A diagnosis of high blood pressure by a physician can be a frightening and challenging aspect of one’s health.  High blood pressure is often referred to Hypertension by healthcare providers.  After diagnosis, the management of high blood pressure is a combination of different medications and lifestyle modifications. The importance of management is crucial due to the risk factors high blood pressure has on the body. High blood pressure is the most common health problem seen in primary care, especially in the older adult population. If high blood pressure is not detected and treated early, serious complications can occur such as heart attack, stroke, and kidney failure. In most communities, about one third of adults have a diagnosis of high blood pressure (Weber et al., 2014).

The Joint National Committee Eighth Report or JNC 8 guideline states the desired blood pressure for those older than 60 years of age should be less than 150/90. For people younger than 60 or people of any age who have chronic kidney disease or diabetes, the desired blood pressure is less than 140/90. Hypertension, under JNC 8 guidelines, is anything at or above the targeted blood pressure ranges for the specific population (James et al., 2014).  These guidelines do not replace the judgement of the healthcare provider managing the high blood pressure.

After diagnosis of high blood pressure, physicians recommend 6 to 12 months of modifying risk factors before resorting to medications as long as the situation is not severe. The interventions listed below are essential for both the prevention and management of hypertension (Weber et al., 2014).

 

Lifestyle Interventions:

• Weight loss
  • In patients who are overweight or obese
  • Body Mass Index (BMI) greater than 25
• Salt reduction
  • 2400 mg or less
  • Avoid canned soup, processed foods
• Exercise 3 to 4 days per week
  • 30 minutes per day
  • Combination of resistance and aerobic exercises
• Alcohol consumption
  • Men: less than 2 drinks per day
  • Women: less than 1 drink per day
• Cigarette and/or tobacco cessation (Weber et al., 2014)

 

The JNC 8 guidelines focus on five main classes of medications in regards to the management of high blood pressure with medications. An individual may be prescribed one or more classes of blood pressure medications, based on the prescribing physician’s preference. The class of drug chosen will be based on each person’s specific history and health problems. It is not uncommon for a patient to be prescribed two or more classes of drugs (James et al., 2014).

 

Medication Classes:

• Angiotensin-Converting Enzyme (ACE) Inhibitors
  • Blocks the body’s natural system of raising blood pressure
  • End in “pril”
  • Examples: Lisinopril, Enalapril
• Angiotensin Receptor Blockers (ARBs)
  • Blocks the body’s natural system of raising blood pressure
  • End in “sartan”
  • Examples: Valsartan, Losartan
• Beta Blockers
  • Lowers heart rate and blood pressure by blocking the excitatory functions in the heart
  • End in “olol”
  • Examples: Atenolol, Metoprolol
• Calcium Channel Blockers
  • Relaxes the heart muscle and dilates vessels to lower blood pressure
  • Examples: Amlodipine, Diltiazem
• Thiazide-type Diuretics
  • Reduce the amount of fluid in the body by urination, therefore reducing blood pressure
  • Usually the first line of medications for high blood pressure
  • Example: Hydrochlorothiazide (James et al., 2014)

 

Regardless of the type/types of medications prescribed, it is extremely important for managing high blood pressure to take the medication exactly as instructed. It is important to take the medications at regular intervals, and also make sure not to miss any doses. Since taking many different types of medications is common for older adults, it can be challenging to take each medication properly. Older adults may want to use a pill organizer or written medication schedule to aid in maintaining an appropriate medication routine. It is also important to check all other medications an individual is taking in order to ensure no negative interaction between drugs occurs. If cost is a concern for the older adult, the individual can ask the health care provider if a generic form is available or another medication with the same actions at a lower cost (Weber et al., 2014).

Conclusion

 

A diagnosis of hypertension should not be taken lightly. In summary the proper management, as described in this paper, is essential in avoiding the numerous serious complications that can occur with untreated or uncontrolled high blood pressure. It is important to follow the recommendations of the Joint National Committee Eighth Report in order to manage one’s high blood pressure. The management of high blood pressure consists of lifestyle interventions and medications. Every case of high blood pressure is different and patient specific, so there is no simple solution when it comes to managing hypertension. As previously stated, high blood pressure is the most common health issue among older adults, and it will take a collaborative effort among health providers and patients to ensure proper management and promote patient safety.

 

Kurtis Anthony, BSN Student

Eric Tatum, BSN Student

Pam Thomas, MSN, RN, CCRN

Charlotte Connerton, EdD, RN, CNE-BC

University of Southern Indiana College of Nursing and Health Professions

 

References

James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J., … Ortiz, E. (2014). 2014 Evidence-based guideline for the management of high blood pressure in adults. JAMA, 311(5), 507. http://dx.doi.org/10.1001/jama.2013.284427

Weber, M. A., Schiffrin, E. L., White, W. B., Mann, S., Lindholm, L. H., Kenerson, J. G., … Harrap, S. B. (2014). Clinical practice guidelines for the management of hypertension in the community a statement by the American Society of Hypertension and the International Society of Hypertension. Journal of Hypertension, 32(1), 3-15. http://dx.doi.org/10.1097/hjh.0000000000000065