Lipp Vis Nursing ChaptLWBK1630_C02_p013-068

Chapter 2 • Cardiovascular Care  29

Treatment of Hypertension The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure has developed an innovative flow chart to guide the treatment of patients with hypertension.

L i fes t y l e Modi f i cat i ons

Not at goal blood pressure (BP) ( < 140/90 mm Hg) ( < 130/80 mm Hg for patients with diabetes or chronic kidney disease)

In i t i a l Drug Cho i ces

With compelling indications

Without compelling indications

Stage 1 Hyper tens ion (systolic BP 140 to159 mm Hg OR diastolic 90 to 99 mm Hg) Thiazide-type diuretics for most; consider angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), beta-adrenergic blockers, calcium channel blockers, or combination

Stage 2 Hyper tens i on (systolic BP ≥ 160 mm Hg OR diastolic BP ≥ 100 mm Hg)

• Drug(s) for compelling indications (see prescriber) • Other antihypertensive drugs (diuretics, ACE inhibitors, ARBs, beta- adrenergic blockers, calcium channel blockers) as needed

Two-drug combination for most (usually thiazide-type diuretic and ACE inhibitor, ARB, beta-adrenergic blocker, or calcium channel blocker)

Not at Goa l BP

• Optimize dosages or add additional drugs until goal BP is achieved. • Consider consultation with hypertension specialist.

Source: Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. U.S. Department of Health and Human Services, NIH, NHLBI; 2004.

Teaching About Hypertension • Teach the patient to

• Encourage a change in dietary habits. Help obese patients plan a reducing diet. Advise against intake of high-sodium foods (such as pickles, potato chips, canned soups, and cold cuts), table salt, and foods high in cholesterol and saturated fat. • Teach the patient and family that this is a lifelong treatment. Warn the patient and family about complications that may occur from noncompliance and uncontrolled blood pressure, such as stroke and heart attack.

taking medication. Tell patient to report any adverse reactions to prescribed drugs. Advise patient to avoid high-sodium antacids and over-the-counter cold and sinus medications containing harmful vasoconstrictors. • Help the patient examine and modify their lifestyle. Suggest stress-reduction groups, dietary changes, and an exercise program, particularly aerobic walking, to improve cardiac status and reduce obesity and serum cholesterol levels.

use a self-monitoring blood pressure cuff and to record the reading at least twice weekly in a journal for review by the physician at every office appointment. • Tell the patient and family to keep a record of drugs used in the past, noting especially which ones are or are not effective. • To encourage compliance with antihypertensive therapy, suggest establishing a daily routine for LESSON PLANS