Hypertension Flashcards
What are the SBP/DBP parameters for Normal BP, Elevated BP, Stage 1 hypertension, and Stage 2 hypertension in adults per the 2017 ACC/AHA guidelines?
Normal SBP: < 120 mmHg &
Normal DBP: < 80 mmHg
Elevated SBP: 120 - 129 mmHg &
Elevated DBP: < 80 mmHg
Stage 1 HTN SBP: 130 - 139 mmHg OR
Stage 1 HTN DBP: 80 - 89 mmHg
Stage 2 HTN SBP: >/= 140 mmHg OR
Stage 2 HTN DBP: >/= 90 mmHg
Per JNC8, at which SBP/DBP level/s with which comorbidities or at which age should antihypertensives be started?
Start pharmacology if SBP/DBP exceeds:
140/90 mmHg with:
- < 60 years old
- DM
- CKD
150/90 mmHG with:
- >/= 60 years old
Which antihypertensives are recommended by the ACC/AHA and which are recommended by the JNC8 and for which categories?
ACC/AHA -
All patients:
- TZD (thiazides diuretics)
- CCB (calcium channel blockers)
- ACE (ace inhibitors)
- ARB (angiotensin receptor blockers)
JNC8 -
Black patients:
- TZD
- CCB
Nonblack patients:
- TZD
- CCB
- ACE
- ARB
What medication is NOT recommended by ACC/AHA or JNC8 for HTN and which two antihypertensives should NOT be given together?
BB’s (beta blockers) are NOT recommended for HTN
ACE’s (ace inhibitors) and ARB’s (angiotensin receptor blockers) should NOT be given together
What are the drugs and doses of TZD primary antihypertensive agents?
HCTZ (hydrochlorothiazide): 12.5mg - 50 mg
Chlorthalidone 12.5mg - 25mg (more potent than HCTZ)
What are the drugs and doses of CCB primary antihypertensive agents?
DHP’s (dihydropyridine - more potent vasodilators than non-DHP):
- Amlodipine 5mg - 10mg
- Nifedipine ER 30mg - 90mg
Non-DHP’s:
- Diltiazem 180mg - 360mg
- Verapimil 80mg - 120mg
What are the drugs and doses of ACE inhibitor primary antihypertensive agents?
What is a common side effect of these drugs?
What group of antihypertensives should not be given with ACE inhibitors?
ACE:
- Lisinopril 10mg - 40mg
- Benazapril 10mg - 40mg
- Ramipril 5mg - 10 mg
Common S/E: Cough
Ace inhibitors should NOT be given with ARB’s
What are the drugs and doses of TZD primary antihypertensive agents? What group of antihypertensives should NOT be given with ARB’s?
ARB’s:
- Candesartan 8mg - 32mg
- Valsartan 80mg - 320mg
- Losartan 50mg - 100mg
- Olmesartan 20mg - 40mg
ARB’s should NOT be given with ACE inhibitors
Which antihypertensives are recommended for patients with heart failure? Which antihypertensive should NOT be given to patients with heart failure?
Recommended with heart failure:
- ACE inhibitors —OR— ARB’s
&
- Beta blockers
&
- Sprionalactone
CCB’s should NOT be given with heart failure!!!
Which antihypertensives are recommended for patients with CAD (coronary artery disease)?
CAD:
- ACE inhibitors —OR—
- Beta blockers —OR—
- TZD’s —OR—
- CCB’s
Which antihypertensives are recommended for patients post-MI (myocardial infarction)?
Post-MI:
- ACE inhibitors —OR— ARB’s
&
- Beta blockers
Which antihypertensives are recommended for patients with DM?
DM:
- ACE inhibitors —OR— ARB’s
—OR—
- CCB’s
—OR—
- TZD’s
Which antihypertensives are recommended for patients with CKD?
CKD:
- ACE inhibitors —OR— ARB’s
Which antihypertensives are recommended for stroke prevention?
Stroke prevention:
- ACE inhibitors —OR— TZD’s
Which antihypertensives are recommended for pregnant patients?
First line with pregnancy:
- Labetolol (BB) —OR—
- Nifedipine (CCB) —OR—
- Methyldopa (centrally-acting agent)
What are the drugs and doses included in loop diuretic secondary antihypertensive agents?
Loop diuretics:
- Furosemide 20mg - 80mg
- Torsemide 10mg - 40mg
What are the drugs and doses included in aldosterone receptor blockers (diuretic) secondary antihypertensive agents? What is a special feature of this group?
Aldosterone receptor blockers:
- Spironalactone 25mg - 50mg
It is K+ (potassium)-sparing
What are the drugs and doses included in K+-sparing diuretic secondary antihypertensive agents?
K+-sparing diuretics:
- Amloride 5mg - 10mg
- Triamterene 100mg
What are the drugs and doses included in beta blocker secondary antihypertensive agents?
With which conditions may BB’s be safer?
BB’s:
- Metoprolol 50mg - 100mg
- Propanolol 40mg - 120mg
- Labetolol 100mg - 300mg
- Carvedilol 6.25mg - 25mg
May be safer with:
- COPD
- asthma
- DM
- PVD
What are the drugs and doses included in centrally-acting secondary antihypertensive agents?
Centrally-acting agents:
- Clonidine 0.1mg - 0.2mg
- Mehtyldopa 250mg - 500mg
What are the drugs and doses included in vasodilator secondary antihypertensive agents?
Vasodilators:
- Hydralazine 25mg - 100mg
- Minoxidil 5mg - 10mg
What are the drugs and doses included in alpha blocker secondary antihypertensive agents?
Alpha blockers:
- Terazosin 1mg - 5mg
- Doxazosin 1mg - 4mg HS
Name medications that may increase BP.
NSAID’s:
- they hold Na+ which pulls water (increases fluid volume)
Cyclosporine
EPO
TCA’s
SNRI’s & NDRI’s
Which labs and at which intervals should be checked when prescribing primary antihypertensive agents?
Labs:
- CCB: none
- ACE/ARB: K+, BUN, Cr
- TZD: K+
Intervals:
- At initiation
- At 2 weeks
When should you expect the maximum drop in BP for patients on antihypertensive agents?
4 weeks
Which primary antihypertensive agents are recommended for patients with heart failure?
- ACE or ARB
+ - Beta blocker
+ - Spironolactone
***NO CCB with heart failure!!!!
Which primary antihypertensive agents are recommended for patients with coronary artery disease?
ACE —OR—
BB —OR—
TZD —OR—
CCB
Which primary antihypertensive agents are recommended for patients post-MI?
ACE —OR— ARB
+
BB
Which primary antihypertensive agents are recommended for patients with DM?
ACE —OR— ARB
—OR—
CCB
—OR—
TZD
Which primary antihypertensive agents are recommended for patients with chronic kidney disease?
ACE —OR— ARB
Which primary antihypertensive agents are recommended for stroke prevention?
ACE
—OR—
TZD
Which primary antihypertensive agents are recommended for pregnant patients?
First line with pregnancy:
- Labetolol (BB)
—OR— - Nifedipine (CCB)
—OR— - Methyldopa (centrally-acting agent)
