When To Hold Blood Pressure Meds?

[registerednutrn, BSN, RN]

It depends on the doctors orders and on the med. I generally hold meds for sbp below 100 and/dbp below 50 unless there are other parameters. If in doubt talk to the physician and see I'd he/she will give you parameters.

[turnforthenurse, MSN, NP]

It depends on the doctors orders and the patient. Sometimes the docs are good about writing parameters. For example, I had a patient on metoprolol and he wrote to HOLD if SBP

If you're really unsure and the doctor did not write parameters, I would call and ask. I had a patient who had a BP of 134/43. Pt was to receive metoprolol, 50mg of PO hydralazine (scheduled) in addition to isosorbide for angina, which can also drop your BP. I looked at the trends and the MAR to see if the meds were given in the past. They were, but the BP was higher. The metoprolol had parameters written on the MAR (HOLD if SBP

When in doubt, ask! Whether it's another nurse or calling the doc him/herself.

[Aeterna, BSN, RN]

Generally, I hold if SBP

Also, if you have a patient who is on hemodialysis (we see a lot of nephrology patients on our floor for some reason), you will also want to know which meds to hold prior to dialysis (as the nephrologist will generally want to hold BP meds that day, although ours are pretty good about writing out parameters and such).

[llg, PhD, RN]

I am happy to see that so many people are recommending to check with the doctor and to look at the patient's usual patterns. As someone who has hypertension, it scares me to think that a nurse might withhold my meds when my BP is normal for me.

Anything over 120 for the systolic is too high -- so to consider holding the meds for numbers in the desired neighborhood of 110 doesn't make sense unless it is known that the patient doesn't tolerate BP's in that range. 110 is a great number for most people -- a sign that the meds are doing their job and keeping the patient in the desired range.

Yesterday evening, my BP was 87/56. What did I do? I took my 2 BP pills a half hour later, as always. That's lower than usual for me, but reading like 100/66 are quite common. I would hope that nurses wouldn't withhold my meds for numbers like that without checking with me first as to what was I used to tolerating and/or checking with my doctor.

[turnforthenurse, MSN, NP]

llg said:

I am happy to see that so many people are recommending to check with the doctor and to look at the patient's usual patterns. As someone who has hypertension, it scares me to think that a nurse might withhold my meds when my BP is normal for me.

Yes...renal patients in particular have compensatory hypertension - they may be used to having a SBP of 150-180mm Hg. If you give them BP meds and their SBP drops to say, 110, they might not tolerate that. When in doubt always ask, whether it is the patient or the MD or look at the trends. If you call the MD, ask for parameters, and ask them when they want to be notified. Some MD's may tell you to not call them unless the pt's SBP is 80 or less.

[Do-over, ASN, RN]

I'll hold for a bit and re-check, but ultimately (unless we already have parameters) I want an order from the doc to give or not.

Ex - had a patient with SBP 92, toprol (forget dose) and NTP due at bedtime. Called doc (no parameters on either) - doc gave guidelines on the toprol (so it was held) but wanted the NTP even with the low-ish SBP (elevated trops, etc)

[Do-over, ASN, RN]

Another thought - picked up a patient awhile back, previous nurse held cardizem d/t low BP (90s I think). However, his heart rate had been consistently in the 140s (a-fib), which is why the cardizem was ordered that day in the first place. The initial dose was held and the doc wasn't notified... I re-checked the BP, had no concern there and gave the med. HR dropped beautifully.

[Aeterna, BSN, RN]

Do-over said:

Another thought - picked up a patient awhile back, previous nurse held cardizem d/t low BP (90s I think). However, his heart rate had been consistently in the 140s (a-fib), which is why the cardizem was ordered that day in the first place. The initial dose was held and the doc wasn't notified... I re-checked the BP, had no concern there and gave the med. HR dropped beautifully.

In that case, I would give the doctor a call and express my concern about his low BP but high HR. I had a patient a while back who had the same problem (although, low BP was normal for him). The doctor ordered a stat beta-blocker (can't remember which one) and day shift nurse gave it (this was near the end of her shift). When I came on for night shift and reassessed the patient, his BP had dropped further but his heart rate was the same. Called the doctor again, he ordered something else similar to be given stat. I expressed my concern that his BP would tank too far but the doctor said as long as the SBP stays 80 or above, he was willing to go ahead with it.

I was nervous but it turned out ok in the end. I just never have qualms over calling a doctor if there's any doubt in giving important medications.

[I<3H2O, BSN, RN]

I totally agree with the PPs. Look at BP trends for this specific patient, ask the pt. themselves if they routinely check their BP at home and how it normally is (I find that most do not), find out the specifics on the drug you are ordered to give, and then once you have all of that information and are still unsure-call the doctor!

I find that some nurses will hold meds (usually BP meds but sometimes it is other stuff) and will not notify the doctor a med is being held. This is a huge issue for some of our docs. ALWAYS call the doc if you are holding a routine med.

[nursingcares, RN]

I think it also depends on the patient. I had one that if I had given it for a bp of 110 sbp he would have bottomed out quickly.

[tokmom, BSN, RN]

Sbp 100 or under, but at times 110. Depends on the amount, and if Lasix or something will be given as well, and if the pt is eating, drinking or have an IV running.

[Jamie Lloyd]

What BP med would you hold if your patient had a low BP, HR WNL and they are on a BB, ACE, and CCB?