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Often a single medication will not adequately control an individual’s BP, and combination therapy using lower doses of two or more drugs may be necessary. The sidebar “Combating Hypertension” on page 18 describes some of the most commonly prescribed medications for hypertension, along with adverse events of which nurses should be aware.

Beta-blockers offer another treatment option for hypertension; however, they should be used with caution among diabetic individuals, especially those prone to hypoglycemia. In diabetics who take beta-blockers, the medications may mask the warning signs of an impending hypoglycemic reaction such as diaphoresis, anxiety, or increased heart rate.

When it comes to the treatment of hypertension, nurses need to do more of what nurses do best — developing therapeutic relationships with patients and encouraging patients to ask questions and become involved in their hypertension management care plan. No longer should patients with hypertension sit on the sidelines. Nurses must facilitate a solid game plan, one based on education that promotes healthy lifestyle changes, to defeat hypertension.

Lifestyle changes and drug therapy individualized to target patients’ unique circumstances afford the best chance to reduce the risk for devastating consequences of uncontrolled hypertension, namely, cardiovascular events and renal failure, particularly for African Americans.¹

Nurses should develop familiarity with the various classifications of medications used to treat hypertension, including their common adverse effects. They should also encourage patients to report any adverse effects, even if those effects are minimal, to their care provider. Patients should be reassured that there are many different treatment options for hypertension and that finding the right strategy may take a little time. Nurses can encourage them to be proactive members of a team approach to controlling hypertension.

Editor’s Note: Visit Education/CE to view our self-study modules on hypertension.

Susanne J. Pavlovich-Danis, RN, MSN, ARNP-C, CDE, maintains a private adult health practice in Plantation, Fla. She is also a professor and area chair for nursing at the University of Phoenix, Fort Lauderdale, Fla.

References

1. Douglas JG, Bakris GL, Epstein M, et al. Management of high blood pressure in African Americans. Consensus statement of the Hypertension in African-Americans Working Group of the International Society on Hypertension in Blacks. Arch Intern Med. 2003;163:525-541.

2. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7 Express). NIH Publication No. 03-5233. May 2003.

3. Clement DI, De Buyzere ML, De Bacquer DA, et al, for the Office Versus Ambulatory Pressure Study Investigators. Prognostic value of ambulatory blood pressure recordings in patients with treated hypertension. N Engl J Med. 2003;348: 2407-2415.

4. Fox CH, Mahoney MC, Ramsoomair D, Carter CA. Magnesium deficiency in African Americans: does it contribute to increased cardiovascular risk? J Natl Med Assoc. 2003;95(4):257-262.

5. Vlachopoulos C, Hirata K, Stefanadis C, Toutouzas P, O’Rourke MF. Caffeine increases aortic stiffness in hypertensive patient. Am J Hypertens. 2003;16(1):63-66.

6. Hoq S, Chen W, Srinivasan S, Berenson GS. Childhood blood pressure predicts adult microalbuminuria in African Americans but not in Whites: the Bogalusa Heart Study. Am J Hypertens. 2002;15:1036-1041.

7. Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988-2000. JAMA. 2003;290(2):199-206.

8. Morgan TO, Anderson A. Different drug classes have variable effects on blood pressure depending on the time of day. Am J Hypertens. 2003;16(1):46-50.

9. U.S. National Library of Medicine. (2004). Medline Plus Drug Information. Available: http://www.nlm.nih.gov/medlineplus/druginformation.html. Accessed 1/15/04.