• Diuretics

  • Act on kidneys to help eliminate water and sodium, reducing blood volume

• Calcium Channel Blockers

  • Help relax the muscles of the blood vessels

• Angiotensin-converting enzyme inhibitors

  • Dilates blood vessels by blocking the formation of angiotensin II

• Angiotensin II receptor blockers (ARBs)

  • Dilates blood vessels by blocking the formation of angiotensin II

• Beta Blockers

  • Reduces the afterload on the heart and dilate blood vessels, causing the heart to beat more slowly

• Combined alpha and beta blockers

  • Reduces nerve impulses that promote vasoconstriction

• Vasodilators

  • Relaxes the muscle tissues in the blood vessel walls

• Central agonist

  • Decrease blood vessels' ability to contract and cause vasocontraction

> May be primary or secondary

> Related to water and sodium retention, altered renin-angiotensin-aldosterone mechanism, stress and increased sympathetic nervous system activity, insulin resistance and hyperinsulinemia, and endothelium dysfunction

Lab Tests: Routine urinalysis

BUN

Creatinine / creatinine clearance

Basic metabolic panel/ CBC

Lipid profile

Electrocardiogram (ECG/EKG): This quick and painless test measures the heart's electrical activity. It can tell how fast or how slow the heart is beating.

Echocardiogram: A noninvasive test using sound waves to create detailed images of the heart and blood flow.

(increased overload causes diastolic dysfunction)

-renal failure

(high pressure in the walls causes thickening & bloodflow is reduced)

-stroke

(prolonged high BP can cause vessel rupture, leading to hemorrhage & disrupted bloodflow to part of the brain)

-aneurysm

(dilation of cerebral artery walls presses on nerves & brain tissue causing damage/ruptures which causes hemorrhage or stroke)

-hypertensive crisis

(acute, severe elevations in BP)

• Assessments

  • Neurological assessment

  • Blood pressure

  • Heart rate

  • Examination of the optic fundi

  • Auscultation for carotid, abdominal, and femoral bruits

  • Palpation of the lower extremities for edema and pulses

  • Serum creatinine, BUN, estimated glomerular filtration rate, and 24-hr urine collection for creatine clearance

  • Albumin excretion rate

  • Calculation of BMI and waist circumference

• Actions

  • Administer antihypertensive medications as ordered

~Race (x4 in African Americans)

~Gender (Men)

~Renin elevation

~Genetics

Modifiable:

~Obesity

~Vitamin D deficiency

~Cigarette smoking

~Salt sensitivity

~Insulin resistance

> Monitoring of blood pressure with phone apps, home monitoring

> Life-long treatment, adherence to medication regimen, and lifestyle changes

• DASH diet: diet rich in fruits, vegetables, and low-fat dairy products, and reduced in saturated fat and cholesterol

• Sodium restriction: less than or equal to 1,600 mg sodium per day is recommended

• Moderate exercise: at least 150mins of moderate aerobic exercise each week

• Limit alcohol: no more than one drink per day for women, two drinks per day for men

• Stress reduction

• Smoking cessation

> Explore use of fish oils and Omega-3 fatty acids

> Contact HCP before using OTC medications