establish – v. 确立，设立
secondary hypertension – 继发性高血压
coarctation – n. 缩窄
fluid depletion -- 体液耗竭
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Antihypertensives in Children and Adults
儿童及成人抗高血压药的使用
Children 儿童
National standards for determining normal levels of BP in children are quite new. It has been determined that hypertension may start as a childhood disease, and more screening studies are being done to establish normal values for each age group.
Children are thought to be more likely to have secondary hypertension, caused by renal disease or congenital problems such as coarctation of the aorta.
人们认为，儿童更容易得继发性高血压，它是由肾病或先天性问题引起的，如主动脉瓣狭窄。
Treatment of childhood hypertension should be done very cautiously because the long-term effects of the antihypertensive agents are not known. Lifestyle changes should be instituted before drug therapy if at all possible. Weight loss and increased activity may bring an elevated BP back to normal in many children.
If drug therapy is used a mild diuretic may be tried first, with monitoring of blood glucose and electrolyte levels on a regular basis. Beta-blockers have been used with success in some children; adverse effects may limit their usefulness in others. The safety and efficacy of the ACE inhibitors and the ARBs have not been established in children. Calcium-channel blockers have been used to treat hypertension in children and may be a first consideration if drug therapy is needed. Careful follow-up of the growing child is essential to monitor for changes in BP, as well as for adverse effects.
Adults receiving any of these drugs need to be instructed about adverse reactions that should be reported immediately. They need to be reminded of safety precautions that may be needed in hot weather or with conditions that cause fluid depletion (e.g., diarrhea, vomiting). If they are taking any other drugs the interacting effects of the various drugs should be evaluated. The importance of other measures to help lower BP—weight loss, smoking cessation, and increased activity—should be stressed.
The safety for the use of these drugs during pregnancy has not been established. ACE inhibitors, ARBs, and renin inhibitors should not be used during pregnancy, and women of childbearing age should be advised to use barrier contraceptives to prevent pregnancy while taking these drugs. Calcium-channel blockers and vasodilators should not be used in pregnancy unless the benefit to the mother clearly outweighs the potential risk to the fetus. The drugs do enter breast milk and can cause serious adverse effects in the baby. Caution should be used or another method of feeding the baby should be used if one of these drugs is needed during lactation.
1. The nurse is reviewing the laboratory tests for a patient who has recently been diagnosed with hypertension. Which result is most important to communicate to the health care provider?
A. Serum creatinine of 2.6 mg/dL
B. Serum potassium of 3.8 mEq/L
C. Serum hemoglobin of 14.7 g/dL
D. Blood glucose level of 98 mg/dL 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. A. Serum creatinine of 2.6 mg/dL Rationale: The elevated creatinine indicates renal damage caused by the hypertension. The other laboratory results are normal. 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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