Hypertension Healthcare Consideration: Affecting approximately 50 million Americans, high blood pressure (hypertension) is BP >130/80 mmHg. Most cases (90% to 95%) are idiopathic (Princewel et al., 2019). This is often an asymptomatic condition that increases the workload on the heart. It can lead to serious health conditions, including stroke, aneurysm, coronary artery disease, and kidney damage. It is especially dangerous when paired with diabetes, which is a common comorbidity. Persistent hypertension can contribute to eye, kidney, and brain injury (Fuchs & Whelton, 2020). Among the factors contributing to the risk of hypertension is the excess secretion of aldosterone, which causes the body to retain sodium, as well as the excess secretion of cortisol, which breaks down fat and proteins to facilitate the creation of glucose. A class of drugs called mineralcorticoid receptor antagonists (MRAs) is sometimes used in hopes of minimizing the effects of aldosterone. In some patients, surgical removal of one of the adrenal glands (which secrete aldosterone) can control aldosterone levels, and subsequently regulate blood sodium and reduce the risk of high blood pressure (Fuchs & Whelton, 2020). Medications to treat hypertension are often grouped into four major classes, which can be easily remembered as the ABCDs (Jarari et al., 2016): ● Angiotensin-converting enzyme (ACE) inhibitors. ● Beta blockers. ● Calcium channel blockers. ● Diuretics. These medications are sometimes used in combination with other drugs such as antithrombotics and to treat other diseases such as diabetes, kidney disease, and cancer. Patients should resume work and daily activities with caution when there is any change in medications (Jarari et al., 2016). ACE inhibitors (end in - pril ): ACE changes an inactive enzyme called angiotensin 1 (A1) into angiotensin 2 (A2), an active enzyme. This active form stimulates the smooth muscles of the arteries to contract and constrict the arteries. ACE inhibitors are vasodilators. ACE inhibitors block the conversion of A1 to A2 so that arteries remain dilated, which causes the pressure to drop. Because they work on the Myocardial infarction (MI) An MI is defined as damage to the heart muscle due to reduced blood supply, typically because of occlusion of the coronary arteries. Americans suffer approximately 1.5 million myocardial infarctions every year, with nearly 50% of them being fatal. For survivors, life after MI includes challenging realities. MI patients present with lower resting cardiac output, due to either reduced stroke volume or heart rate. Patients also exhibit aerobic capacity 50% to 70% below age and gender norms. They may also present with inefficient SA or AV node function (chronotropic impairment). MI survivors have a greater risk of a second heart attack. The degree of risk is affected by several factors, including the extent of ventricular damage suffered in the original episode, as well as the degree of remaining coronary ischemia. Myocardial infarctions can be classified into two major categories (Kumar, 2021): ● Transmural infarction (Q wave Infarction) : Occurs when the full thickness of the ventricular wall is damaged. ● Subendocardial (non-Q-wave infarction) : Only the inner half of the ventricular wall is affected.
arteries, there is no effect on heart rate response to exercise or activity. These drugs also draw salt into the urine, which brings extra water through osmosis and decreases plasma content, further reducing pressure. ACE inhibitors are newer than beta blockers. Usage has recently declined because some patients are now prescribed angiotensin receptor blockers (ARBs; Thompson & Ozemek, 2023). Beta blockers (end in -lol ): Beta blockers block the receptors of beta-adrenergic (sympathetic) nerve signals. The central nervous system generates sympathetic nerve signals in response to excitement or danger. This is the flight-or-fight response and is associated with hormones such as epinephrine. These drugs may decrease predicted submaximal and max heart rate, thus reducing the patient’s exercise capacity. Beta blockers reduce the risk of cerebrovascular accidents (CVA) and myocardial infarctions (MI) but may limit a patient’s activities of daily living (ADL) due to limited aerobic capacity (Thompson & Ozemek, 2023). Calcium channel blockers (end in - pine, -zem ): Calcium channel blockers decrease the number of cardiac muscle fibers that are contracting by preventing calcium from entering some of the sarcomeres in the myocardium. Some calcium channel blockers also work on the smooth muscles of the arteries to prevent vasoconstriction. Calcium clears tropomyosin from actin and allows myosin bonding (Thompson & Ozemek, 2023). Diuretics (end in - ide ): Diuretics increase urine output by allowing more sodium to pass into the urea. This attracts more water by osmosis, which lowers plasma volume and pressure. Healthcare professionals must ensure patients have proper hydration and potassium intake, as physical activity blunts the thirst reflect (Thompson & Ozemek, 2023). Healthcare Consideration: In active patients, ACE inhibitors and calcium channel blockers are associated with increased intramuscular blood flow compared to beta blocks, which may be secondary to increased activity. Clients taking these vasodilators may be susceptible to orthostatic hypotension and so may experience dizziness when they stand up, especially after intense exertion (Thompson & Ozemek, 2023). One of the first markers of cardiac muscle damage is troponin in the blood. Troponin is an inhibitory protein that blocks myosin from attaching to actin and prevents muscle contractions. In damaged cardiac muscle, troponin dissociates and escapes into the bloodstream. The level of elevation is used to diagnose the severity and degree of damage to the heart tissue. MI can cause death due to ventricular fibrillation (v-fib). Treatment for MI may involve thrombolytic drugs, balloon angioplasty, stenting, or arterial bypass to address the blocked blood vessel(s). A coronary artery bypass graft (CABG) is another procedure that is often used to restore blood flow. With a CABG, surgeons transplant a section of a healthy blood vessel (such as the great saphenous vein) and direct the blood flow through the newly created route. As with other bypass procedures, anticoagulant medications are often prescribed following CABG surgeries. Long-term MI management strategies include lifestyle management (i.g. diet, physical activity, etc), medications to prevent recurring occlusion, and formation of a social support network –including cardiac and/or physical therapy. (Kumar, 2021).
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