Hypertension Flashcards
BP
= CO X SVR
-Determinants of Arterial Pressure
—-Cardiac Output
SV x HR = CO
Intravascular Volume / Na+ effect
-Peripheral Resistance
—Size & Compliance of the arteries/arterioles
—Autonomic Nervous System
—RAAS
Target HTN goal <130/80
Diagnostic Workup
-H&P including accurate measurement of BP on both arms with a calibrated device (use average of 3 readings on each arm)
Labs:
-Fasting glucose, CBC, Lipid Profile, serum creatinine with GFR, serum -Sodium, Potassium & Calcium, TSH
-Urinalysis, urine excretion of albumin or albumin/creatinine ratio (+1 or greater)
-ECG
When to screen for secondary causes of Htn?
New onset or uncontrolled hypertension in adults with:
-Drug resistance (> 3 drugs)
-Abrupt onset
-Age < 30
-Excessive target end organ damage
-New onset diastolic hypertension in older adults
-Presence of unprovoked or excessive hypokalemia
Secondary causes of HTN
OSA
Primary aldosteronism
renovascular disease
drug or alcohol
renal parenchymal disease
Pheochromocytoma/ Paraganglioma
Cushings Syndrome
Hypothyroidism
Aortic Coarctation (unrepaired)
Primary Hyperparathyroidism
Congenital Adrenal Hyperplasgia
Mineral Corticoid Excess Syndromes
Acromegaly
Initial therapy for stage 1 htn w/out comorbid conditions
Thiazide diuretics
Calcium Channel Blockers
Ace inhibitors or Angiotensin Receptor Blockers
Stage 2 HTN or average BP of 20-10 mmHg above BP target:
Use 2 first line drugs of different classes
Diuretics-preferred initial therapy: Thiazides
Hydrochlorothiazide (HCTZ) 12.5-50 mg
*Chlorthalidone 12.5-50 mg
Inexpensive; long half-life; need to monitor K+ & Na+; not in renal failure
Diuretics-preferred initial therapy: K sparing
Triamterene 50-100 mg; max 300 mg/day
Amiloride 5-10 mg; max 20 mg/day
not in renal failure or hyperkalemia
Diuretics-preferred initial therapy: Aldosterone antagonists
Spironolactone 12.5-50 mg
Eplerenone ($) 25-50 mg; max 100 mg/day
HF, both increase K+
Diuretics: Loops
-Furosemide 10-40 mg; max 600 mg/day;
-Bumetanide 0.5-2 mg; max 10 mg/day
PO or IV, monitor K+
-Toresmide 5-10 mg
PO only, but better gut absorption in HF; monitor K+
-Ethacrynic Acid 25-100 mg; max 100 mg/day
PO or IV, allergy to Furosemide, monitor K+
*Higher doses to treat HF
Beta Blockers: Known CAD or CV event-selective
-Metoprolol Tartarate (Lopressor) 25-200 mg BID PO; 5-10 mg IV
-Metoprolol Succinate ER (Toprol XL) 25-400 mg PO
CAD, Post MI, Tachyarrhythmias/Ectopy
-Atenolol 50-100 mg
PO only; caution in reduced kidney function/elderly
Beta Blockers: Known CAD or CV event-Nonselective
-Propranolol 40-240 mg; max 640/day
Taper dosing to DC
-Bisoprolol 2.5-5 mg daily for HTN; 1.25 mg daily for HF; max 10 mg/day. Good for patients with lung disease.
BB combined alpha/beta
Carvedilol 3.125-25 mg BID; max 50-100 mg/day
Preferred for treatment of HFrEF
-Labetalol 200-400 mg PO BID; max 2400mg/day
Hypertensive Emergency:
20-80 mg q 10 min prn; max 300 mg/total dose; IV gtt
ACE Inhibitors (for patients w/ DM, CKD, Stroke/TIA)
-Captopril 12.5-50 mg BID or TID; max 450 mg/day
Short-acting, post MI, LV dysfunction
-Lisinopril 5-40 mg QD or BID; max 80 mg/day
-Enalapril 5-40 mg daily
LV dysfunction, HF; caution in renal failure/bilateral renal artery stenosis; may cause angioedema
DO NOT combine with ARBs!
-ACE induced cough
-Angioedema cannot go on volsartan or entresto
ARBS
-Candesartan 8-32 mg; max 32 mg/day
-Losartan 25-100 mg; max 100 mg/day
-Valsartan 80-320 mg; max 320 mg/day
HF; allergy to ACEi; caution in renal failure/bilateral renal artery stenosis
-DO NOT combine with ACE inhibitors!
