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Background
Hypertension affects millions of people around the world and is a primary cause of mortality, potentially leading to the development of cardiovascular disease, renal disease, and stroke. Effective management includes lifestyle changes and medication to reduce blood pressure and prevent complications. With so many drugs available to treat hypertension, nurse practitioners (NPs) must ensure that treatment plans are individualized to specific client circumstances and conditions (Rosenthal & Burchum, 2021).
Management of Hypertension
Managing hypertension requires a comprehensive approach to nonpharmacologic interventions and medication therapy using one or more of the below drug classes. Medication selection is influenced by the assessment of an individual’s overall health, comorbidities, and other specific health needs. The choice of medication should be tailored to the individual client, aiming to manage blood pressure and side effects effectively. The following drug classes offer multiple mechanisms to lower blood pressure (Rosenthal & Burchum, 2021).
Diuretics play a crucial role in managing hypertension by decreasing blood volume through diuresis to contribute to decreased blood pressure. They can be effective when administered alone or with other antihypertensive medications (Rosenthal & Burchum, 2021).
Thiazide diuretics target the distal convoluted tubule in the nephron to inhibit sodium and water reabsorption, leading to increased diuresis.
Furosemide (Lasix) is a potent loop diuretic that is effective for clients with varying degrees of kidney function, including those with renal impairment. Loop diuretics work by inhibiting sodium and chloride reabsorption in the nephron’s loop of Henle to produce sigifnicant diuresis and subsequent fluid volume reduction. Furosemide can be prescribed for many indications, including edema, heart failure, cirrhosis, kidney disease, pulmonary edema, and hypertension in limited circumstances (for example, if clients do not have adequate renal function and require fluid volume reduction and are hypertensive or clients who have heart failure and hypertension). Due to its mechanism of action, it can result in side effects like electrolyte imbalanaces and hypovolemia, requiring close monitoring of electrolyte levels and renal function. Loop diuretics are covered later in the lesson when heart failure medications are covered, as that is their primary indication.
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