Question about blood pressure medications

[NoobRN]

Im a relatively new nurse and still confused about when to hold blood pressure medication. Most of the patients i see have isolated diastolic hypotension bp ranging like 110/54, 135/55, etc etc. One patient i had was at the end of the shift had scheduled hydralazine 100 mg tab and carvedilol 12.5mg and her bp was 141/51 hr ~70s. I asked my preceptor if it was safe to be given as well as supervisor and they said yes. I was confused because I learned/heard usually if sys <90 and/or diastolic bp <60 we have to hold blood pressure medication and I feel like I should've held this medication but ended up giving them because they said it was ok to give. Can someone explain to me what I should've done in this situation? also, if pts have isolate hypotension and have more than 1 bp medication, what is the right thing to do?

-thx

[Rose_Queen, BSN, MSN, RN]

Usually parameters to hold a medication are included in the order. If they are not, find out if your facility has a standing protocol for holding medications.

[brownbook]

I'm not sure what "isolated" diastolic hypotension means?

You can't give, or hold, a blood pressure medication based on one blood pressure reading (if that's what it means)? Retake the blood pressure.

[NoobRN]

12 hours ago, brownbook said:

I'm not sure what "isolated" diastolic hypotension means?

You can't give, or hold, a blood pressure medication based on one blood pressure reading (if that's what it means)? Retake the blood pressure.

well I didn't know it either but found after googling that isolated hypotension is when blood pressure, usually diastolic hypotension, is < 60 while systolic is normal or above the normal (e.g. > 120).

[NoobRN]

Among many blood pressure medications, are there medications that specifically lowers systolic more than diastolic or vice versa?

[BSNnurse20]

Diastolic blood pressure can be low in cases of aortic regurgitation or even old age. You still have to treat the systolic if high. Diastolic in the 50s is not much concern. At least this is what I’ve seen.

[NoobRN]

49 minutes ago, Ehartl said:

Diastolic blood pressure can be low in cases of aortic regurgitation or even old age. You still have to treat the systolic if high. Diastolic in the 50s is not much concern. At least this is what I’ve seen.

oh....so even though diastolic maybe <60, if systolic is high (>120), we still treat it? then if systolic is little low (e.g ~100) and diastolic low as well (e.g. <60), then that's when we have to hold if no parameter present? do we have to consider map if this is the case where both are low? sorry Im getting little confused and my critical thinking is not solid...

[brownbook]

Great to learn new stuff in my old age. Never heard of isolate hypotension. Irregardless this discussion seems very academic.

If the patient was in CCU, Swan Ganz, artline, etc. his isolate hypotension would be closely monitored and treated.

What unit are you working on? What is the rest of the patient's medical history? Why is he in the hospital? How long has he been taking carvedilol and hydralazine? Was this a one time blood pressure reading or was it repeated with similar results. What has his blood pressure trend been since his admit? How is the patient looking and feeling? All that, to me, is what critical thinking means. But I was never clear on the concept of critical thinking ?.

[NoobRN]

16 hours ago, brownbook said:

Great to learn new stuff in my old age. Never heard of isolate hypotension. Irregardless this discussion seems very academic.

If the patient was in CCU, Swan Ganz, artline, etc. his isolate hypotension would be closely monitored and treated.

What unit are you working on? What is the rest of the patient's medical history? Why is he in the hospital? How long has he been taking carvedilol and hydralazine? Was this a one time blood pressure reading or was it repeated with similar results. What has his blood pressure trend been since his admit? How is the patient looking and feeling? All that, to me, is what critical thinking means. But I was never clear on the concept of critical thinking ?.

so this pt is in med surge unit, and don't remember everything but pt was on those two medications for some time and hx wise pt came in for pressure ulcer. Pt's vital signs seemed to be within that range but diastolic was lower than usual and last time I talked to pt before medications, pt seemed stable.

[BSNnurse20]

18 hours ago, NoobRN said:

oh....so even though diastolic maybe <60, if systolic is high (>120), we still treat it? then if systolic is little low (e.g ~100) and diastolic low as well (e.g. <60), then that's when we have to hold if no parameter present? do we have to consider map if this is the case where both are low? sorry Im getting little confused and my critical thinking is not solid...

Depends on why the patient is being treated with carvedilol and hydralazine? Is it specifically for high blood pressure or for some other reason (heart failure). If it was just for BP then yes I would personally hold if both low, but if it’s for decreased LV function then you might have to present the case the to the Dr. For some CHF patients as long as BP is above 100 systolic and they are asymptomatic they take their medications (i.e., lisinopril, carvedilol, diuretics, etc).

[amoLucia]

It always amazes me that folk get sooooo hung up on blood pressures that direct continued administration of BP meds. Has it ever occurred to people that BPs remain controlled on the low side BECAUSE of the BP med!?!?

Like I suspect that BPs fluctuate r/t inconsistent med administration. I take BP meds but I rarely take my own BP. Even when I do, it's always controlled which I attribute to the UNINTERRUPTED administration of my meds.

If the BP is extremely low and/or the pt is experiencing some s & s of hypotension, then YES, by all means, the med should be held. But otherwise, I'd just give the med (unless here was some very specific parameter).

JMHO

[Lipoma, BSN, RN]

Also new nurse here, I rarely hold PO BP medications. If a patient is to get PO BP meds, and their systolic is 110..I'd still give it. IV Lasix or antihypertensives get held.

In your case, the patient's BP is being maintained with the PO meds and they are used to it so I'd give it anyways...to agree with amoLucia.

However, if they are symptomatic, I page the resident/attending and confirm if they still want me to give it....and chart whatever response I get.

PS, I'm more concerned with systolic measurement because that tells me what's more important...perfusion to the brain and vital organs. Diastolic not so much because that's when the heart is at rest and gets perfused.