39 - Hypertension Flashcards
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
non-pharms
- healthy lifestyle
- 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
- exercise
- reduce alcohol
- stop smoking
If BP > ______ start meds and non-pharms at the same time
160/100
If BP is _______ start meds if patient has organ damage or other risk factors for CV disease
140-159/90-99
Dose increase every ____ weeks
2-4
What is 1st line for uncomplicated HTN?
low-dose thiazide or related diuretics
Diuretics can cause _____
hypokalemia
Consider alternate agent to thiazide diuretic if patient is strongly predisposed to _____ _____
serious arrhythmia
Use a _____ diuretic for those with renal impairment
loop
Diuretics can worsen _____
dysglycemia
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.
CV
What are examples of RAAS drugs?
- ACEis
- ARBs
- direct renin inhibitors
- spironolactone
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
aliskiren
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
- black patients
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
60
Pregnancy:
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
Pregnancy:
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
Pregnancy:
What can we use for severe HTN ?
IR oral nifedipine, parenteral labetaolol or parenteral hydralazine
Pregnancy:
What drugs do you want to avoid?
atenolol - associated with IUGR (intrauterine growth restriction)
avoid thiazide and loop diuretics, ACEi, and ARBs, and spironolactone
Breastfeeding:
What drugs do you want to avoid?
- diuretics suppress lactation
- avoid atenolol and other BBs with low serum protein-binding (which concentrate in breast milk)
- avoid long acting ACEi (ramipril, lisinopril, cilazapril, perindopril)
