Hypertension: 1st/2nd Line Flashcards
HTN Diagnosis
-BP ≥ 130 or ≥80 (taken on two occasions)
-(≥140 or ≥90 ISH and WHO guidelines)
Goal
<140/90 for no CVD risk
<130/80 for CVD risk, DM, etc
BP Categories
-Normal: <120 and <80
-Elevated: 120-129 and <80
-Stage 1: 130-139 or 80-89
-Stage 2: 140+ or 90+
-Crisis: 180+, 120+
First Line Agents
-Thiazides
-ACEI/ARB
-DHP CCB
- initiate with 1 agent then titrate/add
- > 160/100, initiate 2 first line agents of different classes
Diuretics or CCBs in…
65+ or those of African descent
Beta blockers in…
IHD (ischemic heart disease), aortic disease
asthma, bronchoconstriction AE = metoprolol, atenolol
ACEI/ARB in…
proteinuria, diabetes, HF, KD
Lifestyle Mods
-Weight Reduction (18.5-24.9)
-Salt Reduction, 2g/day
-Exercise, 150 min/wk, 2x/wk RT
-Moderate alcohol, 1 drink/day
Thiazide Diuretics Pros/Cons
-Chlorthalidone preferred (helps CVD)
-Reduces CV events
-For ISH older pts
-African, elderly, diabetes pts
-Metabolic AE: HYPER GLUTC, HYPO KNM
-Sexual dysfunction, pancreatitis, photosensitivity, rash
-Worsen gout/diabetes
hyper GLUT hypo KNM, PSPR
Thiazide Diuretics Dosing
-Chlorthalidone: 12.5-25 QD
-HCTZ: 12.5-25 QD
-Metolazone: 2.5-10 QD
ACEI/ARB Pros/Cons
-Reduce CV events, MI, CHF, LVEF, cardiac remodeling, CKD
-Reduce proteinuria
-Preferred agent for combo with thiazides or CCBs
-Reduced efficacy in low renin states: elderly and Africans
-CI in pregnancy
-Avoid in CKD5
-ACE escape, blunting
ACEI Adverse Effects
-Hyperkalemia
-Cough (switch to arb)
-Nephrotoxicity (>30 Scr = d/c, <30 monitor)
DHP CCBs “dipines” Pros/Cons
-Reduce CV events, all pt groups
-Help Raynauds, migraines, CSA
-ISH older pts too
-CI in heart block, worsen CHF
-Worsen proteinuria
CRMC, PH of C
NON DHP verapamil, dilitazem
-Reduce proteinuria
-Some arrhythmias, angina
-Significant interactions
DHP CCB DIPINES Side Effects
-Tachycardia
-Peripheral Edema
-Headache
Loop Diuretics (when to consider)
-Diuresis, edema pts (CHF/KD)
-CKD stages 4-5
