Cardiac Question #44


The emergency department (ED) nurse assessed a client with complaint of headache for the past two days. Blood pressure on admission to the ED was 196/114 and second blood pressure was 188/100. The ED nurse administered hydrochlorothiazide followed by losartan. Five hours later the blood pressure was reduced by 10% and complaints of headache lessened. The ED nurse provided instructions based on follow-up for which type of hypertension?


  1. Pre-hypertension
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  2. Stage 1 hypertension
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  3. Stage 2 hypertension
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  4. Stage 3 hypertension
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The client presents with Stage 2 hypertension. Stage 2 systolic is 140 or higher and diastolic is 90 or higher. Stage 1 presents with systolic between 130-139 and diastolic between 80-90. There is no stage 3 hypertension; however, there is a hypertensive crisis which occurs with systolic higher than 180 and diastolic higher than 120. The goal of treatment was to reduce the blood pressure gradually. Stage 2 hypertension may benefit best with a combination of anti-hypertensive drug combination with a diuretic. Angiotensin-receptor blockers (ARBs) blocks angiotensin II from constricting blood vessels and stimulating sodium and fluid retention. Diuretic like hydrochorothiazide will help lower blood pressure through urinary output and its action is enhanced with concomitant use of ARB.

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