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

[Crystal-Wings, LVN]

Are there parameters in the MAR that say when the bp med should be held?

[Glycerine82, LPN]

Those meds are likely ordered more for the heart rate than for the BP. Generally if the systolic is >100 and the pulse is >60 most docs will want you to give it.

[KeepGoingRN]

There's usually a parameter in the orders when to hold meds. However, if a pt is borderline the parameter with multiple BP meds. I'll hold off giving one and re-check in about 45-min to an hour and see how they are to give the rest. I also look at their baseline, if they've been taking the same meds the past couple of days at the same time/together and the BP is usually hovering around baseline then I would probably just give all of them and re-check BP/pt just to make sure.

[Mavnurse17, BSN, RN]

I'm not sure if this has been said yet (I haven't read through the entire thread), but did you look at the MAR? Have those meds been given consistently throughout the hospital stay/are these the patient's home meds? If the patient has been getting the meds consistently and the BP has stayed relatively the same (albeit "low" per nursing textbook standards), then you can give it without worry. If these were brand new meds or if you were restarting them after a few days of pause, then I would clarify with the provider but most likely still give.

P.S. when evaluating a BP, always look at the clinical status of your patient. I used to get patients that lived with BP's 80's/40's, which made my fresh-out-of-RN-school brain PANIC, but they were chronic HF patients and they were still perfusing. I'm sure ICU sees much worse.

[NoobRN]

22 hours ago, KeepGoingRN said:

There's usually a parameter in the orders when to hold meds. However, if a pt is borderline the parameter with multiple BP meds. I'll hold off giving one and re-check in about 45-min to an hour and see how they are to give the rest. I also look at their baseline, if they've been taking the same meds the past couple of days at the same time/together and the BP is usually hovering around baseline then I would probably just give all of them and re-check BP/pt just to make sure.

so similar situation happened, this pt had cad, htn, dm, a.fib, dialysis w/ckd and on carvedilol 3mg, amiodarone, and hydralazine 100 mg and bp ~120/48, hr 80 at the end of the shift. Gave first two except hydralazine thinking pt prob needs carvedilol and amio for a.fib, held hydralazine thinking it could dropped too much and confirmed this with md. When i returned and got report, night after i left pt's bp dropped to 96/38 ?. I still think it was right choice but I don't know why pt dropped so much..