Hypertension Flashcards
(52 cards)
What are the first line classes for HTN?
Thiazides, ACEi, ARBs, and CCBs
Why are first line Rx’s considered first line Rx’s?
- *Double check w/ lecture recording**
1) Able to prove ↓ M/M in long-term
2) Not a great deal of SE
1) What is the BP goal for HTN + stable ischemic heart dz (SIHD), HF, CKD, and DM? JNC8
2) ACC/AAHA?
JNC8 <140/90 mmHg
ACC/AHA < 130/80 mmHg
2) They Have HTN + known CVD and/or ASCVD risk >/= 10%
What two Rx’s are used for HTN with angina
- BBs or 2. dhpCCBs
What Rx is used for HTN with MI or ACS?
BBs
What Rx is used for HTN with CAD?
BBs and/or ANY CCB
What are the 7 BBs proven beneficial in SIHD?
- Carvedilol N
- Metoprolol tartrate
- Metoprolol succinate
- Nadolol N
- Bisprolol
- Propanolol N
- Timolol N
What are the Rx’s to use in HTN + HF?
- ACEi/ARB/ANRI
- BB’s (carvedilol, metoprolol succinate, or bisprolol)
- Aldo Antag’s
1) What Rx’s should you avoid in HTN + HF?
2) Why?
1) CCBs
2) Negative inotropy, especially verapamil
1) What Rx’s can be used in HTN + CKD/DM?
1) (+) albuminuira = ACEi or ARB
2) (-) albuminuria = any 1st line
Why are African Am populations at greater risk for HTN complications (vs. other sub pop’s)?
1) HTN at younger age
2) Absolute pressures often higher
DIET Lifestyle etc…
1) Most effective HTN Rx therapy for African Am?
2) Less effective?
1) Thiazides AND CCBs
2) BBs, ACEi, ARBs
What are the preferred Rx’s for Chronic and gestational HTN during pregnancy?
- Magnesium ACUTE???
labetalol, nifedipine (long-acting) methyldopa
Alternatives to preferred Rx’s for HTN during pregnancy?
- Other BB’s and CCBs
What Rx’s contraindicated in pregnancy?
Why?
- ACEi, ARB, and direct renin inhibitors
teterogenic
1) JNC 8 HTN Goals for >/= 60 yo?
2) ACC et. al HTN Goals for >/= 65 yo?
1) <150 / <90
2) <130 / <80
What Rx’s to generally avoid in >/= 65 (elderly) Pts with HTN?
Central and peripheral alpha blocking agents –> risk of orthostasis, falls, and Duke having to do q15 neurochecks and V/S
How is hypertension different in the elderly?
How should you guide treatment?
1) Present often with isolated systolic HTN
2) No specific agent more effective, follow general guidelines
3) Start secondary Rx’s @ lower doses
What two things should be considered with HTN in children/adolescents?
1) Fatty’s more common to have HTN
2) 2nd HTN more common so look for kidney dz
What Rx’s are supported by evidence to use in children and adolescents?
- HTN first lines
ACE/ARB/CCB/Thiazides
and BB’s
What criteria qualifies for non pharmalogic management of HTN IN JNC and ACC/AHA
everything above normal includes non pharmacologic therapy.
Which diuretic is the best of the diuretic class for idiopathic HTN?
Thiazides
When are loop diuretics best used for HTN?
Only for high BP r/t vol overload (CKD)
When are K-sparring diuretics used for HTN?
To prevent K-wasting from other diuretics (has weak anti-HTN effect)
