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DiureticsThiazide diuretics are highly effective in African-American patients. They promote sodium and water excretion, which directly reduces blood pressure without depending on renin levels. They are often part of the first-line therapy for hypertension in this population.

Calcium channel blockers and vasodilatorsCalcium channel blockers are particularly effective in African-American patients because they cause vasodilation through inhibition of calcium influx into vascular smooth muscle, leading to improved blood pressure control. Vasodilators can also be effective in resistant hypertension.

Alpha blockersAlpha blockers, such as prazosin, lower blood pressure by relaxing vascular smooth muscles and have no evidence of reduced efficacy in African-American patients. However, they are usually not first-line agents due to risks of orthostatic hypotension and reflex tachycardia.

ChlorthalidoneAlthough chlorthalidone is also a thiazide-like diuretic and may be more potent than HCTZ, it is less frequently used in fixed-dose combination products. It has a longer half-life, but HCTZ remains the most common diuretic found in combination formulations due to extensive clinical use and established safety data.

BendroflumethiazideThis diuretic is used in some regions (especially the UK), but it is not as widely available or commonly combined with antihypertensive agents as hydrochlorothiazide in standard practice, particularly in the United States.

Potassium-sparing diureticAgents such as spironolactone or amiloride are sometimes combined with thiazides to reduce potassium loss, but they are not the most frequent diuretic combined with antihypertensives. These are typically used in resistant hypertension or in patients with specific conditions like heart failure.

The blood pressure will decrease faster.
The goal of combination therapy is safe and sustained blood pressure control, not a rapid decrease. A sudden drop in BP can lead to hypotension, dizziness, or syncope, especially in older adults.

There is less daily medication dosing.Combination therapy often involves multiple doses or separate tablets, not necessarily fewer doses. The purpose is enhanced control, not dosing convenience.

Combination therapy will treat the patient’s other medical conditions.
Although atenolol may help with cardiac conditions like angina, combination therapy in this context is specifically aimed at improving blood pressure control, not managing unrelated diseases.

Increase fluids and fiber to prevent constipation.
Constipation is not a typical adverse effect of nadolol. Increasing fiber and fluids is more applicable to drugs such as opioids or calcium channel blockers, not beta blockers.

Report a weight gain of 1 kg per month or more.Although weight gain can be concerning in clients with heart failure, the nurse should teach the client to report rapid weight gain (e.g., 1–2 kg in 2 days), not gradual monthly gain. Nadolol’s main concern is bradycardia and hypotension, not fluid retention.

Immediately stop taking the medication if sexual dysfunction occurs.
Abruptly discontinuing nadolol can lead to rebound hypertension or angina, which may precipitate a myocardial infarction. The client should report sexual dysfunction to the provider, not stop the drug independently.

Giving the two drugs together will lower the blood pressure even more than just one alone.
While combination therapy can enhance blood pressure control, the main reason for adding propranolol is not simply to intensify the hypotensive effect, but to prevent reflex tachycardia and excessive cardiac stimulation caused by hydralazine.

The propranolol is to prevent lupus erythematosus from developing.Drug-induced lupus-like syndrome is a rare side effect of hydralazine, but propranolol does not prevent this condition. Monitoring for symptoms such as joint pain, rash, and fever is more appropriate than using propranolol for prevention.

Direct-acting vasodilators such as hydralazine cause fluid retention and the propranolol will prevent excessive fluid buildup.
Fluid retention occurs due to activation of the renin-angiotensin system after vasodilation. Diuretics, not beta blockers, are used to counteract this effect. Propranolol helps control heart rate, not fluid balance.

DiabetesAlthough propranolol can mask symptoms of hypoglycemia such as tachycardia, it is not an absolute contraindication. Caution is needed, and diabetic clients should monitor their blood glucose closely.

AnginaPropranolol is commonly prescribed to treat angina pectoris because it reduces myocardial oxygen demand by lowering heart rate and contractility. It is not contraindicated for this condition.

TachycardiaPropranolol is often used to control tachycardia, especially those related to anxiety or hyperthyroidism, by decreasing sympathetic stimulation of the heart. It is therefore therapeutic, not contraindicated.

Dry mouth:
Although dry mouth can occur with some antihypertensive agents (e.g., clonidine), it is a minor discomfort compared to the safety risks associated with hypotension. It can be managed with oral fluids, sugar-free gum, or saliva substitutes.

Restlessness:Restlessness is not a typical adverse effect of most antihypertensive medications. It may occur from anxiety or unrelated causes but is not the main concern in this population.

Constipation:
Constipation can occur with certain antihypertensives (e.g., verapamil), but it is not life-threatening and is manageable with dietary adjustments or stool softeners. It poses far less danger than hypotension and fall-related injuries.

Diuretics such as furosemide (Lasix):
Diuretics increase urine output, which can lead to nocturia if taken at bedtime. Therefore, they are typically administered in the morning to prevent nighttime interruptions and maintain patient safety.

ACE inhibitors such as captopril (Capoten):Although ACE inhibitors can cause hypotension, especially after the first dose, the effect is generally less abrupt than that seen with alpha blockers. Timing of administration is flexible and not specifically recommended at bedtime unless the client experiences dizziness.

Vasodilators such as hydralazine (Apresoline):
Vasodilators may cause hypotension, but the first-dose phenomenon is not as pronounced as with alpha blockers. These drugs are usually given as scheduled, with blood pressure monitoring rather than timing adjustment.

“Not to worry. Eventually, tolerance will develop.”
This statement is inaccurate and dismissive. Tolerance to sexual side effects does not typically occur with antihypertensive therapy, and reassurance without intervention may discourage further communication about the issue.

“Sexual dysfunction happens with this therapy, and you will learn to accept it.”This response is non-therapeutic and lacks empathy. It dismisses the patient’s concern and may lead to nonadherence, as sexual health is an important aspect of quality of life.

“This is an unusual occurrence, but it is important to stay on your medications.”
This response provides false reassurance, as sexual dysfunction is actually a common side effect of many antihypertensive drugs. It also ignores the opportunity to address the patient’s concern through collaborative problem-solving.

AsthmaAsthma is not directly affected by ACE inhibitor therapy. However, beta-blockers, not ACE inhibitors, are used cautiously or avoided in asthma due to bronchoconstriction risk. ACE inhibitors do not cause airway constriction but may cause a dry cough, which should not be confused with asthma symptoms.

Rheumatoid arthritisThere is no significant interaction or contraindication between ACE inhibitors and rheumatoid arthritis. These medications can be safely used unless the patient is taking other drugs that may affect renal function, such as NSAIDs.

HyperthyroidismACE inhibitors do not influence thyroid hormone levels or metabolism. Blood pressure changes in hyperthyroidism are due to increased metabolic activity, and ACE inhibitors can still be used safely for hypertension in these clients.

“I will walk every day at least 20 minutes.”
This reflects positive adherence to exercise recommendations. Regular physical activity, such as brisk walking for 20–30 minutes most days of the week, improves cardiovascular function and helps reduce blood pressure.

“I will weigh myself at the same time every day and report a weight gain of more than 2 pounds.”Daily weight monitoring helps detect fluid retention, especially in clients taking diuretics or those with cardiovascular comorbidities. This is an appropriate and safe self-care behavior.

“I think that I can keep track of my blood pressure using a journal to record it.”
Keeping a blood pressure log demonstrates active self-monitoring, which allows both the patient and provider to evaluate treatment effectiveness and make necessary adjustments. This behavior supports effective long-term hypertension management.