Cardiovascular Conditions: Hypertension Flashcards
Primary vs secondary HTN?
Primary = cause unknown, combo of risk factors
Secondary = can be caused by renal or adrenal disease, sleep apnea
Stages of HTN
Normal = SBP < 120, DBP < 80
Elevated = SBP 120-129, DBP < 80
Stage 1: SBP 130 - 139, DBP 80-89
Stage 2: SBP > 140, DBP > 90
Proven lifestyle interventions
Weight loss
Heart Healthy Diet = DASH
Sodium intake < 1,500mg
Exercise
Stop smoking
Limit alcohol smoking
ACC/AHA treatment principles
Lifestyle modifications
QD regimen preferred
4 drug classes preferred (ACE, ARB,DHP CCBs, Thiazide diuretics)
most req combo, dont add second until max dose of 1st. Dont use ACE/ARBs together
Which HTNsion drugs have boxed warnings in pregnancy
ACE
ARB
PSCK9i
First line txm for HTN in pregnancy
labetalol
nifedipine ER
Metyhldopa less effective but an optionW
When to start txm for HTN?
Start stage 2
Stage 1 + CVD, ASCVD > 10%, dont drop BP after 6 month of life changes
Goal = <130/80
Where do thiazide diuretics work?
Inhibit sodium reabsorption in DCT< inc excretion of sodium, Cl, H20, potassium
Thiazide CI
cross hypersensitivity with sulfonamide-derived drugs
Thiazide side effects
dec K/Mg/Na
Inc Ca/UA/LDL/TG/BG
Photo sensitivity
Thiazides are not effective when
CrCl < 30 mL/minT
Thiazide notes
take during day to avoid nocturia
Chlorothiazide only one you can get IV
Dont use thiazides in combo with drugs that inc sodium/water retention such as…
NSAID
Two types of CCB
DHP
Non-DHP
DHP CCBs
Nifedipine
Amlodipine
Non-DHP CCBs
diltiazem
Verapamil
DHP CCB warnings
Hypotension
** Nifedipine IR: dont use for chronic HTN or acute BP reduction in non-pre adults **
DHP CCB side effects
Peripheral edema
Headache
flushing
palpitations
reflex tachycardia
gingival hyperplasia (more w/ non DHP)
Safest CCB to use in HFrEF?
Amlodipine
Which DHP is drug of choice in pregnancy
Nifedipine ER
Clevidipine CI
allergy to soybeans, products or eggs
Clevidipine warnings
Hypotension
reflex achy
infections
Clevidipine side effects
Hypertriglyceridemia
DHP CCB work by
inhibit Ca ions form entering vascular smooth muscle and myocardial cells, causing peripheral arterial vasodilation (dec SVR/BP)
Non-DHP CCB work by
inhibit Ca ions from entering vascular smooth muscle and myocardial cells (more selective for myocardium than DHP)
decrease in BP due to negative inotropic and chronotropic effects
Non-DHP CCBs CI
AV block or sick sinus syndrome
acute MI and pulmonary congestion
Non-DHP CCBs warnings
May worsen HF symptoms
bradycardia
Non-DHP CCBs side effects
Edema
constipation (more w/ verapamil)
gingival hyperplasia
All CCBs should not be used with….
grapefruit juice
Pts on diltiazem and verapamil who are taking statins should….
lower doses of simvastatin or lovastatin
Angioedema is more common with…
ACEi than ARBs or aliskiren
black patients higher risk
if pts develops it with any RAASi, other RAASi should be avoided
ACEi mechanism of action
block conversion of angiotensin I to angiotensin II, leading to dec vasoconstriction and aldosterone secretion
ACEi side effects
dry cough**
hyperkalemia (inc potassium)
inc SCr
ACEi boxed warnings
D/c if pregnancy detected
ACEi CI
Dont use w/ history of angioedema
Dont use within 36hrs of entresto
dont use w/ aliskiren in diabetes
ACEi warnings
angioedema
hyperkalemia
renal impairment
ARBs mechanism of action
Block Angiotensin II form binding to receptor
ARBs safety/side effects
Less cough
Less angioedema
No washout period required w/ Entresto
ACEi/ARBs effect in lithium?
Can decrease lithium renal clearance and inc risk of lithium toxicity
Potassium-sparing diuretics
Triamterene and amiloride
Potassium-sparing diuretics used often in….
combo with HCTZ to counteract mild potassium lossess
Preferred add-on drugs in resistant HTN are
aldosterone receptor antagonists
spironolactone & eplerenone
Spironolactone vs eplerenone
Spironolactone = non-selective
Eplerenone = selective, doesnt exhibit endocrine side effects
Boxed warnings for Amiloride and triamterene
K > 5.5
Spironolactone SE and CI
CI: dont sue in hyperkalemia, severe renal impairment or Addison’s disease
SE: Gyno, breast tenderness, impotence
Beta-1 Selective Blockers : AMEBBA
Atenolol
Metoprolol tartrate/succinate
Esmolol
Bisoprolol
Betaxolol
Acebutolol
Beta blockers boxed warnings
Down stop abruptly, taper slowly over 1-2 weeks
Beta blocker warnings
caution pts with diabetes, can mask hypoglycemia
caution in COPD/asthma
caution Reynaud’s
Beta blocker side effects
Bradycardia
Fatigue
hypotension
dizziness
depression
impotence
Metoprolol notes
tartrate IV:PO ratio 1:2.5
should be taken with food, but other ones dont need to
Nebivolol CI
severe liver impairment Child-Pugh B or C
Beta blockers used in portal hypertension?
Non-selective
Propranolol, nadolol, pindolol, timolol
All forms of carvedilol should be taken with….
food, to dec rate of absorption and risk of orthostatic hypertension
Which beta blocker is drug of choice in pregnancy?
Labetolol
Clondine is usually used for….
resistant hypertension
Methyldopa CI
concurrent use with MAOi and acute liver disease
Clonidine warning
Dont d/c abrupt y, can cause rebound hypertension and should taper
Clondine side effects
dry mouth
somnolence
fatigue
dizziness
constipation
dec HR
Hypotension
impotence
** remove patch before MRI**
Methyldopa Side effects
DILE
edema or weight gain
inc prolactin lvls
** can use in pregnancy **
Direct vasodilators mechanism of action
Hydralazine
Minoxidil
Hydralazine warnings & SE
warnings: DILE
SE: peripheral edema
Headache
flushing
palpitations
reflex tachy
Minoxidil Boxed warning, CI, SE
Boxed warning: potent antihypertensive, with with Beta-blocker n loop diuretic
CI: Pheochromocytoma
SE: Fluid retention, tachycardia, hair growth
Alpha blockers not recommended for HTN but may be used in men with….
HTN and benign prosaic hyperplasia
Alpha blockers
Doxazosin
prazosin
terazosin
Hypertensive crisis
BP > 180/120
2 types, emergency or urgency
Hypertensive emergency
patient has acute target organ damage that may be life threatening
Treat with IV meds, decrease BP by no more than 25% in 1st hour
Hypertensive urgency
no evidence of acute target organ damage
Use short acting oral med, gradually decrease BP over 24-48hrs
