2: Adult HTN Management

Question 1

What is the treatment for pre-HTN?

Answer 1

Lifestyle modifications

Question 2

What is the treatment for Stage 1 HTN?

Answer 2

• Lifestyle modifications
• Thiazide diuretic (for most)
• Can consider ACEs, ARBs, BBs, CCBs, or combination

Question 3

What is the treatment for Stage 2 HTN?

Answer 3

• Lifestyle modifications
• 2-drug combo
• Usually thiazide diuretic + ACE, ARB, BB, or CCB

Question 4

What lifestyle changes are recommended in HTN?

Answer 4

• Weight reduction or maintenance
• DASH diet and sodium reduction
  
  • Total sodium per day should not exceed 2,400 mg
  • Goal of 2,000 mg
• Increase physical activity
  
  • Thirty minutes of brisk exercise most days of the week
• Moderate alcohol consumption
  
  • ≤2 drinks per day for men
  • ≤1 drink a day for women and lighter weight individuals
• Smoking cessation

Question 5

When is pharm treatment initiated in HTN?

Answer 5

• Healthy 60+ (no DM or CKD) = >150/90
• Everyone else = >140/90

Question 6

In the population aged 18+ with CKD, when is pharm treatment initiated?

Answer 6

>140/90 (Grade E)

Question 7

What is a Grade B recommendation for 18+ with CKD?

Answer 7

HTN treatment should include an ACE or ARB regardless of race or DM status.

Question 8

What is the main objective of HTN treatment?

Answer 8

To attain and maintain goal BP.

Question 9

When do you change the drug treatment?

Answer 9

If goal is not reached within a month of treatment, increase the dose or add a second drug.

Question 10

What 2 anti-HTN drugs are contraindicated to be used together?

Answer 10

ACEs and ARBs

Question 11

Excluding HTN with CKD, what is initial treatment choice for all other types of HTN?

Answer 11

• Nonblack = Initiate thiazide or ACE, ARB, or CCB alone or in combination.
• Black = Initiate thiazide or CCB, alone or in combination.

Question 12

T/F Treating HTN in 60+ patients with a goal of 130/80 increases survivability.

Answer 12

False. Aggressively treating hypertension in >60 patients with a goal of 130/80 mm Hg does not increase survivability or comorbidity, but in fact causes health problems from drugs.

Question 13

Name 3 drug treatment titration strategies for HTN according to JNC 8.

Answer 13

1. Maximize first medication before adding second.
2. Add second medication before reaching maximum dose of first medication.
3. Start with 2 medication classes separately as a fixed-dose combination.

Question 14

If goal BP is not met after increasing med or adding 2nd med, what is the next step?

Answer 14

1. Add and titrate thiazide or ACE or CCB (use med class not previously selected).
2. If already on 2 meds, max doses of initial 2 meds.
3. If still not met, add medication class not previously used (ACE, ARB, CCB).
4. If still not met, add additional med class (BB, aldosterone antagonist, or other) and/or refer to specialist.

Question 15

If starting a patient on a thiazide or ACEI, what would be the dose?

Answer 15

• HCTZ = 25 mg
• ACE = 10-20 mg