antihypertensive – a. n. 抗高血压的；抗高血压药
single-drug therapy – 单药治疗
opposed to – 与…相对
drug regimen – 给药方案，药物疗法
drug combination – 药物联用，联合用药
combination drug regimens – 药物联合治疗
ACE – angiotensin-converting enzyme 血管紧张素转换酶
thiazide – n. 噻嗪类药
thiazide-like diuretics – 噻嗪样利尿剂
first-line – 一线的，首要的
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Antihypertensive Therapy 抗高血压疗法
In the United States, African Americans are at highest risk for developing hypertension, with men more likely than women to develop the disease. African Americans have documented differences in response to antihypertensive therapy. For example, African Americans are:
在美国，非洲裔美国人得高血压的风险最高，而且男性比女性更容易得此病。根据记录，非洲裔美国人对抗高血压药疗法的反应并不相同。例如，对于非洲裔美国人：
l Most responsive to single-drug therapy (as opposed to combination drug regimens).
单药疗法（相对于多药混合治疗方案）非常有效
l More responsive to diuretics, calcium-channel blockers, and alpha-adrenergic blockers.
利尿剂、钙通道阻滞剂和肾上腺素能α拮抗剂非常有效
l Less responsive to ACE inhibitors and beta-blockers.
抑制剂和β-阻滞剂效果较差
Increased adverse effects (depression, fatigue, drowsiness) often occur when using thiazide and thiazide-like diuretics, potentially requiring the use of different diuretics or lower doses of the thiazide diuretics.
使用噻嗪和噻嗪样利尿剂时，不良效应经常增多（抑郁、疲劳、嗜睡），可能需要使用不同的利尿剂或减少噻嗪利尿剂剂量。
Screening for hypertension among African Americans is very important to detect hypertension early and to prevent the organ damage that occurs with prolonged hypertension. Because African Americans are more responsive to diuretics, the treatment approach should include the first-line use of a diuretic in combination with diet and other lifestyle changes. The use of calcium-channel blockers or alpha-adrenergic blockers should follow.
1. Which action will the nurse in the hypertension clinic take in order to obtain an accurate baseline blood pressure (BP) for a new patient?
A. Obtain a BP reading in each arm and average the results.
B. Deflate the BP cuff at a rate of 5 to 10 mm Hg per second.
C. Have the patient sit in a chair with the feet flat on the floor.
D. Assist the patient to the supine position for BP measurements.
2. A patient with a history of hypertension treated with a diuretic and an angiotensin-converting enzyme (ACE) inhibitor arrives in the emergency department complaining of a severe headache and has a BP of 240/118 mm Hg. Which question should the nurse ask first?
A. Did you take any acetaminophen (Tylenol) today?
B. Do you have any recent stressful events in your life?
C. Have you been consistently taking your medications?
D. Have you recently taken any antihistamine medications?
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答案 Answers
1. C. Have the patient sit in a chair with the feet flat on the floor. Rationale: The patient should be seated with the feet flat on the floor. The BP is obtained in both arms, but the results of the two arms are not averaged. The patient does not need to be in the supine position. The cuff should be deflated at 2 to 3 mm Hg per second. 2. C. Have you been consistently taking your medications? Rationale: Sudden withdrawal of antihypertensive medications can cause rebound hypertension and hypertensive crisis. Although many over-the-counter medications can cause hypertension, antihistamines and acetaminophen do not increase BP. Stressful events will increase BP but not usually to the level seen in this patient.
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