PreHTN
121-139 systolic OR 81-89 diastolic
Stage 1 HTN
140-159 systolic OR 90-99 diastolic
Stage 2 HTN
> /=160 systolic OR >/=100 diastolic
Lifestyle Modifications for HTN
smoking cessation, salt restriction, Diet (DASH), exercise, weight management
BP goal for DM and kidney pts
140/90
> 60yo goal for HTN
150/90
Thiazide diuretics
HCTZ, chlorothiazine, metolazone (thiazide related)
-may have cross sens with sulfa allergy
Loop diuretics
torsemide, furosemide, bumetanide
- not as effective in HTN
- add potassium
Potassium sparing diuretics
spironolactone, triamterene, amiloride
Diuretic side effects
HYPOKALEMIA, HYPONATREMIA, hyperuricemia, hypercalcemia, hypercholesterolemia, hypertriglyceridemia
may precipitate gout in HIGH doses
diuretics
decrease HR, force of contraction and CO
beta blockers
1st generation (non-cardioselective) beta blockers
propanolol, nadolol, penbutolol, pindolol, timolol
1st generation (non-cardioselective) beta blockers side effects
BRONCHOSPASM, WORSEN CHF, IMPAIRED GLUCOSE TOLERANCE, FATIGUE, raises lipids, dec. libido, depression, impotence, insomnia
contraindicated in acute CHF exacerbation
1st generation (non-cardioselective) beta blockers; may be helpful in long run
2nd generation (cardioselective) beta blockers
acebutolol, atenolol, betaxolol, bisoprolol, metoprolol
2nd generation (cardioselective) beta blockers side effects
reduced s/e compared to first gen, raises lipids
ACE-I MOA
block angiotensin converting enzyme and stop formation of angiotensin 2; cause venous dilation, reduce total peripheral resistance, and arterial BP
ACE-I drug names
end in -pril
drug to tx BPH
alpha blocker
CONTRAINDICATED IN PREGNANCY
ACE-I, ARBs
ARBs MOA
block effect of angiotensin 2 on tissue receptors
central alpha agonist side effects
sedation, drowsiness, ORTHOSTATIC HYPOTENSION
ARBs side effects
may cause hypotension, hyperkalemia
CCBs MOA
cause arterial smooth muscle relaxation and decrease in PVR
CCBs that are potent vasodilators
dihydropyridines (end in -dipine)
dihydropyridines drug names
end in -dipine; these are more selective vasodilators and have less cardiac depressant effect
dihydropyridines short acting CCBs side effects
may cause mild to moderate reflex tach, may see HA, flushing, ankle edema
dihydropyridines long acting CCBs side effects
usually only cause edema
better in black people
CCBs with THIAZIDE
Nondihydropyridines MOA
same as other CCB with less vasodilation more cardiac depressant effect
diphenylalkylamine CCB name/uses
verapamil; used with supraventricular arrhythmias and variant angina
benzothiazipine CCB name
diltiazem
Nondihydropyridines side effecst
bradycardia, SA dysfunction, heart block
alpha antagonist MOA
arteriolar dilation and vasodilation
selective alpha antagonist
prazosin, doxazosin, terazosin
non-selective alpha antagonist
phenoxybenzamine
alpha antagonist side effects
first dose syncope, ORTHOSTATIC HYPOTENSION, fatigue, weakness, nasal congestion, and HA, beneficial effect on lipids
uses of alpha antagonists
BPH, pheochromocytoma
central alpha agonist MOA
reduce sympathetic vasoconstriction and total PVR
Central alpha agonist drug names
clonidine, methyldopa
central alpha agonist side effects
sedation, drowsiness, ORTHOSTATIC HYPOTENSION
systolic heart failure tx
ACE-I, ARBs, beta blocker, diuretic, aldosterone antagonist
post MI drugs
ACE-I, beta blocker, ARBs,aldosterone antagonist
proteinuric kidney ds tx
ACE-I, ARB
angina pectoris tx
beta blocker, CCB
a fib rate control tx
beta blocker, nondihydropyridine CCB
a flutter rate control tx
beta blocker, nondihydropyridine CCB
essential tremor symptom tx
beta blocker
hyperthyroidism symptom tx
beta blocker
migraine symptom tx options
beta blocker, CCB
osteoporosis symptom tx option
thiazide
raynauds syndrome symptom tx option
nondihydropyridine CCB
Angioedema contraindication
ACE-I
bronchospastic disease contraindication
beta blocker
contraindication in depression
reserpine
contraindication in liver disease
methyldopa
contraindication second or third degree heart block
beta blocker, nondihydropyridine CCB
may have adverse effect in depression
beta blocker, central alpha agonist
may have adverse effect in hyperkalemia
aldosterone antagonist, ACE-I, ARB, renin inhibitor
may have adverse effect in hyponatremia
thiazide diuretic
may have adverse effect in renovascular disease
ACE-I, ARB, or renin inhibitor
Anti-anginal drugs
CCBs, beta blockers, long acting nitrates, rapid acting nitrates
best for vasospastic (prizmentals) angina
CCB
best for long term management of chronic stable angina and sometimes unstable angina
beta blockers
oral or topical and best used for long term management of chronic stable angina
long acting nitrates (isosorbide)
sublingual/spray best used for acute angina or to prevent attack
rapid acting nitrates (nitroglycerin)