Hypertension

Question 1

BP Goal >= 60 YO

Answer 1

< 150/90

Question 2

BP Goal < 60 YO

Answer 2

< 140/90

Question 3

BP Goal - all ages w/ DM no CKD

Answer 3

< 140/90

Question 4

BP Goal CKD w/ or w/o DM

Answer 4

< 140/90

Question 5

CKD

Answer 5

ACEI or ARB

Question 6

HTN initial treatment - Nonblack

Answer 6

Thiazide, ACEI, ARB or CCB - alone or combo

Question 7

HTN initial treatment - Black

Answer 7

Thiazide or CCB - alone or combo

Question 8

Initial combo therapy when?

Answer 8

BP > 20/10mm Hg above goal

Question 9

Lifestyle changes - HTN

Answer 9

Smoking cessation, control BG & lipids, Diet (DASH, moderate EtOH, Na < 2400 mg/day), Activity (3-4x/wk - av 40 min/session)

Question 10

Heart Failure Treatment

Answer 10

ACEI/ARB + BB + Diuretic + Spironolactone

Question 11

Post-MI/Clinical CAD

Answer 11

ACEI/ARB & BB

Question 12

CAD

Answer 12

ACEI, BB, Diuretic, CCV

Question 13

Diabetes

Answer 13

ACEI/ARB, CCB, Diuretic

Question 14

CKD

Answer 14

ACEI/ARB

Question 15

Recurrent stroke prevention

Answer 15

ACEI, Diuretic

Question 16

Pregnancy

Answer 16

Labetolol (1st line), nifedipine, methyldopa

Question 17

Diuretics - Agents of Choice

Answer 17

HCTZ 12.5 - 50 mg
Chlorthalidone - 12.5 - 25 mg
Indapamide 1.25 - 2.5 mg
Furosemide 20 - 80 mg BID
Torsemide 10 - 40 mg

Question 18

Diuretics - Potassium Sparing

Answer 18

Spironolactone - 25 - 50 mg
Amiloride - 5 - 10 mg
Triamterene 100 mg

Question 19

Diuretics Comments

Answer 19

Monitor for hypokalemia
Most effective when combined w/ ACEI
Stronger clinical evidence w/ chlorthalidone
Spironolactone - gynecomastia & hyperkalemia
Loops when GFR < 40 mL/min

Question 20

ACEI

Answer 20

Lisinopril, benazapril, fosinopril & quinapril 10 - 40 mg
Ramipril 5 - 10 mg
Trandolapril 2 - 8 mg

Question 21

ARB

Answer 21

Candesartan 8 - 32 mg
Valsartan 80 - 320 mg
Losartan 50 - 100 mg
Olmesartan 20 - 40 mg
Telmisartan 20 - 80 mg

Question 22

ACEI/ARB Comments

Answer 22

SE: Cough (ACEI), angioedema (more w/ ACEI), hyperkalemia
Losartan lowers uric acid levels
Candesartan may prevent migraines

Question 23

Beta-Blockers

Answer 23

Metoprolol 50 - 100 mg
Nebivolol 5 - 10 mg
Propanolol 40 - 120 mg BID
Carvedilol 6.25 - 25 mg BID
Bisoprolol 5 - 10 mg
Labetolol 100 - 300 mg BID

Question 24

Calcium Channel Blockers - Dihydropyridines

Answer 24

Amlodipine 5 - 10 mg

Nifedipine ER 30 - 90 mg

Question 25

Calcium Channel Blockers - Non-Dihydropyridines

Answer 25

Diltiazem ER 180 - 360 mg

Verapamil 80 - 120 mg TID or ER 240 - 480 mg

Question 26

Calcium Channel Blockers - Comments

Answer 26

Cause edema
Dihydropyridines may be safely combined w/ BB
Non-dihydropyridines reduce HR & proteinuria

Question 27

Vasodilators

Answer 27

Hydralazine 25 - 100 mg BID
Minoxidil 5 - 10 mg
Terazosin 1 - 5 mg
Doxazosin 1- 4 mg QHS

Question 28

Vasodilator - Comments

Answer 28

Hydralazine & minoxidil may cause reflex tachycardia & fluid retention - usually require diuretic & BB
Alpha-blockers may cause orthostatic hypotension

Question 29

Centrally-Acting Agents

Answer 29

Clonidine 0.1 - 0.2 mg BID
Methyldopa 250 - 500 mg BID
Guanfacine 1 - 3 mg

Question 30

Centrally-Acting Agents Comments

Answer 30

Clonidine available in weekly patch formulation for resistant hypertension