I’m working on a nursing discussion question and need an explanation to help me study.
Raul Urquiaga
Advanced Clinical Pharmacology
The pressure in the cardiovascular system is determined by heart rate, stroke volume, and total peripheral resistance (TPR). When a person’s blood pressure is above normal limits for a sustained period, a diagnosis of hypertension is made. The underlying danger of hypertension of any type is the prolonged force on the vessels of the vascular system. The muscles in the arterial system eventually thicken, leading to a loss of responsiveness in the system. Untreated hypertension increases the risk for cardiac death, CAD, stroke, renal failure and loss of vision (Bhurane, Sharma & Acharya, 2019).
Drugs used to treat hypertension work to alter the normal reflexes that control blood pressure. Treatment for essential hypertension does not cure the disease but is aimed at maintaining the blood pressure within normal (accepted) limits to prevent the damage that hypertension can cause.
Treatment of hypertension that uses a diuretic-based strategy has been effective in preventing stroke and cardiac disease. Diuretics lower blood pressure by flushing salt out of the body, taking the unwanted extra fluid with it.
ACE inhibitors block the conversion of angiotensin I to angiotensin II in the lungs. These drugs stop the renin–angiotensin system, preventing vasoconstriction and aldosterone release. The ACE inhibitors may be used as a monotherapy for hypertension management or they may be combined with diuretics. The actions of ACE inhibitors include a decrease in blood pressure and in aldosterone secretion, with a resultant slight increase in serum potassium and a loss of serum sodium and fluid.
The ARBs selectively bind to angiotensin II receptors in blood vessels to prevent vasoconstriction and in the adrenal cortex to prevent the release of aldosterone that is caused by reaction of these receptors with angiotensin II. These actions lead to a decrease in blood pressure caused by a decrease in TPR and blood volume.
The calcium channel antagonists prevent the movement of calcium into the cardiac and smooth muscle cells when the cells are stimulated. This blocking of calcium interferes with the muscle cell’s ability to contract, leading to a loss of smooth muscle tone, vasodilation and a decrease in peripheral resistance (Gibbs, Jackson & Lip, 2014).
Drugs that block the effects of the sympathetic nervous system are useful in blocking many of the compensatory effects of the sympathetic nervous system (Gibbs, Jackson & Lip, 2014). If other drug therapies do not achieve the desired reduction in blood pressure, it is sometimes necessary to use a direct vasodilator. Vasodilators produce relaxation of the vascular smooth muscle, decreasing peripheral resistance and reducing blood pressure. They do not block the reflex tachycardia that occurs when blood pressure drops. Most of the vasodilators are reserved for use in severe hypertension or hypertensive emergencies.
Important teaching points should include information about disease management. Disease management of hypertension is a complex process that involves the perfect triangle: an interprofessional healthcare team, the patient, and family members or friends. Current hypertension management guidelines acknowledge the value of proper patient education and nursing input is a vital part of adherence to medication and health plan (Kear, 2015). The significance of evaluating ways to enhance adherence to medication and hypertension health care plan cannot be understated. Nurses are in a unique position to address possible barriers that may be impeding patients from adhering to a medication plan and from following up with a health plan.
References
Bhurane, A. A., Sharma, M., & Acharya, U. R. (2019). An efficient treatment plan of congestive heart failure. Cognitive Systems Research, 55, 82–94.
https://doi.org/10.1016/j.cogsys.2018.12.017
Gibbs, C. R., Jackson, G., & Lip, G. Y. (2014). ABC of heart failure. Non-drug management. BMJ, 320(7231), 366-9.
Kear, T. (2015). Exploring the evidence. Placing patients with hypertension at the center of self-management and research. Nephrology Nursing Journal, 42(2),
181-189.
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