LOWERING BP ON THE SPOT
I frequently see patients who have JNC-7 stage-2 pressures >180/110 mm Hg but few symptoms. With so many antihypertensive medications available, are there any that can safely lower BP during an office visit and allow the patient to follow up in two to three days? Are there JNC 7-approved BP ranges that allow patients to be sent home and re-evaluated a day or two later in the office setting?
—Debra C. Allen, ANP/GNP, MSN, Reidsville, N.C.
Since JNC 7 guidelines recommend two-drug combination therapy for stage 2 hypertension, it is not likely that any single-dose drug will achieve an adequate level of control. The antihypertensive most frequently used for quick, in-office BP reduction is clonidine. Given orally, this medication usually produces a significant BP reduction within 30-60 minutes. A patient with stage-2 hypertension could then be given a prescription for the combination therapy of the provider’s choice to continue after the office visit. A return visit within a few days should verify the effect of the prescribed medication.
—Sherril Sego, MSN, FNP (99-8)