Hypertension Blog

Before starting antihypertensive drug therapy, obtain a baseline blood pressure reading from each arm. Then, administer the drug, as prescribed. Use caution when administering it so that your patient’s blood pressure doesn’t fall below the limit of autoregulation. For example, assess your patient for dizziness and light-headedness. If they occur, withhold the drug and notify the physician.Monitor a hospitalized patient’s blood pressure every 1 to 2 hours after administering the first dose. And continue to monitor his blood pressure every 2 to 4 hours, even after it begins to stabilize. Teach an outpatient how to check his blood pressure and when to call the physician. Also, instruct him to check his blood pressure at least once a day until it’s stable, and then to check it once a week.

Monitor your patient for adverse effects of the drug. As prescribed, administer an analgesic for headache and monitor its effectiveness.

Following the physician’s guidelines, adjust the antihypertensive drug dosage as your patient’s blood pressure drops to the target level. Also, assess your patient’s cardiovascular, neurologic, retinal, and renal status after 1 to 4 weeks of drug therapy to evaluate its adverse and therapeutic effects.

Information for Patient

After your patient’s urgent hypertension has subsided, instruct him to adhere to his antihypertensive drug regimen to reduce the risk of future episodes. Teach him the names of all his prescribed drugs and their dosages, expected effects, and adverse effects.

Warn your patient about orthostatic hypotension, a common adverse effect of antihypertensive drugs. Tell him to rise slowly from a sitting position to a standing position and to dangle his feet over the side of the bed for several minutes before getting up. If he becomes dizzy, he should sit or lie down until the feeling passes.

Tell your patient about lifestyle changes that can help prevent a recurrence of urgent hypertension. These changes include avoiding alcohol, stopping smoking, increasing his amount of exercise, doing different types of exercise, performing relaxation and other stress-reduction techniques, and following a low-fat, low-sodium diet. As appropriate, refer him to other health care professionals, such as a dietitian.

Make sure your patient knows the signs and symptoms of hypertension, including headache, dizziness, light-headedness, weakness, VISIOn changes, and chest discomfort. Also, spell out the signs and symptoms of altered organ functioning, such as headache, dizziness, and weakness in cerebrovascular dysfunction; chest pain, palpitations, dyspnea, and peripheral edema in cardiovascular dysfunction; and nocturia, polyuria, and hematuria in renal dysfunction. Instruct the patient to promptly report such signs and symptoms to his physician.

Explain that hypertension can be dangerous even without obvious symptoms. Stress the importance of taking his antihypertensive drug even if he feels well. Tell him to report unpleasant adverse effects, such as beta-blocker-induced fatigue, nightmares, and sexual dysfunction, because the physician may be able to change the prescription.

Discuss the need to have his blood pressure evaluated frequently so that appropriate adjustments can be made in his drug regimen. Confirm that he knows the date and time of the follow-up appointment with his physician and, if appropriate, the date and time of diagnostic testing to evaluate organ function.

After discharge, your patient may need follow­up care by a home care nurse. Explain that the home care nurse will monitor his blood pressure daily for the first few days after therapy begins.

The home care nurse will perform a physical assessment to obtain baseline blood pressure readings. Then she’ll monitor the patient’s blood pressure and report values outside the limits prescribed by the physician.

The home care nurse will confirm that the patient has a follow-up appointment with his physician and ensure that he’s making lifestyle changes, as needed. She’ll also note whether he’s taking his antihypertensive drugs as prescribed. If necessary, she’ll teach him to take his blood pressure. And she’ll remind him to report signs and symptoms of hypertension to his physician.

Diagnostic Tests

Computed tomography (CT) and magnetic resonance imaging help rule out other causes of your patient’s severe headache, such as a CVA. Imaging may reveal areas of hemorrhage ranging in size from pinpoint to massive.

A lumbar puncture is contraindicated because of the patient’s high ICP. Introducing a needle into the central canal of his spinal cord would cause cerebrospinal fluid (CSF) to gush, and the sudden and dramatic decrease in CSF could force delicate brain tissue to herniate into the spinal canal, resulting in immediate death

Usually, a physician prescribes an antihypertensive drug to rapidly reduce ICP and arterial blood pressure and to maintain diastolic blood pressure at about 100 mm Hg. The drugs used to treat hypertensive encephalopathy include vasodilators, beta-blockers, and osmotic diuretics. Most commonly, a physician prescribes the vasodilator nitroprusside. Vasodilators relax vascular smooth muscle, which reduces peripheral artery and vein dilation. Beta-blockers may be used to reduce vascular resistance.

The physician may prescribe mannitol, an osmotic diuretic, if the patient already shows signs and symptoms of cerebral edema. Although osmotic diuretics reduce ICP, they’re contraindicated in patients with active cerebral bleeding. The adverse effects of osmotic diuretics-confusion, convulsions, dizziness, disorientation, headache, rebound increased ICP, and syncope-can mimic a worsening neurologic condition .

Although rapidly reducing your patient’s blood pressure will dramatically improve the symptoms of hypertensive encephalopathy, he’ll require continued close monitoring in an ICU.

Many types of diuretics are used to mobilize edematous fluid, reduce pulmonary vein pressure, and reduce preload. Usually, a physician first prescribes a thiazide diuretic. These drugs reduce hypertension and treat edema by inhibiting sodium reabsorption in the distal renal tubule and promoting sodium and water excretion. If your patient has pulmonary edema, his physician also may prescribe morphine to reduce preload and control anxiety.By acting on the loop of Henle, loop diuretics also promote sodium and water excretion. With thiazide or loop diuretics, the patient may need potassium supplements. Or the physician may prescribe potassium sparing diuretics if the patient is prone to hypokalemia.

The only class of drugs that improves survival in patients with heart failure, vasodilators reduce systemic vascular resistance and pulmonary and peripheral vein pressures, increase left ventricular stroke volume and CO, and enhance myocardial function by reducing myocardial oxygen demand. Sodium nitroprusside, a potent vasodilator, commonly is administered for acute heart failure.

A physician also may prescribe an ACE inhibitor. These drugs prevent the conversion of angiotensin I to angiotensin II, thus increasing CO by reducing systemic vascular resistance.