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Hypertension

Treatment
1. Nonpharmacological Interventions
  1. Lifestyle Modifications
    1. Drug Therapy if Lifestyle Modifications Ineffective
    2. DASH Diet
      1. Fruits & Veggies, Low Fat & Na
    3. Exercise
      1. 30 min/ Day
      2. Decreases Afterload
    4. Weight Loss
      1. BMI 18.5-24.9 kg/m2
    5. Stress Reduction
    6. Monitor BP
    7. Sodium Reduction
      1. 2.4 grams or Less
      2. Decreases Preload
    8. Moderate ETOH
      1. 1-2 Drinks/ Day
    9. Goal: Decrease Afterload
    10. Goal: Increase Contractility
    11. Goal: Decrease Preload
2. Pharmacological Interventions
  1. Beta Blockers
    1. Slows HR--LV Fills
    2. Dilates Arteries
      1. Decreased Afterload
    3. Decreased contractility
    4. Mild Vasoconstriction vs Renin
    5. Non-selective vs Selective
      1. Suffix -olol
    6. Slows HR
  2. Alpha Blockers
    1. Vasodilation
      1. Decreases Afterload
    2. Ex: doxazosin
      1. Elevated CV Risk
  3. Diuretics
    1. Act on Renal Tubules
      1. Increase Water Excretion
    2. 1st Line Therapy
    3. Osmotics
      1. Glomeruli
      2. Ex: mannitol
    4. Carbonic Anhydrase Inhibitors
      1. PCT & Descending Loop of Henle
      2. Ex: Acetazolamide
    5. Loop Diuretics
      1. Ascending Loop of Henle
        Absorbs 25% of Na
      2. Ex: furosemide
    6. Ex: Spironolactone
      1. Distal Convoluted Tubule
        Reabsorbs 5% of Filtered Na
    7. Thiazide-like
      1. Ex: HCTZ & chlorothiazide
    8. Potassium Sparing
      1. Monitor K+ Level
  4. Calcium Channel Blockers
    1. Smooth Muscle Dilators:
    2. Uses: HTN, Angina & Arrhythmias
    3. Decreased Contractility
    4. Reduces Afterload
    5. Increases Preload
    6. 1st Line Therapy
      1. Black Persons
    7. Ex: amlodipine & diltiazem
  5. ACE Inhibitors
    1. Block Conversion of Angio I to Angio II
    2. Promote Renal Excretion of Na & H2O
    3. Dilate Arteries to Decrease BP
    4. Ex: lisinopril
      1. Conversion in Lungs
        Monitor for Cough
        May Need to Change to ARB
        Rechallenge
    5. Monitor for Angioedema
  6. Angiotension II Receptor Blockers
    1. Block Angio II from Angio II Receptors
    2. Ex: losartan
    3. Less Angioedema than ACE I
    4. Better for Post Stroke
    5. Renal Protective
  7. Centrally Acting Vasodilators
    1. Relaxation of Vascular Smooth Muscle
    2. Acts on Arterioles
      1. Decrases Afterload
    3. Ex: hydralazine
    4. Last Line Therapy--Emergency
  8. Refer to Nephrologist if Drug Therapy Ineffective
3. Preload
  1. End Diastolic Pressure
    1. Decrease
      1. Fluid Volume
        RAS
        ADH
        Natriuretic Peptides
4. Afterload
  1. Resistance LV
  2. Decrease
  3. Block Angio II
  4. Chronic Elevation = CHF
5. Contractility
  1. Increase
  2. Starling's Law
6. Educate Patient
7. Individualize Tx Regimen
8. Goals for Impaired Cardiac Function
Cardiac Output Increaased
1. Hypervolemia
  1. Increased Preload
2. Stress
  1. HR & SV Increased
  2. Increased Preload
3. Pheochromocytoma
4. Preload Increased
Systemic Vascular Resistance Increased
1. Stress
2. Atherosclerosis
3. Renal Artery Disease
4. Diabetes
5. Afterload Increased
Blood Vessel Damage
Snethen_NUR 5038_F17

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Hypertension

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	Created by Tanya Snethen about 7 years ago