HTN Meds for Patient Specific Factors Flashcards
Stable ischemic heart disease
- ACEi/ARB & BB
- add CCB if not controlled
Heart Failure Reduced Ejection Fraction (HFrEF)
- Anything except CCB (esp NON DHP)
Heart Failure Preserved Ejection Fraction (HFpEF)
Based on symptoms
* Fluid overload: diuretics
* Elevated BP: ACEi/ARB
* Elevated HR: beta blockers
CKD
ACEi/ARB if…
* Stage 3+
* albuminuria
Renal transplant
- CCB
Secondary stroke prevention
if BP ≥ 140/90 then…
* ACEi/ARB AND thiazide
if not then…
* ACEi/ARB or thiazide
DM
any first line option
* if albuminuria: ACEi/ARB
Atrial Fibrillation
ARB
Aortic disease
Beta blocker
Black patients
Thiazide or CCB (including DM)
if HF or CKD: follow those guidelines
Pregnancy
Methyldopa, nifedipine, or labetalol
Resistant HTN Steps
- Optimize therapy
- Switch to chlorthalidone or indapamide
- Add spironolactone
- If HR>70, add BB; if HR<70, clonidine or guanfacine
- Hydralazine
- Replace hydralazine with minoxidil
ACE
- angioedema
- cough
- take at night
Beta blocker
- masks hypoglycemia
- exercise intolerance
- do not stop abruptly
Aliskiren
- musculoskeletal
- diarrhea
Thiazide
- uric acid
- hypokalemia
- sulfa allergy
- CrCl > 30
DHP CCB
- Reynaud’s pts
- peripheral edema
- reflex tachycardia
Non DHP CCB
- angina pts
- bradycardia
Loop
- CrCl<30
- uric acid
- hypokalemia
- sulfa allergy
Hydralazine
- lupus-like symptoms (joint pain, generalized weakness, fever)
- use in severe CKD/hemodialysis
Spironolactone
- resistant HTN
- gynecomastia
Potassium-sparing
- use in combo w/ thiazide
- uric acid
Diuretics in general
- watch out for uric acid
- hypokalemia (unless potassium-sparing or aldosterone receptor antagonist)
- take in AM
Anything that causes SE of hyperkalemia
- avoid drugs that also cause hyperkalemia
- don’t start if K>5
- hold/reduce dose if K>5.5 or SCr increase >25%
