Hypertension is one of the most common conditions nurses encounter in clinical practice. For NCLEX preparation and real-world nursing care, understanding antihypertensive drug classes is essential. Because many patients take more than one blood pressure medication, every nurse and registered nurse must know how these drugs work, their side effects, and key nursing considerations.
This article simplifies antihypertensive drug classes to help nursing students, RN nurses, and practicing nurses provide safe, effective care.
Why Antihypertensive Medications Matter in Nursing
High blood pressure increases the risk of stroke, heart attack, kidney disease, and heart failure. Therefore, nurses play a critical role in medication administration, patient education, and monitoring for complications.
On the NCLEX, antihypertensive drugs frequently appear in pharmacology and medical-surgical nursing questions. For this reason, mastering these drug classes is a must for every nursing student and registered nurse.
1. ACE Inhibitors (Angiotensin-Converting Enzyme Inhibitors)
Common examples:
- Lisinopril
- Enalapril
- Captopril
How They Work
ACE inhibitors lower blood pressure by blocking the conversion of angiotensin I to angiotensin II. As a result, blood vessels relax, and blood pressure decreases.
Key Nursing Considerations
- Monitor blood pressure regularly
- Assess kidney function (BUN, creatinine)
- Watch for dry cough
- Monitor for hyperkalemia
NCLEX Tip
If a patient develops angioedema, stop the medication immediately and notify the provider.
2. ARBs (Angiotensin II Receptor Blockers)
Common examples:
- Losartan
- Valsartan
How They Work
ARBs block angiotensin II receptors, causing vasodilation without increasing bradykinin levels.
Nursing Focus
- Often used when ACE inhibitors cause cough
- Monitor potassium levels
- Assess kidney function
NCLEX Reminder
ARBs are contraindicated in pregnancy, which is a common NCLEX question.
3. Beta Blockers
Common examples:
- Metoprolol
- Atenolol
- Propranolol
How They Work
Beta blockers reduce heart rate and cardiac output, leading to lower blood pressure.
Nursing Responsibilities
- Check heart rate before administration
- Hold medication if HR < 60 bpm (per facility policy)
- Monitor for fatigue and dizziness
NCLEX Safety Point
Never stop beta blockers abruptly. Doing so may cause rebound hypertension or angina.
4. Calcium Channel Blockers (CCBs)
Common examples:
- Amlodipine
- Diltiazem
- Verapamil
How They Work
CCBs relax blood vessels by blocking calcium entry into smooth muscle cells.
Nursing Considerations
- Monitor blood pressure closely
- Assess for peripheral edema
- Encourage oral hygiene (gingival hyperplasia risk)
NCLEX Tip
Avoid grapefruit juice with calcium channel blockers.
5. Diuretics
Thiazide Diuretics
Example: Hydrochlorothiazide
Loop Diuretics
Example: Furosemide
How They Work
Diuretics reduce blood volume by increasing urine output, which lowers blood pressure.
Nursing Monitoring
- Check electrolyte levels
- Monitor intake and output
- Assess for dehydration
NCLEX Alert
Loop diuretics can cause hypokalemia, leading to cardiac dysrhythmias.
6. Alpha Blockers
Common examples:
- Prazosin
- Doxazosin
How They Work
Alpha blockers relax blood vessels by blocking alpha-adrenergic receptors.
Nursing Care
- Monitor for orthostatic hypotension
- Teach patients to rise slowly
NCLEX Pearl
First-dose hypotension is common with alpha blockers.
7. Central-Acting Alpha Agonists
Common examples:
- Clonidine
- Methyldopa
How They Work
These medications decrease sympathetic nervous system activity.
Nursing Focus
- Monitor blood pressure carefully
- Assess for sedation and dry mouth
NCLEX Warning
Do not stop clonidine abruptly, as rebound hypertension can occur.
Patient Education: A Key Nursing Role
Nurses must educate patients about:
- Taking medications consistently
- Monitoring blood pressure at home
- Recognizing side effects
- Avoiding sudden medication discontinuation
Effective teaching improves adherence and reduces complications, which is a major nursing priority.
NCLEX Strategy for Antihypertensive Medications
When answering NCLEX questions:
- Identify the drug class first
- Consider vital signs before administration
- Think about electrolyte imbalances
- Watch for classic adverse effects
Using a structured nursing bundle for pharmacology can greatly improve retention and confidence.
Final Thoughts for Nurses and Nursing Students
Understanding antihypertensive drug classes does not have to be overwhelming. By breaking medications into categories and focusing on nursing considerations, RN nurses and nursing students can safely manage patients with hypertension.