Clinical Considerations in Antihypertensive Therapy

Question 1

Stage 1 hypertension (no comorbid conditions)

Answer 1

Thiazide diuretic for most patients, ACE inhibitor, ARB, calcium channel blocker, combo

Question 2

Stage 2 hypertension (no comorbid conditions)

Answer 2

Thiazide diuretic and ACE inhibitor, ARB, or CCB

OR ACE inhibitor and CCB

Question 3

Hypertension + coronary artery disease or previous MI

Answer 3

Beta-blocker and ACE inhibitor or ARB (if patient has significant side effects on ACE inhibitors)

Question 4

Hypertension + systolic heart failure

Answer 4

ACE inhibitor (or ARB), thiazide diuretic, aldosterone antagonist, beta-blocker (stable)

Do not use: non-dihydropyridine CCB

Question 5

Hypertension + diastolic heart failure

Answer 5

ACE inhibitor (or ARB), thiazide diuretic, beta-blocker (stable)

Question 6

Hypertension + diabetes

Answer 6

ACE inhibitor (or ARB), thiazide diuretic, beta-blocker, non-dihydropyridine CCB

ACE inhibitors- renal protection

Beta-blockers not used with brittle diabetics (prone to hypoglycemia)

Question 7

Hypertension + chronic kidney disease

Answer 7

ACE inhibitor or ARB

ACE inhibitors contraindicated in bilateral renal artery stenosis, caution in hyperkalemia

Question 8

Hypertension + previous stroke or TIA

Answer 8

ACE inhibitor or ARB, thiazide diuretic

Question 9

Hypertension + exertional angina

Answer 9

Beta-blockers, CCB

Do not use: direct vasodilators, short acting dihydropyridine CCB

Question 10

Hypertension + Prinzmetal’s variant angina

Answer 10

CCB

Do not use: beta-blockers

Question 11

Hypertension + dyslipidemia

Answer 11

Alpha-blocker, ACE inhibitor/ARB, CCB, indapamide

Do not use: thiazide diuretics, beta-blockers (especially non-selective)

Question 12

Hypertension + osteoporosis

Answer 12

Thiazide diuretic- causes resorption of calcium

Question 13

Hypertension + benign prostatic hypertrophy

Answer 13

Alpha-blocker

Question 14

Hypertension + migraine cephalgia

Answer 14

Beta-blocker (non-selective), non-dihydropyridine CCB

Non-selective beta-blockers prevent recurrence of migraine

Question 15

Hypertension + gout

Answer 15

Avoid thiazide diuretics, let patient know there is increased risk of precipitation of gout

Question 16

Hypertension + asthma, severe COPD

Answer 16

Avoid beta-blockers

Question 17

Hypertension + depression

Answer 17

Avoid central alpha-agonists, reserpine, beta-blockers

Question 18

Hypertension + pregnancy

Answer 18

Methyldopa, hydralazine

Avoid: ACE inhibitors, ARB

Question 19

Hypertension + physically active/athlete

Answer 19

Do not use high-dose diuretics, beta-blockers

Question 20

Hypertension + sexually active male

Answer 20

Do not use beta-blockers, thiazide diuretics

Question 21

Hypertension + truck driver

Answer 21

Avoid central alpha-agonists (sedation), diuretics

Question 22

Hypertension + African American

Answer 22

Thiazide diuretics, CCB

Do not use: ACE inhibitors, ARB

Question 23

Hypertension + elderly with isolated systolic hypertension

Answer 23

Thiazide diuretics, dihydropyridine CCB

Question 24

Hypertension + elderly with orthostatic hypotension

Answer 24

Avoid alpha-blockers