When to hold antihypertensive meds

[Isadora_Faye]

I need some assistance on this topic and I don't have much clinical experience. A lot of times on the MAR it will state with blood pressure medications to "hold if SBP less than 120," etc. Sometimes, however, medications that will lower the blood pressure do not have any printed parameters listed on the MAR or in the drug guides. I am curious how to know when to hold the medication? Granted if someone's blood pressure was 80/50 I wouldn't be giving an antihypertensive, but how do I know where that line is? I know problems can be caused by not giving a regularly scheduled medication even if the blood pressure is stable (because then it will rise), but I also know that giving a medication that will lower blood pressure when the blood pressure is already low is unsafe. Advice is appreciated!

[Boston-RN, RN]

As far as when to hold meds....Doctors orders should indicate at what point the med should be held ..... or there may be standing orders or guidelines should be in med books

If someone is normally hypertensive and the're BP is now 80/50 sounds like more of a problem than just holding the meds.

[NurseyBaby'05, BSN, RN]

Another thing to consider is the patient's baseline. If they have been running in the 150s and now they're in the low teens, I may wait a little while and recheck it. If they are consistently in the teens on the meds, I would give them. That meds are probably what's keeping the BP there. A lot of variables.

[Daytonite, BSN, RN]

You want to look at significant changes or trends in the patient's blood pressure. It's important to check blood pressure at the same time of day, each day, under the same or similar conditions. So, if previously taken blood pressures aren't listed on the MAR you'll have to go back into the chart and find the nursing form where the blood pressures are listed. If the patient's blood pressure is stable and consistently at around 124/80 AND at the same time of day each day then you're going to give the medication.

If I wasn't confident about giving the medication based on one reading with no other documented vital signs, I'd wait a half hour or so and check the blood pressure again. I'd also check it in both arms. Often the blood pressure is slightly higher in one arm. The pressure in the left arm is supposed to be the most accurate.

[crb613, BSN, RN]

If I have any holds...I take the b/p & pulse myself. I just do not trust anyone else's reading...If I am to give a b/p med at 10 & the pressure was taken at 7....I want a reading at the time I am giving the med. I also check the notes to see what the norms are & how it has been running. I then chart on the MAR what my readings are at the time I give the med. I am new, and all this may not be necessary, but I want to be careful as humanly possible. I don't want to loose my license before the ink is dry & I sure don't want to hurt anyone!