Hypertension Flashcards
How long does it take take for a BP drug to have full effect?
1 month
By how much to most BP drugs lower BP?
-10/-5
When is HTN treatment resistant?
When using 3 anti hypertensives in combination
One of the drugs is a diuretic and
Non-adherence is ruled out
What drugs can elevate BP?
NSAIDs - lower renal perfusion
Steroids - mineralocorticoid effect
Decongestants/certain anti-depressants/stimulants - SNS activity
Alcohol - impairs ADH + other mechanisms
When are BB used in HTN?
Uncomplicated HTN if <60yo
Complicated pts + HTN (extremely protective for other conditions)
When are vasodilators used in HTN?
DHP CCB - arterial vasodilator - extremely useful
Alpha-blockers - less effective (used for BPH)
Smooth muscle relaxant
What are the first line therapies for HTN?
Thiazide diuretics, CCB, ACE, ARB
What meds should be avoided in elderly?
Combos. Especially ACE, diuretics, central agents
What combos should be avoided?
ACE + ARB - reduces renal function too much
BB + non-DHP CCB - reduces HR too much
What do we do for treatment resistant HTN?
Add on therapy of:
Spironolactone (DOC)
Alpha-2 agonists
Hydralazine/minoxidil + BB (plus diuretic)
What is isolated systolic hypertension (ISH)?
High SBP yet normal DBP
Classified if different between SBP-DBP is greater then 98
How is ISH treated?
Any of the following: TZD, ARB, DHP CCB
Dual combo of two of above
Triple combo (all three)
What are indications of complicated HTN?
Diabetes w/so nephropathy
Kidney disease
CHD
Heart failure
LVH
Stroke or TIA
What is the target BP for complicated HTN in diabetes ?
<130/80
Treatment for complicated HTN in diabetes without risk factors?
1 of the following: ACE, ARB, DHP- CCB, or TZD
ACE and DHP-CCB preferred
2nd line add on: TZD OR a CCB
What are the risk factors for complicated HTN in diabetes?
Microalbuminuria
Renal disease
CVD or other CV factors
Treatment for patients with diabetes and HTN with risk factors
Initial therapy: ACE or ARB
For second line: ACE + DHP-CCB
What is the target BP for CKD patients with HTN?
<120/NA
What is the treatment for CKD patients with HTN?
ACE or ARB at highest approved or maximally tolerated dose (+/- diuretic)
What is the target BP for HTN with artery disease?
<120/80
What are the treatments for patients with HTN and artery disease?
1st line: ACE or ARB; BB or CCB in those with stable angina
2nd line add-on: THZ or DHP CCB(preferred)
How does hypokalemia happen?
Results from diuretic tx
Common TZD AE - start with low dose
Treatment options for hypokalemia
- Reduce Na+ intake and increase K+ intake
- Lower diuretic dose
- Add K+ sparing agent (BB, ACE/ARB, K-diuretic)
- Add K+ supplement
- D/c diuretic if seriously low
What drugs can increase K+ and lead to hyperkalemia?
RAAS drugs
NSAIDs
Vitamins/supplements
K+ sparing diuretics
TMP/SMX
For treatment we could remove the drug unless it is providing other major benefit
