Treatments

Question 1

Thiazide diuretics

Answer 1

Thiazide/thiazide type diuretics
Blocks Na/Cl symporter in DCT of nephron

1. Chlorthalidone 12.5-25 mg : preferred long half-life and CVD reduction
2. Hydrochlorothiazide 25-50 mg
3. Indapamide 1.25-2.5 mg
4. Metolazone 2.5-5 mg

Question 2

Thiazide monitoring

Answer 2

Hyponatremia, hypok , Uric acid and Ca levels

Question 3

ACEI

Answer 3

Benazepril, captopril, enalapril, lisinopril 10-40 mg

• don’t use in combination with ARBs
• increase risk of Hyperk esp in patients with CKD or those on K+ sparing diuretics
• don’t use in angioedema hx
• avoid in pregnancy

Question 4

ARBs

Answer 4

Azilsartan, Irbesartan, Losartan, Olmesartan, Valsartan

Azilsartan 80 mg—> greater BP reduction

• don’t use in combination with ACEI
• increase risk of Hyperk esp in patients with CKD or those on K+ sparing diuretics
• don’t use in angioedema hx
• avoid in pregnancy

Question 5

CCB-DHP

Answer 5

Amlodipine, nicardipine, nifedipine

Nifedipine ER&raquo_space; amlodipine
Bc onset 20 min vs 24-48 hrs

Avoid use in patients with HFrEF

Question 6

CCB-nonDHP

Answer 6

Diltiazem, verapamil

• avoid use with BB because of increased risk of bradycardia and heart block
• avoid in HFrEF

Question 7

Secondary agents

Answer 7

1. Diuretics- loop, k sparing, aldosterone antagonists, BB, alpha 1 blockers, direct renin inhibitors, alpha 2 agonist, direct vasodilators

Question 8

Stage 1 treatment

Answer 8

<10% ASCVD : life style modification
>10% ASCVD: no hx of CVD: lifestyle
Hx of CVD: add 1 med

Question 9

Stage 2 treatment

Answer 9

Lifestyle + 1 Med

If BP >150/90, add 2 meds

Question 10

DASH DIET

Answer 10

Dietary approaches to stop HTN

• fruits, vegetables, low fat dairy
• cut back on foods that are high in saturated fat, cholesterol, trans fat
• whole grain, fish, poultry nuts
• limit Na (1500 mg/day), sweets, red meats

Question 11

1st line agents

Answer 11

Thiazide diuretics
ARBs
ACEI
CCBs (DHP and Non-DHP)

Question 12

2nd line agents

Answer 12

Loop 
Aldosterone antagonist diuretics 
Direct renin inhibitors 
Beta antagonists 
K-sparing diuretics
Alpha 2 central agonists 
Alpha 1 antagonists 
Direct vasodilators

Question 13

Chlorthalidone MOA

Answer 13

Works to help your body get rid of salt and water, putting less pressure on your heart to pump blood, so it helps to lower you BP

SUN SENSITIVITY - wear long sleeves, sunscreen
Can make u dizzy so get blood done regularly to check electrolytes and make sure your kidneys are working well

Question 14

Combinations to use

Answer 14

THZD+BB
THZD+RAAS
RAAS+DHP CCB
THZD+K-sparing diuretics

Question 15

Combinations to AVOID

Answer 15

ACEI+ ARB
DIRECT RENIN INHIBITOR (aliskiren) + RAAS

BB+ centrally acting BP LOWERING AGENTS

Question 16

Direct renin inhibitors

Answer 16

Aliskiren
Prevents conversion or angiotensinogen to angiotensin I

DO NOT TAKE W ACEI OR ARB

Question 17

BB

Answer 17

Except Labetolol

Question 18

K sparing/ aldosterone antagonist diuretics

Answer 18

1. Amiloride
2. Triamterene
3. Eplerenone
4. Spironolactone

Question 19

Direct vasodilators

Answer 19

Hydralazine, Minoxidil

Allows easier blood flow decreasing SVR and BP

Question 20

Resistant HTN treatment algorithm

Answer 20

1. Low Na diet and maximize lifestyle interventions
2. THZD : consider switching HCTZ to Chlorthalidone
3. Add mineralcorticoid receptor antagonist : Spironolactone (titrate max 1000 mg/day) or eplerenone
4. If BP > 70, add selective BB (carvedilol)
   Consider switching ACEI and ARBs if BP not at target on optimized dose
5. If BB IS CI—> consider central alpha agonist (Clonidine patchH
6. Add hydralazine 25 mg TID
   IF HFrEF, hydralazine + isosorbide mononitrate 30 mg QD (max 90mg)
7. Substitute minoxidil 2.5 mg BID OR TID for hydralazine