Hypertension drug therapy

FIGURE 10-1. Algorithm for treatment of hypertension. Drug therapy recommendations are graded with strength of recommendation and quality of evidence in brackets. Strength of recommendations A, B, C = good, moderate, and poor... 

McCombs, J., et al., "The Costs of Interrupting Anti-Hypertensive Drug Therapy in A Medicaid Population," Med. Care, 32, 214-226 (1994). 

Chemical Society. Division of Medicinal Chemistry. III. Series American Chemical Society. ACS symposium series 27. [DNLM 1. Antihypertensive agents—Congresses. 2. Hypertension—Drug therapy—Congresses. WG340 A629 1975]. 

STEP 1 In patients with mild hypertension, drug therapy is usually initiated with a single agent (monotherapy) from one of the following classes a diuretic, a beta blocker, an angiotensin converting enzyme (ACE) inhibitor, or a calcium channel blocker. 

Should one of the causes of secondary hypertension be diagnosed, treatment directed at the disease may often lead to the resolution of the hypertension. Treatment of essential hypertension may involve lifestyle modillcalions and the use of anti-hypertensive drugs (Table I). A decision to proceed to anti-hypertensive drug therapy should alw ays balance the risks of the treatment against the benefits which will ensue. 

Centrally acting receptor agonists such as clonidine are useful in the treatment of hypertension. Drug therapy of hypertension is discussed in Chapter 32. 

A blood pressure of 160-179 systolic and/or 100-109 diastohc is considered Stage 2 hypertension, and the driver is not necessarily imqualified during evaluation and institution of treatment. The driver is given a one time certification of three months to reduce his or her blood pressure to less than or equal to 140/90. A blood pressure in this range is an absolute indication for anti-hypertensive drug therapy. Provided treatment is well tolerated and the driver demonstrates a BP value of 140/90 or less, he or she may be certified for one year firom... 

Explain why blood pressure determinations are important during therapy with an anti hypertensive drug. 

Discuss ways to promote an optimal response to therapy, how to manage adverse reactions, and important points to keep in mind when educating patients about the use of an anti hypertensive drug. 

Diaz oxide (Hyperstat IV) and nitroprusside (Nitropress) are examples of intravenous (IV) drugs that may be used to treat hypertensive emergencies. A hypertensive emergency is a case of extremely high blood pressure that does not respond to conventional antihypertensive drug therapy. 

Each time the blood pressure is obtained, the nurse uses the same arm and the patient is placed in die same position (eg, standing, sitting, or lying down). In some instances, die primary care provider may order die blood pressure taken in one or more positions, such as standing and lying down. The nurse monitors the blood pressure and pulse every 1 to 4 hours if the patient has severe hypertension, does not have the expected response to drug therapy, or is critically ill. 

Drug therapy for portal hypertension and cirrhosis can alleviate symptoms and prevent complications but it cannot reverse cirrhosis. Drug therapy is available to treat the complications of ascites, varices, spontaneous bacterial peritonitis, hepatic encephalopathy, and coagulation abnormalities. 

Determine if drug therapy may be contributing to ARF. Consider not only drugs that can directly cause ARF (e.g., aminoglycosides, amphotericin B, NSAIDs, cyclosporine, tacrolimus, ACE inhibitors, and ARBs), but also drugs that can predispose a patient to nephrotoxicity or prerenal ARF (i.e., diuretics and anti hypertensive agents). 

Oates, J.A., Antihypertensive agents and the drug therapy of hypertension, in Goodman and Gilman s The Pharmacological Basis of Therapeutics, 9th ed., Hardman, J.G. and Limbird, L.E., Eds., McGraw-Hill, New York, 1996, chap. 33. 

Lifestyle modification alone is appropriate therapy for patients with prehypertension. Patients diagnosed with stage 1 or 2 hypertension should be placed on lifestyle modifications and drug therapy concurrently. 

Selection of drug therapy should follow the JNC 7 guidelines, but the treatment approach in some patient populations may be slightly different. In these situations, alternative agents may have unique properties that benefit a coexisting condition, but the data may not be based on evidence from outcome studies in hypertension. 

The cure for preeclampsia is delivery of the fetus if the pregnancy is at term. Drug therapy for hypertension in preeclampsia includes methyldopa, labetalol, and calcium channel blockers. Magnesium sulfate is used to prevent eclampsia and to treat eclamptic seizures. 

No evidence exists for the superior efficacy of one antihypertensive agent versus another. For women with severe hypertension (diastolic blood pressure greater than or equal to 100 mm Hg), the benefit of drug therapy may outweigh the risks. 

Initiation factors initiate kidney damage and can be modified by drug therapy. Initiation factors include diabetes mellitus, hypertension, autoimmune disease, polycystic kidney disease, and drug toxicity. 

Constantine, J., McShane, W., Scriabine, A. and Hess, H.-J., "Hypertension Mechanisms and Management." Section VI, "Recent Advances in Drug Therapy," p. 429, 26th Hahnemann Symposium, Ed. Onesti, G., Kim, K. and Moyer, J., Grune and Stratton, New York (1973). 

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