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Hypertension Flashcards

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1
Q

What is primary (essential) HTN?

A

the cause is unknown, but a combination of risk factors is usually present

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2
Q

What are risk factors for HTN?

A
  1. obesity
  2. sedentary lifestyle
  3. excessive salt intake
  4. smoking
  5. family history
  6. diabetes
  7. dyslipidemia
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3
Q

What is secondary HTN?

A

identifiable underlying cause, such as renal disease, adrenal disease (excess aldosterone secretion), obstructive sleep apnea, or drugs

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4
Q

What is the pathophysiology of HTN?

A

activation of the sympathetic nervous system(SNS) and renin-angiotensin-aldosterone system(RAAS), resulting in an increase in neurohormone levels (NE, angiotensin II, aldosterone)

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5
Q

What drugs increase blood pressure by increasing sympathomimetic activity?

A
  1. ADHD drugs (amphetamine)
  2. decongestants (pseudoephedrine, phenylephrine)
  3. recreational substances (cocaine, caffeine)
  4. antidepressants (TCAs, SNRIs, MAO inhibitors)
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6
Q

What drugs increase blood pressure via increased sodium and water retention?

A
  1. NSAIDs
  2. immunosuppressants (cyclosporine)
  3. systemic steroids
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7
Q

What drugs increase blood pressure via increased blood viscosity?

A

erythropoietin stimulating agents (epoetin alfa)

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8
Q

What other drugs classes are known to increase blood pressure?

A
  1. oral contraceptives (higher estrogen content)
  2. VEGF inhibitors
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9
Q

How is HTN diagnosed?

A

based on the average of at least 2 readings on separate occasions

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10
Q

What type of blood pressure monitoring is preferred?

A

out-of-office BP monitoring with an ambulatory BP monitor or automated home device; BP readings in a clinical setting may be falsely elevated

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11
Q

What blood pressure reading is normal?

A

<120/<80

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12
Q

What blood pressure reading is elevated?

A

120-129/<80

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13
Q

What blood pressure reading is stage 1 HTN?

A

130-139 OR 80-89

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14
Q

What blood pressure reading is stage 2 HTN?

A

≥140 OR ≥90

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15
Q

What should be done before BP readings to ensure accuracy?

A
  1. goto the restroom and empty the bladder
  2. sit in a chair (both feet on the ground supported) and relax for at least 5 minutes
  3. use the correct cuff size
  4. support the arm at the heart level (rest on a desk)
  5. wait 1-2 minutes between measurements
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16
Q

What can reduce the accuracy of BP readings?

A
  1. talking
  2. lying down/sitting without back support (on the examination table)
  3. drink caffeine, exercise, or smoke 30 minutes prior
  4. use a finger or wrist monitor (unless necessary, incorrect cuff size for obese patient)
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17
Q

How should patients monitor BP when using an ambulatory BP monitoring device?

A

typically worn continuously during activities and sleep (24 hours), obtains readings every 15-60 minutes; bring device and BP log to clinic visits

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18
Q

How should patients monitor BP when using a home BP monitoring device?

A

the patient should measure and record the average of at least 2 readings in the morning and evening before eating or taking any medications; bring device and BP log to clinic visits

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19
Q

What are lifestyle modifications to treat HTN?

A
  1. weight loss (1kg loss–> 1mmHg decrease)
  2. heart-healthy diet (DASH diet; high in fruits vegetables fiber and low-fat dairy, low in saturated fat and sugar)
  3. adequate dietary potassium intake or supplementation if not CI (CKD)
  4. sodium intake <1,500mg/day
  5. limited alcohol consumption (<1 drink woman and ≤2 men per day)
  6. tobacco cessation
  7. diabetes and cholesterol mamangement
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20
Q

What natural products can be used to treat (or supplement) hypertension?

A

garlic and fish oil; counsel patients that both products can increase the risk of bleeding (stop before procedures, etc)

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21
Q

Which anti-HTN medications have boxed warnings for teratogenicity and should be discontinued if family planning or pregnant?

A
  1. ACE/ ARB
  2. Aliskiren (direct renin inhibitor)
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22
Q

What oral antihypertensives are preferred in pregnancy?

A
  1. labetalol
  2. nifedipine
  3. extended-release methyldopa (less effective at lowering BP)
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23
Q

What is the BP goal for pregnancy?

A

120-139/80-89

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24
Q

What is the difference between gestational HTN and preeclampsia?

A

both defined as new onset HTN after 20 weeks gestation; preeclampsia also has proteinuria and significant end-organ dysfunction

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25
What IV antihypertensive agents may be used in severe cases of gestational HTN, preeclampsia, and chronic HTN in pregnancy?
1. IV labetalol 2. IV hydralazine
26
What are ACC/AHA HTN treatment principles?
1. emphasize lifestyle modifications 2. treatment initiation is based on stage and ASCVD risk 3. QD regimens and combination products preferred for adherence 4. agents for the 4 preferred classes should be used first 5. when titrating medications, adding a second medication before reaching the maximum dose of the first can be more effective with fewer SEs 6.Do not use ACE and ARBs together
27
When should HTN treatment be initiated?
Stage 2 HTN OR Stage 1 HTN AND 1 of the following: 1. clinical CVD (stroke, HF, or coronary heart disease) 2. 10-year ASCVD risk ≥10% 3. does not meet BP goal after 6 months of lifestyle modification
28
What are the 4 preferred drug classes for HTN?
1. Thiazide diuretic (may be preferred in self-identified black patients) 2. Dihydropyridine CCB (may be preferred in self-identified black patients) 3. ACE inhibitor 4. ARB
29
What are the preferred drug classes in stage 3 CKD (eGFR <60) or albuminuria ≥ 30mg/day)?
ACE or ARB
30
When should 2 drugs be initiated at once?
When BP is >20/10mmHg above goal (>150/90)
31
How often should BP be monitored by a clinician?
every months and titrate medications to goal BP
32
What is goal BP in those with HTN and CKD?
<130/80; (2021 KDIGO BP in CKD goal SBP <120 if tolerated)
33
What is the MOA of thiazide diuretics?
inhibit sodium reabsorption in the distal convoluted tubule causing increased sodium, chloride, potassium, and water excretion
34
What is the dosing for chlorthalidone?
12.5-25mg QD
35
What is the typical dosing for hydrochlorothiazide?
12.5-50mg daily
36
What is the typical dosing of chlorothiazide?
500-2000mg QD 1-2 doses
37
What is the typical dosing for indapamide (thiazide)?
1.25-2.5mg QD
38
What is the typical dosing for metolazone (thiazide)?
2.5-5mg
39
What are CIs to using thiazides?
1. hypersensitivity to sulfonamide drugs (not likely to cross-react) 2. anuria
40
What are warnings with thiazides?
1. can precipitate/ exacerbate other conditions like lupus, gout, dyslipidemia, and diabetes 2. severe renal disease (can precipitate azotemia; build-up of nitrogenous waste products) 3. progressive liver disease (fluid and electrolyte changes can precipitate hepatic come) 4. transient myopia or acute angle glaucoma
41
What are SEs with thiazides?
1. decreased K,Mg,Na 2. increased Ca, LDL, TG, BG, UA 3. photosensitivity (including a small risk of non-melanoma skin cancer) 4. impotence 5. dizziness 6. rash
42
What should be monitored with thiazides?
1. electrolytes 2. renal function 3. fluid status (input and output, weight) 4. BP
43
Which thiazide diuretic is available IV?
chlorothiazide
44
Why should thiazide diuretics (except metolazone) not be used with CrCl <30?
diminished diuretic effect
45
What are counseling points on administration of thiazide?
1. take early in the morning to avoid nocturia 2. encourage intake of vitamin-rich foods or supplement to avoid hypokalemia; may consider K-sparing diuretic if not at goal
46
Which diuretic is considered more effective at lowering BP due to its longer duration of action and increased potency?
chlorthalidone
47
What drugs can decrease the effectiveness of thiazide diuretics due to sodium and water retention?
NSAIDs (avoid in cardiovascular disease if possible)
48
What drugs interact with thiazides requiring dosage adjustment?
lithium; decreased renal clearance of Li increases risk of toxicity
49
What drug can increase risk of QT prolongation and should not be used with thiazide diuretics?
increased dofetilide concentration
50
Chlorothiazide
Diuril
51
Lisinoprol/ Hydrochlorothiazide
Zestoretic
52
Losartan/ HCTZ
Hyzaar
53
Olmesartan/HCTZ
Benicar HCT
54
Bezapril/HCTZ
Lotensin HCT
55
Candesartan/ HCTZ
Atacand HCT
56
Enalapril/HCTZ
Vaseretic
57
Azilsartan/HCTZ
Edarbyclor
58
Irbesartan/HCTZ
Avalide
59
Telmisartan/HCTZ
Micardis HCT
60
Benazepril/Amlodipine
Lotrel
61
Valsartan/ Amlodipine
Exforge
62
olmesartan/amlodipine
Azor
63
perindopril/amlodipine
Prestalia
64
Atenolol/chlorthalidone
Tenoretic
65
Bisoprolol /HCTZ
Ziac
66
Triamterene/HCTZ
Maxzide, Maxzide-25
67
Spironolactone/ HCTZ
Aldactazide
68
Olmesartan/Amlodipine/HCTZ
Tribenzor
69
Valsartan/Amlodipine/HCTZ
Exforge HCT
70
What is the MOA of DHP CCBs (-pine)?
more selective for vascular smooth muscle --> peripheral arterial vasodilation--> decreases systemic vascular resistance (SVR) and BP
71
What are the indications for DHP CCBs?
1. HTN 2. chronic stable and vasospastic angina 3. Raynaud's phenomenon (cold/blue fingertips secondary to peripheral vasoconstriction)
72
What are CIs with DHP CCBs?
Nicardipine should not be used in advanced aortic stenosis
73
What are the warnings with DHP CCBs?
1. hypotension (especially with advanced aortic stenosis) 2. worsening angina and/or MI 3. severe hepatic impairment 4. caution in HF
74
What are the warnings with Nicardipine IR?
do not use for chronic hypertension or acute BP reduction in non-pregnant adults
75
What are SEs with DHP CCB?
1. peripheral edema 2. headache 3. flushing 4. palpitations 5. reflex tachycardia 6. gingival hyperplasia (or over growth) 7. fatigue/nausea
76
What should be monitored when taking DHP CCBs?
1. peripheral edema 2. BP 3. HR
77
Which DHP CCB is the DOC in pregnancy?
Nifedipine ER
78
Which DHP CCB is considered safe if a CCB must be used in someone with HFrEF?
Amlodipine
79
Which DHP CCB can leave a ghost tablet that patients need to be counseled on?
Procardia XL: OROS/gel matrix formulation
80
Amlodipine
Norvasc Katerzia (suspension) Norliqva (solution)
81
Nicardipine
Cardene IV
82
Nifedipine
Procardia XL Adalat CC (brad d/c)
83
Clevidipine
Cleviprex
84
Which DHP CCB is dosed BID?
felodipine
85
Nisoldipine ER
Sular 17-34mg
86
What are CIs to using clevidipine?
1. allergy to soybean, soy products, or eggs 2. defective lipid metabolism (lipoid nephrosis, hyperlipidemia with acute pancreatitis) 3. severe aortic stenosis
87
What are the warnings with clevidipine?
1. hypotension 2. reflex tachycardia 3. infections (strict aseptic technique due to infection risk; maximum time of use after vial puncture if 12 hours) 4. milky white in color
88
What are SEs with clevidipine?
1. hypertriglyceridemia 2. headache 3. AF 4. heache
89
How much nutritional value is in clevidipine?
2kcal/mL
90
What is the MOA of non-DHP CCBs?
more selective for myocardium; negative inotrope (decreased force of contraction) and chronotropic (decreased heart rate) effects
91
What indications are non-DHP CCBs most commonly used for?
1. control HR in certain arrhythmias (AF) 2. chronic stable and vasospastic angina 3. hypertension
92
What are CIs to using non-DHP CCBs?
1. hypotension (SBP<90) or cardiogenic shock 2. 2nd or 3rd degree AV block 3. sick sinus syndrome (unless patient has a functioning artificial ventricular pacemaker) 4. AF/atrial flutter and accessory bypass tract 5. concurrent use with IV beta-blocker (IV CCBs only) 6. acute MI and pulmonary congestion (diltiazem)) 7. severe left ventricular dysfunction (verapamil
93
What are warnings with non-DHP CCBs
1. HF (may worsen symptoms) 2. bradycardia 3. hypotension 4. acute liver injury/ elevated LFTs 5. conduction abnormalities (diltiazem) 6. hypertrophic cardiomyopathy (verapamil)
94
What are SEs with non-DHP CCBs?
1. constipation (more with verapamil) 2. gingival hyperplasia 3. edema (more with diltiazem) 4. cutaneous hypersensitivity reactions (diltiazem) 5. headache 6. dizziness
95
What is monitored with non-DHP CCBs?
1. BP 2. HR 3. ECG 4. LFTs
96
Diltiazem
Cardizem Tiazac
97
Which non DHP CCBs are available as injections?
diltiazem and verapamil
98
Verapimil
Calan SR Verelan Verelan PM
99
In patients with what conditions/lab values are ACE/ARBs beneficial for?
1. CKD (eGFR<60 and/or albuminuria) slows progression of kidney damage by blocking constriction of afferent arteriole 2. HF prevents remodeling effects of Ang II and improves survivial
100
What populations have a higher risk of angioedema with ACE/ARB?
Black people
101
What are BBWs with ACEi?
Injury and death to developing fetus, no kidney production in 2nd/3rd trimester; D/C as soon as pregnancy detected
102
What are CIs to using ACEi?
1. Hx of angioedema 2. Do not use within 36 hours of sacubitril/valsartan (Entresto); washout requires 3. Do not use with aliskiren in patients with DM
103
What are warnings with ACEi/ARBs?
1. Angioedema 2. Hyperkalemia 3. Renal impairment: Avoid with bilateral stenosis 4. Hypotension/dizziness (increased risk with vol depletion/diuretic use)
104
What are SEs with ACEi/ARBs?
1. Cough 2. headache
105
What is monitored with ACEi/ARBs?
1. BP 2. K+ 3. Renal fxn (SCr) 4. s/sx angioedema
106
Benzapril
Lotensin
107
Enalapril
Vasotec Epaned oral solution Vasotec IV
108
Lisinopril
Zestril/Prinivil Qbrelis oral solution
109
Quinapril
Accupril
110
Ramipril
Altace
111
What are differences in warnings/SEs between ACE/ARBs?
1. ARBs have less cough, less angioedema, and NO washout period required with Entresto 2. Olmesartan: warning for spruce-like enteropathy; severe, chronic diarrhea with substantial weight loss (can occur months to years after initiation)
112
What special storage is required for Azilsartan (Edarbi)?
Keep in original container to protect from light/moisture
113
Irbesartan
Avapro
114
Losartan
Cozaar
115
Olmesartan
Benicar
116
Valsartan
Diovan
117
Azilsartan
Edarbi
118
Candesartan
Atacand
119
Telmisartan
Micardis
120
What are CIs to using aliskiren?
Use of ACE/ARBs with aliskiren in patients with DM
121
How is aliskiren dosed/stored/administered?
1. Take with or without food but be consistent (avoid high fat means, decreased abs) 2. Tekturna tablets must be protected from moisture
122
Aliskiren
Tekturna
123
What are DIs with RAAS inhibitors?
1. Hyperkalemia: caution with other meds that increase K and salt substitutes 2. Use of more than 1 RAAS inhibitor: risk of renal impairment, hypotension, hyperkalemia 3. NSAIDs: risk of renal impairment and reduced anti-HTN effect 4. 36 Hour washout period: required when switching to/from an ACE with sacubitril/valsartan (Entresto) 5. Lithium: decreased renal clearance, risk of Li toxicity
124
How do traditional K+ sparing diuretics (triamterine/amiloride) work?
1. Directly blocks Na channels in the distal convoluted tubule and collecting duct; increases Na/water excretion and conserves K 2. Minimal BP lowering means they are usually used to counter act low K due to thiazides
125
How do K+ sparing diuretics with aldosterone antagonist activity work?
1. Indirectly inhibit sodium channels by inhibiting aldosterone receptors 2. Used for persistence HTN/HF
126
What are BBWs with K+ sparing diuretics?
Amiloride/ Triamterene: Hyperkalemia (K>5.5); more likely inpatients with renal impairment, DM, elderly
127
What are CIs with K+ sparing diuretics?
Do not use with: 1. Hyperkalemia 2. Severe renal impairment 3. Addison's disease (Spirinolactone) 4. Strong CYP3A4 inhibitors (eplerenone)
128
What are SEs with K+ sparing diuretics?
1. Hyperkalemia 2. Elevate SCr 3. Dizziness 4. Hyperchloremic metabolic acidosis (rare) 5. Spirinolactone: Gynecomastia, Breast tenderness, Impotence, irregular menses/amennorrhea (androgen inhibition)
129
What is monitored with K+ sparing diuretics?
1. BP 2. K 3. Renal function (with dose changes) 4. Fluid status
130
What are dosing considerations with spirinolactone?
CaroSpir suspension (approved for resistant HTN, HF, and edema due to cirrhosis) is not therapeutically equivalent to Aldactone and dosing recommendations differ; doses >100mg can cause unexpectedly high concentration, use a different formulation in this case
131
What are DIs with K+ sparing diuretics?
1. Additive risk of hyperkalemia 2. Eprelenone: major substrate for CYP3A4, do not use with strong inhibitors
132
Sprinolactone
Aldactone CaroSpir suspension (not equivalent)
133
Triamterene
Dyrenium
134
Triamterene + HCTZ
Maxzide Maxzide-25
135
Eplerenone
Inspra
136
When are beta blockers 1st line for HTN?
If the patients also has stable angina, HR, arrhythmias or are post-MI
137
What beta blockers have intrinsic sympathomimetic activity (ISA)? What is ISA?
1. Acebutolol 2. pindolol ISA: partially stimulate beta receptors while still blocking catecholamines
138
When should beta blockers with intrinsic sympathomimetic activity (ISA) be avoided?
Post-MI and HF: do not adequately decrease HR/myocardial oxygen demand
139
What are BBWs with beta blockers?
DO NOT D/C abruptly, gradually taper over 1-2 weeks to avoid acute tachycardia, HTN, or ischemia (MI)
140
What are CIs with beta blockers?
1. Severe bradycardia 2. 2nd/3rd degree AV block or sick sinus syndrome (unless a pacemaker is in place) 3. Cardiogenic shock 4. overt cardiac failure 5. pulmonary HTN and use of IV non-DHP CCBs (Esmolol)
141
What are warnings with beta-blockers?
1. Caution with DM: an cause/worsen hypoglycemia 2. Caution with bronchospastic disease: asthma/COPD 3. Caution with Raynaud's/other peripheral vascular disease (requires slow titration) and pheochromocytoma (alpha-blockade required first) 4. Can mask hyperthyroidism (tachycardia)
142
What are SEs with beta blockers?
1. Bradycardia 2. Hypotension 3. CNS effects (dizziness, fatigue, depression) 4. Impotence (less than thiazide) 5. cold extremities (can exacerbate Raynaud's)
143
What should be monitored with beta blockers?
1. HR 2. BP
144
How should beta blockers be titrated?
every 1-2 weeks (as tolerated)
145
Which beta blockers need to be taken with food?
Lopressor and Toprol XL (metoprolol)
146
How is metoprolol tartrate converted from IV to PO?
IV:PO= 1:2.5
147
How is Kapspargo Sprinkle administered?
Should swallow whole; can open capsule and sprinkle on 1 tsp of soft food and swallow within 60min
148
How is Toprol XL administered?
Scored tablet can be cut in half; DO NOT crush/chew
149
What beta-blockers are B1 selective?
AMEBBA: Atenolol Metoprolol Esmolol Bisoprolol Betaxolol
150
Atenolol
Tenormin
151
Metoprolol tartrate
Lopressor (PO/IV)
152
Metoprolol succinate
Toprol XL Kapspargo Sprinkle (capsule)
153
Betaxolol
Betoptic S (opthalmic)
154
What is unique about the MOA of nebivolol?
Selective B1 blocker with nitric-oxide dependent vasodialation; NO lowers SVR
155
What are CIs to using nebivolol?
Severe liver impairment (Child-Pugh class B/C)
156
What are SEs with nebivolol?
1. fatigue 2. headache 3. N/D 4. Elevated TG/ Low HDL 5. Renal dosing required CrCl<30
157
Nebivolol
Bystolic
158
What beta blockers are non-selective?
Propranolol Nadolol Pindolol Timolol
159
What are CIs to using non-selective beta blockers?
Bronchial asthma
160
Why is propranolol useful for migraine/essential tremor?
Has high lipid solubility and is able to cross the BBB but also has more CNS SEs
161
What beta blockers are useful for variceal hemorrhage in patients with portal HTN?
Non-selective beta blockers
162
Proproanolol
Inderal LA Inderal XL InnoPran XL Hemangeol
163
Nadolol
Corgard
164
Timolol
Timoptic (opthalmic)
165
What BBs are non-selective and have alpha blockade?
Carvedilol Labetalol
166
What are CIs to using carvedilol/labetolol?
Severe hepatic impairment
167
What are warnings/SEs with carvedilol/labetolol?
1. Intraoperative floppy iris syndrome (IFIS) has occurred in cataract surgery patients who were previously treated with an alpha blocker 2. Weight gain 3. Edema 4. nausea (labetolol)
168
How is carvedilol converted between CR and IR formulations?
CR:IR= 1.5:1
169
How is carvedilol administered?
Take all forms of carvedilol with food to reduce rate of absorption and orthostatic hypotension
170
Carvedilol
Coreg Coreg CR
171
What are DIs with beta blockers?
1. Caution with other drugs that lower HR (verapamil, diltiazem, digoxin, clonidine, amiodarone, dexmedetomidine (Precedex)) 2. Masked hypoglycemia (except sweating/hunger) 3. Reduced insulin secretion may cause hyperglycemia 4. CYP2D6 substrates: carvedilol, propranolol, nebivolol, metoprolol 5. Pgp inhibitors: carvedilol, propranolol may increase Pgp substrate conc (cyclosporine, dabigitran, digoxin, ranolazine)
172
What is the MOA of clonidine/guanfacine/methyldopa?
Centrally acting alpha-2 adrenergic agonists in the brain decrease sympathetic outflow of NE
173
What are warnings with clonidine/guanfacine?
1. Do not D/C abruptly; rebound HTN, sweating, anxiety, tremors 2. Taper gradually over 2-4 days
174
What are SEs with clonidine/guanfacine?
1. Dry mouth 2. Somnolence 3. Fatigue 4. Dizziness 5. Constipation 6. Low HR 7. Hypotension 8. Impotence 9. headache 10. behavioral changes (irritability, confusion, anxiety, nightmares) 11. skin rash, pruritus, erythema (clonidine patch)
175
What is monitored with clonidine/guanfacine?
BP/HR mental status
176
How is the clonidine patch administered?
1. Apply WEEKLY to clean/dry area on upper outer arm/upper chest 2. REMOVE before MRI 3. May wear an adhesive cover if patch loosens 4. DO NOT CUT PATCH 5. Takes 2-3 days to reach therapeutic effect 6. No overlap needed when transitioning from the oral formulation
177
Clonidine
ER tablet: Nexiclon XR Patch: Catapres- TTS Epidural: Duraclon ADHD: Kapvay
178
Guanfacine ER
Intuniv (ADHD only)
179
What are CIs with methyldopa?
1. Concurrent use of MAOi 2. active liver disease
180
What are warnings/SEs with methyldopa?
1. Risk for hemolytic anemia (+ coombs test) 2. Drug Induces Lupus Erythematosus 3. hepatic necrosis 4. edema/weight gain 5. elevated prolactin 6. transient sedation 7. headache
181
What agents are direct vasodialators?
1. Hydralazine 2. Minoxidil
182
What are CIs to using hydralazine?
1. mitral valvular rheumatic heart disease 2. CAD
183
What are warnings/SEs with hydralazine?
1. Drug indices lupus (dose/duration related) 2. Peripheral edema 3. Headache 4. Flushing 5. Palpitations 6. Reflex tachycardia 7. N/V 8. peripheral neuritis 9. blood dyscrasia 20. hypotension
184
What is monitored with hydralazine?
1. HR/BP 2. ANA titier
185
What are BBWs with minoxidil?
1. Potent vasodialator: can cause pericardial effusion (due to fluid retenetion) and angia exacerbation (due to reflex tachy) 2. Administer with a beta blocker and loop diuretic
186
What are CIs with minoxidil?
Pheochromocytoma
187
What are SEs with minoxidil?
1. Hair growth 2. Tachycardia 3. Fluid retention (use caution in HF/ recent MI)
188
Minoxidil
Rogaine Mens Rogain Womens (OTC topical for hair growth)
189
What antihypertensives are available IV?
1. Clevepidine 2. Enalaprilat 3. Esmolol 4. Hydralazine 5. Labetalol 6. Nicardipine 7. Nitroprusside 8. Nitroglycerin
190
What is a HTN crisis?
≥180/120
191
What is HTN emergency?
≥180/120 AND acute target organ damage (encephalopathy, stroke, AKI, ACS)
192
How is HTN emergency treated?
IV meds Decrease BP by ≤25% within the 1st hour; if stable decrease to 160/100 in the next 2-6h
193
What is HTN urgency?
No target organ damage but BP ≥180/120
194
How is HTN urgency treated?
PO medications (captopril, clonidine) Decrease gradually over 24-48h

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