irregular heartbeat. Furthermore, the patient should be informed on medication compliance, increase in weight, and blood pressure monitoring at home. Patients should adhere to their medication regimen and take their medicine simultaneously each day. Within 24 hours, they should avoid taking more than the authorized amount (Benetos et al., 2019). On the other hand, medications might lead to dry mouth and eyes. While using these drugs, individuals should abstain from alcoholic beverages and other CNS depressants (Benetos et al., 2019).
Benetos, A., Petrovic, M., & Strandberg, T. (2019). Hypertension management in older and frail older patients. Circulation Research, 124(7), 1045-1060. https://doi.org/10.1161/CIRCRESAHA.118.313236
Sear, J. W. (2019). Antihypertensive drugs and vasodilators. In Pharmacology and Physiology for Anesthesia (pp. 535-555). Elsevier. https://doi.org/10.1016/B978-0-323-48110-6.00026-0