An African-American patient has developed hypertension. The nurse is aware that which group(s) of antihypertensive drugs are less effective in African-American patients?

Atenolol (Tenormin) is a beta-adrenergic blocker that decreases heart rate, cardiac output, and renin release, while doxazosin (Cardura) is an alpha-adrenergic blocker that causes vasodilation by relaxing vascular smooth muscle. Combining these two antihypertensive agents targets different mechanisms involved in blood pressure regulation, allowing for synergistic blood pressure reduction while minimizing side effects associated with higher doses of a single medication.

Rationale for correct answer:

B. Lower doses of both drugs may be given with fewer adverse effects.
Combination therapy allows each drug to complement the other’s mechanism of action—atenolol reduces cardiac workload and renin secretion, while doxazosin reduces peripheral vascular resistance. This dual approach enables the use of lower doses of both drugs, enhancing efficacy and reducing the risk of dose-related adverse effects such as bradycardia (from beta blockers) or postural hypotension (from alpha blockers).

Rationales for incorrect answers:

A. 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.

C. 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.

D. 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.

Take-home points:
• Combining antihypertensive drugs with different mechanisms enhances blood pressure control and limits side effects.
• Lower doses of each drug in combination therapy improve tolerability and adherence.
• The goal is balanced, sustained blood pressure reduction, not rapid or multi-condition treatment.

Nadolol (Corgard) is a nonselective beta-adrenergic blocker used in the management of hypertension and angina pectoris. It decreases heart rate, myocardial contractility, and cardiac output, thereby lowering blood pressure. One of its common adverse effects is orthostatic hypotension, which can cause dizziness or fainting when changing positions quickly. Therefore, clients must be educated on safety measures to prevent falls and injuries related to this side effect.

Rationale for correct answer:
D. Rise slowly after prolonged periods of sitting or lying down.
Nadolol can cause postural (orthostatic) hypotension due to its blood pressure–lowering effects. Clients may feel dizzy, lightheaded, or faint when standing up suddenly. Teaching the client to rise slowly allows the body time to adjust to the change in position, preventing dizziness and falls.

Rationales for incorrect answers:

A. 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.

B. 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.

C. 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.

Take-home points:

• Nadolol can cause orthostatic hypotension; clients should rise slowly to prevent dizziness and falls.
• Never stop beta blockers abruptly; doing so can trigger rebound hypertension or angina.
• Client education focuses on safety, adherence, and recognizing symptoms requiring provider notification.