Hypertension (HTN) is the leading cause of cardiovascular morbidity and mortality worldwide, and it raises the risk of stroke, heart disease, kidney failure, and other debilitating complications. The two major physiological factors that antihypertensive drugs target are cardiac output (CO) and peripheral resistance (PR) both play crucial roles in blood pressure control. By altering these determinants, these medications reduce the heart’s workload and prevent the long-term consequences of untreated HTN (Santisteban et al., 2023). Some antihypertensive medications result in reduced cardiac output, that is, the amount of blood expelled by the heart per unit of time. This is done with beta-blockers such as metoprolol or atenolol, which win and compete for beta-adrenergic receptors and thus reduce heart rate and myocardial contractility. It leads to a reduced stroke volume and, therefore, reduced cardiac output. Calcium channel blockers, such as diltiazem and verapamil (Hill et al., 2022), slow the heart rate and reduce contractility by blocking calcium influx into cardiac muscle cells, thus further decreasing cardiac output. Diuretics that have hydrochlorothiazide and furosemide reduce blood volume, resulting in the reduction of CO because they lower blood volume. They decrease preload and overall cardiac output by increasing the amount of sodium and water excreted by the kidneys, decreasing the fluid in the blood. Two additional classes of other antihypertensive drugs reduce peripheral resistance, or the force that opposes blood flow through the arterial system. Blocking the renin-angiotensin-aldosterone system (RAAS) is one of the predominant ways to achieve this (Budiarto et al., 2023). ACE inhibitors, lisinopril, enalapril, and angiotensin receptor blockers (ARBs), losartan, and valsartan prevent the action or formation of angiotensin II, a powerful vasoconstrictor. This causes the blood vessels to be relaxed, the vascular resistance to decrease, and the blood pressure to decrease. Moreover, calcium channel blockers like amlodipine and nifedipine cause direct vasodilation by inhibiting calcium entry into vascular smooth muscle, thereby inducing arterial relaxation and decreasing PR. Prazosin and doxazosin are alpha-blockers, and they work by blocking alpha-adrenergic receptors to stop them from vasoconstriction and maintain these dilated blood vessels. In more serious cases, direct vasodilators, either hydralazine or minoxidil can be given directly to vasodilate the vascular smooth muscle, rapidly decreasing the peripheral resistance and lowering blood pressure.

Untreated or undertreated hypertension can result in serious complications of multiple organ systems. In particular, the cardiovascular system is particularly vulnerable to these forces that continue for an extended period and take a strain on the heart, which then becomes hypertrophic, and this increases the risk of heart failure (Slone & Commodore-Mensah, 2024). Hypertension, therefore, predisposes to atherosclerosis and, subsequently, to myocardial infarction (heart attack), aortic aneurysm, and peripheral artery disease. With uncontrolled hypertension, there is an increased likelihood of ischemic and hemorrhagic strokes, where blood vessel damage to the brain is due to pressure ruptures or blocks. In addition, chronic hypertension is associated with vascular dementia and cognitive decline, as chronic hypertension induces cerebral perfusion (Yu et al., 2022). Another is the renal system. Suppose the glomeruli in the kidneys are damaged by high blood pressure in the long term. In that case, this may lead to chronic kidney disease (CKD) and, in the worst cases, to end-stage renal disease (ESRD), for which dialysis or transplantation is necessary. As well as the eyes, hypertension can cause hypertensive retinopathy (generated by hypertension that damages the retinal vessels, causing loss of vision or blindness). Furthermore, the peripheral vascular system is also in jeopardy because long-term hypertension can also lead to poor circulation, claudication (pain due to insufficient blood flow), and risk for limb ischemia. Because uncontrolled hypertension carries potentially life-threatening consequences, intervention, either pharmacologically, through meds, or in lifestyle, is essential early on. Prevention of complications and improvement of long-term health outcomes, therefore, requires regular blood pressure monitoring, adherence to antihypertensive medication, and lifestyle changes such as a healthy diet, routine exercise, smoking cessation, and stress reduction.

References

Budiarto, D., Wijianto, B., & Hariyanto, I. H. (2023). Study of anthocyanin molecule blocking as anti-hypertensive through the pathway of the renin-angiotensin-aldosterone system (RAAS). Indonesian Journal of Chemical Research, 11(1), 49-58. https://ojs3.unpatti.ac.id/index.php/ijcr/article/download/8131/5778

Hill, K., Sucha, E., Rhodes, E., Bota, S., Hundemer, G. L., Clark, E. G., … & Sood, M. M. (2022). Amiodarone, verapamil, or diltiazem use with direct oral anticoagulants and the risk of hemorrhage in older adults. CJC open, 4(3), 315-323. https://www.sciencedirect.com/science/article/pii/S2589790X21002997

Santisteban, M. M., Iadecola, C., & Carnevale, D. (2023). Hypertension, neurovascular dysfunction, and cognitive impairment. Hypertension, 80(1), 22-34. https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.122.18085

Slone, S. E., & Commodore-Mensah, Y. (2024). Accurate Blood Pressure Measurement Is a Necessary but Insufficient Step to Diagnose and Control Hypertension. Circulation: Cardiovascular Quality and Outcomes, 17(2), e010738. https://www.ahajournals.org/doi/pdf/10.1161/CIRCOUTCOMES.123.010738

Yu, W., Li, Y., Hu, J., Wu, J., & Huang, Y. (2022). A study on the pathogenesis of vascular cognitive impairment and dementia: the chronic cerebral hypoperfusion hypothesis. Journal of Clinical Medicine, 11(16), 4742. https://www.mdpi.com/2077-0383/11/16/4742

Emphysema, a hallmark of chronic obstructive pulmonary disease, is primarily caused by prolonged exposure to cigarette smoke, which leads to irreversible alveolar damage. Smoking initiates an inflammatory response characterized by increased neutrophils and macrophages, which release proteolytic enzymes such as elastase and matrix metalloproteinases (Barnes et al., 2020). These enzymes degrade elastin, an essential component of alveolar walls, resulting in the destruction of alveolar septa and the formation of enlarged air spaces. This structural damage reduces alveolar surface area, impairing gas exchange and leading to ventilation-perfusion mismatch. Additionally, smoking-induced oxidative stress further exacerbates lung injury by depleting protective antioxidants like glutathione, amplifying inflammation, and inducing apoptosis in epithelial and endothelial cells (Aghapour et al., 2021). Over time, emphysema results in progressive airflow limitation, hyperinflation, and reduced lung compliance, contributing to dyspnea and decreased exercise tolerance.

     β-Agonists are central to managing diseases with increased airway resistance, such as asthma and COPD. These drugs, primarily short-acting such as, albuterol and long-acting such as, salmeterol and formoterol, stimulate β2-adrenergic receptors on airway smooth muscle cells, leading to cyclic adenosine monophosphate activation and smooth muscle relaxation (Rabe & Celli, 2022). By reducing bronchoconstriction, β-agonists improve airflow and alleviate symptoms of wheezing and dyspnea. In addition to bronchodilation, these agents may modulate airway inflammation by inhibiting the release of pro-inflammatory mediators from mast cells and cytokines from immune cells. Their therapeutic role is particularly crucial in COPD, where chronic inflammation and mucus hypersecretion contribute to airway obstruction. Long-acting β-agonists, often combined with inhaled corticosteroids, enhance symptom control, reduce exacerbations, and improve quality of life for patients with obstructive lung diseases.

References

Aghapour, M., Raee, P., Moghaddam, S. J., Hiemstra, P. S., & Smit, J. J. (2021). Airway epithelial barrier dysfunction in chronic obstructive pulmonary disease: Role of cigarette smoke exposure. American Journal of Respiratory Cell and Molecular Biology, 64(2), 163-174. https://doi.org/10.1165/rcmb.2020-0244TR

Barnes, P. J., Baker, J., & Donnelly, L. E. (2020). Cellular senescence as a mechanism and target in chronic lung diseases. Nature Reviews Immunology, 20(12), 707-721. https://doi.org/10.1038/s41577-020-0370-1

Rabe, K. F., & Celli, B. R. (2022). Pharmacological treatment of chronic obstructive pulmonary disease: The ABCD revised. European Respiratory Journal, 59(2), 2100939. https://doi.org/10.1183/13993003.00939-2021

The theory of cultural marginality corresponds with caring in the human health experience by encouraging nurses to critically examine their own cultural biases and privileges, and by understanding the marginalizing experiences of cultural minority groups (Kwame & Petrucka, 2021).The lack of mutual understanding between health care providers and immigrants has increased as more people start to migrate to the United States, an article from 1996 stated that almost 1 in 10 people living in the United States was a foreign-born immigrant and the number of foreign-born in the population exceeded 25 million (H;, 2001), now imagine how that number double or maybe tripled by 2024. Cultural marginality is defined as “situations and feelings of passive betweenness when people exist between two different cultures and do not yet perceive themselves as centrally belonging to either one” (H; 2001).

Cultural marginality can be seen in cities and in a state with a great migration rate such as Florida, working as a nurse in Miami and now in North Florida I can understand and relate to the patients and their needs to find and identify themselves with a culture. Often migrants tend to embrace the American culture but also keep close their own heritage and culture, thus creating a new mixed culture of both nationalities. Since 1960, Florida’s population has increased 248% to 19,057,542 in 2011, making it the fourth largest state in the nation (Hill, 2014) although this vital statistic is from past years one can see the increase in migration to the state of Florida.

Years ago, I worked in a dialysis unit that was the closest unit to the Everglades, and I had a many Native Americans although they are the first Americans their culture is very different from the American culture we see now. He was Miccosukee and I had to learn how to interact with them and learn their culture and costumes. At first it was challenging because they see the white man as a threat, I can say I blame them nevertheless I got to know him and his family during the hours he was on treatment, once I showed interest to learn his culture new doors opened, his friends and family were now wanting to treat at our clinic. Their culture is so fascinating and interesting that once I asked to learn more the better, he felt with me caring for him, his wife was Seminole, and both explained to me that although the same tribe they have different names because Miccosukee separated and reminded in the Everglades where he lived in the reservation. I learned about his culture through his stories, and he taught me beliefs as well as I educated myself through research. My patient was very misunderstood by many of the staff there because of his culture, beliefs and traditions. By educating myself and by showing respect to his culture I was able to provide positive care and achieve trust and provide a safe place to treat three times a week. As nurses we must look beyond our beliefs and our culture and immerse our self to live a different culture in order to help our patients succeed in order to provide positive outcomes for everyone.

References

Kwame, A., & Petrucka, P. M. (2021). A literature-based study of patient-centered care and communication in nurse-patient interactions: barriers, facilitators, and the way forward. BMC nursing, 20(1), 1–10.

H; C. (2001, July 24). Cultural marginality: A concept analysis with implications for immigrant adolescents. Issues in comprehensive pediatric nursing. https://pubmed.ncbi.nlm.nih.gov/12141837/

Smith, Mary J., & Liehr, P. R. (2013a). Middle range theory for nursing Mary J. Smith; Patricia R. Liehr (ed.). Springer Publ.

Hill, J. R. (2014). Cultural indicators report – Florida family policy council. STATE OF FLORIDA Cultural Indicators. https://flfamily.org/wp-content/uploads/2014/03/FFPC-Cultural-Indicators-Report.pdf

What is the most likely diagnosis for a patient with the following CBC findings? WBC: 8.8 × 103/µl; RBC: 3.01 × 103/µl; Hgb: 10.3 g/dL; Hct: 32.2%; MCV: 74 fL; MCHC: 28.3 g/dL; Plt: 400 × 103/µl; RDW: 18.4%; Reticulocytes: 2.1%.

Identify which anemia is the patient experiencing, which tests should be ordered and what type of treatment should be followed.