Another important observation for the registered nurse to keep in mind is many patients demonstrate
“white-coat-hypertension or (WCH).” A phenomenon in which patient’s exhibit elevated B/P in a clinical setting but
not when recorded by themselves at home. It is understood today that this is due to ‘anxiety’ in some patients
experience during a clinic visit. Patients of white-coat-hypertension do not exhibit the signs indicative of
trepidation and their increased B/P does not often accompanied with symptoms such as tachycardia or an irregular
heart rhythm. Studies have shown repeatedly that 15-30% of those patients thought to have mild HPN because of
clinic or an office recording,28 display normal
range B/P, and show little to no unusual response to pressure stimulus.
Concerning talking manual measurements, the nurse taking the measurement should be careful to inflate the
cuff suitably above anticipated systolic pressure. Taking your stethoscope and placing it over the brachial artery,
and making sure that arm is at the level of the heart and the cuff deflates at a rate of 2 to 3
mmHg/s.29 In the elderly patients who
particularly when treated may show ‘orthostatic hypotension,’ measuring lying sitting and standing B/P may indeed
be useful. Blood pressure varies with the time of day, as might the effectiveness of treatment, and archetypes used
to record the data should include the time taken.
Using Medications-
The goal of treatment should be in B/P control of <140/90 mmHg for a significant amount of patients, and
lower in certain contexts such as diabetes or kidney etiology (some textbooks recommend keeping levels below 120/80
mmHg).30 Each added drug may reduce the systolic
B/P by 5-10 mmHg. It is not uncommon to have multiple drugs prescribed to the patient in order to achieve the
necessary B/P control.
Commonly used drugs include the following typical groups:31
ACE inhibitors such as captopril, enalapril, fosinopril (Monopril), lisinopril (Zestril), quinapril, ramipril
(Altace).
Angiotensin II receptor antagonists may be used where ACE inhibitors are not tolerated e.g. telmisartan (Micardis,
Pritor), irbesartan (Avapro), and losartan (Cozaar), valsartan (Diovan), and candesartan (Amias).
Calcium channel blockers such as nifedipine (Adalat), amlodipine (Norvasc), diltiazem, verapamil.
Diuretics: e.g., bendroflumethiazide, chlortalidone, hydrochlorothiazide.
Other Used Groups May Include-
Α - (α) blockers include prazosin, or terazosin.
Β- (β) blockers include atenolol, labetalol, metoprolol (Lopressor, Toprol-XL), and propranolol.
Direct renin inhibitors include aliskiren (Tekturna).
Several Agents May Be Given Simultaneously-
A fixed combination of the
angiotensin-converting enzyme, (i.e., [ACE] inhibitor), perindopril and the calcium channel blocker amlodipine,
recently have been proved to be effective even in patients with additional impaired glucose tolerance and in
patients with metabolic syndrome.32 Keep in mind
that with ACE and/or α-blockers administration therapy, there is the possibility of a metabolic anti-reaction that
can cause serious internal and external swelling in ears, mouth, and throat. In extreme conditions may cause
Stevens - Johnson syndrome (SJS), (i.e., a drug eruption caused by a sensitivity or allergy to some medications).
Symptoms range from a mild rash to life-threatening anaphylaxis.33,34
Awareness of Complications-
Primary or secondary HT is a major risk factor for all clinical manifestations of atherosclerosis since it
is a risk factor for atherosclerosis in itself.35 In addition, it is an independent predisposing factor for heart
failure, coronary artery disease (CAD), stroke, renal disease, and peripheral arterial disease (PAD). It is the
most important risk factor for cardiovascular morbidity and mortality, within an industrialized
nation.36
Epidemiology Findings-
Near the beginning of the twenty-first century, it was estimated that HT worldwide affected nearly one
billion people, and the findings are predicted to increase to 1.5 billion by 2025.37 In addition, medical analysts have estimated that over 43
million people in the United States have HT or are taking an anti-hypertensive medication, which is almost 24% of
the adult population.38
This proportion changes with race, being higher in African-Americans and lower in Caucasians including
Mexican- Americans. Second, it will change with age, because in industrialized countries systolic B/P rises
throughout life, whereas diastolic BP rises until age 55 to 60 years and thus a greater increase in prevalence of
HTN among the elderly. Also, in geographic patterns, because HTN is more prevalent in the southeastern United
States, and gender becomes an important factor as once taught men were at higher risk. Finally, you have to take
into account the socioeconomic status, which is an indicator of one’s lifestyle.
The World Hypertension League (WHL), an umbrella organization of 85 national hypertension societies and
leagues, recognized that more than 50% of the HTN populations worldwide are unaware of their
condition.39
Conclusion-
The primary care nurse owes it to themselves and their patients to be informed on the chronic diseases they
manage in order to achieve maximum patient compliance and satisfaction. Also, remember that HTN by its self is a
reversible condition, not a disease. Well informed, confident practitioners will be able to deliver evidence-based
structured advice, and in doing so reduce morbidity and mortality rates from cerebrovascular accidents and
cardiovascular disease for patients regardless of age, gender, or ethnicity. In addition, HTN and its management is
not a one-size-fits-all approach.
| 
