Flashcards in 39 - Hypertension Deck (28):
What are the HTN targets?
General population: < 140/90
Diabetes: < 130/80
High risk of CV events: SBP < 120
Isolated systolic HTN: SBP < 140
Home setting: < 135/85
-weight loss of > 4 kg if overweight
-waist circumference < 102 cm in men
-waist circumference < 88 cm in women
-sodium < 2g/day
-increase K+ intake if patient not at risk for hyperkalemia
If BP > ______ start meds and non-pharms at the same time
If BP is _______ start meds if patient has organ damage or other risk factors for CV disease
Dose increase every ____ weeks
What is 1st line for uncomplicated HTN?
low-dose thiazide or related diuretics
Diuretics can cause _____
Consider alternate agent to thiazide diuretic if patient is strongly predisposed to _____ _____
Use a _____ diuretic for those with renal impairment
Diuretics can worsen _____
Who are selective B1 blockers 1st line in?
< 60 yo, or who have stable angina, heart failure or a Hx of MI
also useful for those with migraines, tachycardia or essential tremor
BBs are not as effective as ARBs, CCBs or diuretics as initial Tx for primary prevention of ___ events in patients > 60 yo.
What are examples of RAAS drugs?
-direct renin inhibitors
Who are ACEis first line in?
non-black patients with uncomplicated HTN and for patients with DM, recent MI, HF or CKD
Who are ARBs 1st line in?
uncomplicated HTN, DM or ischemic heart disease
*they are a good alternative to ACEis
How do direct renin inhibitors work?
prevent renin from converting angiotensin to angiotensin I
Give an example of direct renin inhibitor
Place in therapy for direct renin inhibitors?
should be used as add-on agent after all 1st line therapies have been tried
Why don't you use short acting DHP CCBs?
bc they can increase CV events so you need to use long-acting DHP CCBs
What type of patients are particularly responsive to CCBs
-elderly patients with isolated systolic HTN
When is it reasonable to start with 2 first line agents at the same time?
if SBP > 20 or DBP > 10 above the recommended target
What defines resistant HTN?
HTN despite being on 3 dose-optimized drugs, 1 of which is a diuretic
BB not recommended as initial therapy in patients over ____ yo
Women at high risk of preeclampsia (all women with HTN included) should be offered what?
-ASA 81 mg daily
-should get 1 g calcium supplement regardless of dietary intake
What options can we use?
methyldopa, labetalol and nifedipine XL for HTN that is not severe
can use clonidine or acebutolol, pindolol, propranolol or metoprolol
What can we use for severe HTN ?
IR oral nifedipine, parenteral labetaolol or parenteral hydralazine
What drugs do you want to avoid?
atenolol - associated with IUGR (intrauterine growth restriction)
avoid thiazide and loop diuretics, ACEi, and ARBs, and spironolactone