Drugs Affecting the Cardiovascular and Renal System

Case Study: The Client with Hypertension

Ronald Sanford, age 37 years, is diagnosed with essential hypertension. His blood
pressure has been ranging between 148-176 and 90-110. His average blood pressure
is 150/94. There is a strong family history of hypertension and stroke on both sides of
the family. Mr Stanford is married with two school-aged children. He works full-time as
a loading dock supervisor for a long-distance trucking company. His elevated blood
pressure was found during a routine physical examination. He reports no other
manifestations. At time there is no evidence of renal insufficiency or retinopathy. Mr.
Stanford is to begin taking Atenolol, 500 mg daily, and Hydrochlorothiazide, 50 mg
daily.
1. Atenolol is a beta-adrenergic blocking agent. How will this drug contribute to the
control of Mr. Stanfords blood pressure? (10 pts)
Atenolol will contribute to Mr. Stanfords blood pressure by lowering it. Since
Atenolol is a beta-adrenergic blocking agent is will reduce his heart rate and
systole.
2. Describe the antihypertensive action of the hydrochlorothiazide? (10 pts)
Hydrochlorothiazide reduces blood pressure by causing direct relaxation of
blood vessels which in turn reduces peripheral vascular resistance.
3. What will Mr. Stanford need to know about taking his medications and avoiding
adverse reactions? (5 pts)
Mr. Stanford should be careful not to completely stop taking his atenolol. This
withdrawal will predispose him to the adverse effects of the drug. He should
also be aware that he shouldnt take too much of his hydrochlorothiazide. His
dose is already over 25mg which predisposes him to the adverse effects of the
drug.
4. In addition to drug therapy, what nonpharmacological measures will you teach
him to help lower his blood pressure? (5 pts)
I would teach Mr. Stanford stress reduction exercises. I would also teach him
the benefits of losing weight, eating healthy, exercising, and reducing sodium
in his diet.
5. After 6 months of drug therapy, Mr. Sanfords blood pressure is maintained at 124
to 138 systolic and 78-88 diastolic. However, he complains that he does not

seen to have the energy he used to have and he is having some decrease in
libido. What will you tell him about these concerns and their relationship to the
drug therapy? (10 pts)
I would tell Mr. Stanford that fatigue and decreased libido are common side
effects of the drug therapy that he is currently receiving. I will also notify him
that he could get his doses lowered or prescribed a different combination of
drugs to potentially help the problem.
6. Over the next 2 years, Mr. Sanford experiences a gradual increase in his blood
pressure. Dosage adjustments in the atenolol and hydrochlorothiazide fail to
effectively lower his blood pressure. Captopril 25 mg, three times per day is
added to his treatment program.
a. How does Captopril lower blood pressure? (5 pts)
Captopril is an ACE inhibitor. ACE inhibitors lower blood pressure by
preventing the breakdown of bradykinin, a vasodilator, and other
potential vasodilators. It also prevents the formation of AII which is a
vasoconstrictor and induces aldosterone. Aldosterone promotes
sodium and water absorption which leads to HTN. If the AII is prevented
then blood pressure can potentially be lowered.
b. What does Mr. Sanford need to know about taking the Captopril in order to
achieve maximum therapeutic benefit? ( 5 pts)
Mr. Stanford should know that Captopril has a very short half-life.
Meaning that it is passed through the body fairly quickly. Therefore, in
order to achieve maximum therapeutic benefit of the drug, he should
make sure that he takes the drug in a timely manner every day and to
not miss any doses.