Assessing hypertension

Construct an appropriate monitoring plan to assess hypertension treatment. 

A. Assessment. Hypertension is frequently overlooked In dmg-intoxicated patients and often goes untreated. Many young persons have normal blood pressures in the range of 90/60 mm Hg to 100/70 mm Hg in such a person an abrupt elevation to 170/100 is much more significant (and potentially catastrophic) than the same blood pressure elevation In an older person with chronic hypertension. Examples of drugs and toxins causing hypertension are listed in Table 1-9. Hypertension may be caused by a variety of mechanisms ... 

Fhtients with hypertension must have their blood pressure and pulse taken on both arms in sitting, standing, and supine positions before therapy is begun. If the patient has a cardiac arrhythmia, the initial assessment includes taking the pulse rate, determining the pulse rhythm, and noting the patient s general appearance. 

Mr. Garcia wasprescribed labetalol (Normodyne) 100 mg orally twice daily for hypertension. The health care provider wants him to monitor his blood pressure once daily. Determine what assessments you would make. Develop a teaching plan for Mr. Garcia that would help him in monitoring his blood pressure and taking labetalol. 

A patient is to receive a (3-adrenergic drag for hypertension. Before the drug is administered the most important assessment the nurse performs is. ... 

During the ongoing assessment the nurse takes the vital signs daily more frequent monitoring may be needed if die patient is moderately to acutely ill or if the patient is taking epoetin alfa (because of the increased risk of hypertension). The nurse monitors the patient for adverse reactions and reports any occurrence of adverse reactions to the primary health care provider before the next dose is due. However, the nurse immediately reports severe adverse reactions. 

The primary objective of a Phase I trial is to assess the safety of the drug in humans. Studies are normally conducted in healthy male volunteers, although specific categories of subject may be used in certain cases. For example, to avoid the risk of low blood pressure, subjects with mild hypertension would be more appropriate for the evaluation of antihypertensive drugs, while patients are likely to be used in the case of drugs that are expected to produce significant toxic effects (e.g. anti-cancer cytotoxic drugs). Remuneration may be offered for participation in the study. The number of subjects is normally between 10 and 100 people. 

The treatment of elderly patients with hypertension, as well as those with isolated systolic hypertension, should follow the same approach as with other populations with the exception that lower starting doses may be warranted to avoid symptoms and with special attention paid to postural hypotension. This should include a careful assessment of orthostatic symptoms, measurement of blood pressure in the upright position, and caution to avoid volume depletion and rapid titration of antihypertensive therapy.2 In individuals with isolated systolic hypertension, the optimal level of diastolic pressure is not known, and although treated patients who achieve diastolic pressures less than 60 to 70 mm Hg had poorer outcomes in a landmark trial, their cardiovascular event rate was still lower than those receiving placebo.69... 

If patient is not at goal BP, assess efficacy, safety, and compliance of the antihypertensive regimen to determine if a dose increase or additional anti hypertensive agent (step 8) is needed to achieve goal blood pressure. 

The results of these trials demonstrate that ERT or HRT should not be prescribed for the prevention of CHD or in patients with preexisting CHD. For women suffering from vasomotor symptoms with a history of CHD, including CHD risk factors, alternative therapies should be considered. Additionally, lifestyle modifications should be implemented, and therapies to treat risk factors such as hypertension and hyperlipidemia should be prescribed. It is important to note that the average age of women included in the HERS and the WHI trials was 67 and 63 years, respectively. Therefore, these trials were unable to assess the true risk in younger, potentially healthier women with fewer cardiovascular risk factors. 

Hypertension Calcium channel blockers ACE inhibitors ARBs Diltiazem, verapamil inhibit CSA/TAC metabolism Dihydropyridines may potentiate CSA-gingival hyperplasia May exacerbate hyperkalemia monitor K+, SCr to assess for renal allograft vascular disease may be useful in posttranplant erythrocytosis (hematocrit greater than 55%)... 

This patient has the subjective symptoms of weight loss, decreased appetite, shortness of breath, and cough. Abnormal laboratory values include elevated temperature, decreased hemoglobin and hematocrit, and decreased CD4 count. Chest x-ray shows diffuse interstitial infiltrates bilaterally. Physical exam reveals thrush. The assessment is possible AIDS with CD4 count of 150 cells/mm3, thrush, a respiratory illness (possibly Pneumocystis jiroveci pneumonia), and anemia of chronic disease. He also has a history of hepatitis B, hypertension, and GERD (on famotidine), poor adherence to his anti hypertensive medications, and likely has an irregular daily regimen due to his occupation as a truck driver. 

Patients with hyperlipidemia or hypertension should be monitored to assess the effects of weight loss on appropriate end points. 

The result of the Phase II trial is information needed to determine the effective dose and the dosing regimen of frequency and duration. Specihc chnical endpoints or markers are used to assess interaction of drug and disease. There are two types of markers definitive and surrogate. For example, in the case of cancer or hypertension, the definitive markers are mortality and stroke, respectively, and the surrogate markers may be tumor size, or cancer-associated proteins p53, TGF-a in the case of cancer, and blood pressure or cholesterol level in hypertension. Statistical analysis is carried out to evaluate the... 

The assessment of the clinical benefit of medicines is generally understood by clinicians, regulatory authorities and reimbursement authorities alike. Everyone instinctively understands the clinical benefit of decreasing a hypertensive patient s blood pressure to 130/90 or the benefit in reducing the number of strokes. However, in an era of increasing healthcare costs and funding decisions, there is a need not only to illustrate the clinical benefit of a drug, but to translate that clinical outcome into an economic benefit. 

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