Module 2 Discussion Hypertension and Teaching Points of Antihypertensive Drugs

Sample Answer

Therapeutic actions of drugs affecting blood pressure

Diuretics

The three basic types of diuretics used to lower blood volume and blood pressure are Thiazide, Loop, and Potassium-sparing diuretics. Thiazide diuretics inhibit the reabsorption of sodium, chloride, and water in the distal tubules while promoting the excretion of potassium, bicarbonate, and magnesium (Oparil et al., 2018).

Loop diuretics inhibit the reabsorption of sodium, chloride, and water in the ascending loop of Henle and promote the excretion of potassium. Potassium-sparing diuretics act on the distal renal tubule to inhibit the reabsorption of sodium ions in exchange for potassium, thus retaining potassium in the body.

Angiotensin-converting enzyme (ACE) inhibitors

ACE inhibitors block the action of the angiotensin-converting enzyme as it attempts to convert angiotensin I to angiotensin II. Angiotensin II is a potent vasoconstrictor (Oparil et al., 2018). This action also decreases sodium and water retention and lowers peripheral vascular resistance, both of which lower blood pressure.

Angiotensin II receptor blockers (ARBs)

ARBs selectively block the binding of angiotensin II to receptor sites in the vascular smooth muscle and adrenal tissues by competing directly with angiotensin II (Oparil et al., 2018).

Calcium channel blockers (CCB)

CCB lowers blood pressure by interfering with the transmembrane flux of calcium ions. This results in vasodilation, which reduces blood pressure. CCBs also block sinoatrial and atrioventricular node conduction, resulting in a decreased heart rate (Silva et al., 2019).

Sympathetic nervous system drugs (sympathomimetic drugs)

Drugs like acebutolol and pindolol have intrinsic sympathomimetic activity (ISA). They stimulate beta-adrenergic receptors and oppose the action of the released epinephrine. Stimulation of beta-adrenergic receptors releases epinephrine, which is responsible for increased heart contraction and heart rate (Silva et al., 2019). Beta-blockers with ISA lower blood pressure and overall resistance to blood flow while maintaining the heart rate.

Important Teaching Points That Should Be Addressed For Patients Receiving Antihypertensive Drugs

Men on Thiazide diuretics should be informed that they may experience decreased libido and sexual performance. Patients on loop diuretics should be educated on the side effects of dehydration and orthostatic hypotension. The side effects increase the risk of falls in older patients. The provider should teach patients and their caregivers to monitor for and report patient dizziness, falls, or confusion as soon as possible and discontinue the medication.

Furthermore, patients should be educated to take diuretic medications in the morning instead of taking them at night to prevent nocturia (Silva et al., 2019). Thiazide and loop diuretics are associated with hypokalemia. Thus, the provider should educate patients on these potassium-depleting diuretics to eat foods high in potassium, like bananas and orange juice. Patients may also require potassium supplementation to maintain adequate serum potassium levels.

Patients taking an ACE inhibitor for the first time should be instructed to get out of bed slowly to avoid the severe hypotensive effect that often occurs with initial use. Orthostatic hypotension may occur with subsequent doses, but it is less severe. Older patients on ACE inhibitors should be informed that they are at the greatest risk for postural hypotension due to the cardiovascular changes associated with aging.

Lifestyle modification should be emphasized in patients on antihypertensives to improve health outcomes. Patients should be educated on taking healthy diets such as the DASH diet, reducing alcohol consumption, quitting smoking, and engaging in regular physical exercises to boost cardiovascular health (Oparil et al., 2018). Lastly, medication adherence should be emphasized to achieve optimal BP control.

References

• Oparil, S., Acelajado, M. C., Bakris, G. L., Berlowitz, D. R., Cífková, R., Dominiczak, A. F., Grassi, G., Jordan, J., Poulter, N. R., Rodgers, A., & sWhelton, P. K. (2018). Hypertension. Nature reviews. Disease primers, 4, 18014. https //doi.org/10.1038/nrdp.2018.14
• Silva, I. V. G., de Figueiredo, R. C., & Rios, D. R. A. (2019). Effect of Different Classes of Antihypertensive Drugs on Endothelial Function and Inflammation. International journal of molecular sciences, 20(14), 3458. https //doi.org/10.3390/ijms20143458