Hypertension Meds and treatments

[sw2rn]

Hi,

I am in my second semester and studying for my cardiac test. I have 2 areas that I am not clear on. In the lecture, it was stressed that Thiazide diuretics were the usual first drug of choice when treating essential hypertension but ACE, BB, CCB may also be used. It was also stated that a second drug may be added if the first, single drug did not lower BP. I am not clear when you add a second drug and what drug is added next. The Pharm D said the drug is added based on cause but my understanding is that the cause of essential HTN is unknown.

The second area is relating to lowering blood pressures in Hypertensive Emergencies and Hypertensive Urgencies. The lectures notes state to lower the BP within hours for HTN Urgency with Lasix, Bumex, etc. But to lower it immediately with HTN Emerceny due to organ damage. I understand this is an ICU treatment with IV meds (Nipride, Vasotec, NTG, etc. ) The next lecture slide says to have no more than a 25% reduction in the MAP in the first 2 hours. I am confused about the need to immediately lower the BP for HTN Emergency.

I would appreciate any insight that can help me clarify and understand these issues.

Thanks

Kim

[psychnurse1998]

Hi,

I am in my second semester and studying for my cardiac test. I have 2 areas that I am not clear on. In the lecture, it was stressed that Thiazide diuretics were the usual first drug of choice when treating essential hypertension but ACE, BB, CCB may also be used. It was also stated that a second drug may be added if the first, single drug did not lower BP. I am not clear when you add a second drug and what drug is added next. The Pharm D said the drug is added based on cause but my understanding is that the cause of essential HTN is unknown.

The second area is relating to lowering blood pressures in Hypertensive Emergencies and Hypertensive Urgencies. The lectures notes state to lower the BP within hours for HTN Urgency with Lasix, Bumex, etc. But to lower it immediately with HTN Emerceny due to organ damage. I understand this is an ICU treatment with IV meds (Nipride, Vasotec, NTG, etc. ) The next lecture slide says to have no more than a 25% reduction in the MAP in the first 2 hours. I am confused about the need to immediately lower the BP for HTN Emergency.

I would appreciate any insight that can help me clarify and understand these issues.

Thanks

Kim

Great question Kim. There are probably others more qualified to answer the question. I am on Hctz or Hyrdochorthiazide and was thinking others were better bp meds. My pharmacist also said it was the first drug of choice. I have had patients with severe htn that are on multiple drugs. That part I am not sure of, but but at least two of my patients had also abnormal heart rythyms in addition to htn, which hctz did not address. As to the last part, visualizing arteries and or arterieroles as balloons about to pop, if no intervention is taken immediately, I would think a 25% drop would prevent that, followed up with further drops. I think one immediate result with severe htn is that more interstitial fluid if forced between the cells than has time to return back into circulation to be return to the heart. So you have the possibility of fluid in the lungs [cant remember technical term] or leg edema.

I hope someone else replies and corrects me. I sure dont want to give incomplete or incorrect advice.

[yoginurse2b]

I am not clear when you add a second drug and what drug is added next.

The second drug is added if pt cannot effectively lower the BP

The second area is relating to lowering blood pressures in Hypertensive Emergencies and Hypertensive Urgencies. The lectures notes state to lower the BP within hours for HTN Urgency with Lasix, Bumex, etc. But to lower it immediately with HTN Emerceny due to organ damage. I understand this is an ICU treatment with IV meds (Nipride, Vasotec, NTG, etc. ) The next lecture slide says to have no more than a 25% reduction in the MAP in the first 2 hours. I am confused about the need to immediately lower the BP for HTN Emergency.

The reason why we need to lower the BP during HTN crisis is to prevent complications like kidney damage, retinopathy, stroke, intercranial hemorrhage, etc. I believe that the reason why you don't want a sudden decrease in BP is b/c it will cause tissue perfusion, thus lead to complications or damage of other major organs, esp the kidneys.

Hope that helps!

[yoginurse2b]

I think one immediate result with severe htn is that more interstitial fluid if forced between the cells than has time to return back into circulation to be return to the heart. So you have the possibility of fluid in the lungs [cant remember technical term] or leg edema.

HTN can indirectly cause peripheral edema or pulmonary edema s/t CHF. The heart has to work extra hard to pump blood into high pressured bv, which will lead to hypertrophy of myocardium. Left ventricle is usually the one that's been affected first. Increased backup of blood flow will cause pulmonary congestion, hence pulmonary edema, and lead to RHF, which cause peripheral edema, increased JVP and ascites.

[sw2rn]

Thanks to all for the input. It is making more sense to me now. I hope it will continue to make sense when I test on it this week! Thanks again for the clarification and education.