Hypertension

Question 1

HTN goals

Answer 1

<140/90

<150/90 if 60+ w/o DM or CKD

Question 2

drug selection

Answer 2

non-black: thiazide or CCB or ACEi or ARB
black: thiazide or CCB
if BP >160/100 start w/ 2 drugs

Question 3

chronic HTN in pregnancy

Answer 3

labetolol, nifedipine ER, methyldopa

Question 4

thiazide diuretics

Answer 4

clorothiazide (diuril)
chlorthalidone
hydrochlorothiazide (Microzide)
s/e: hypokalemia, hypo-Mg, hypo-Na, HYPER-Ca, HYPER-glycemia
not effective if CrCl <30

Question 5

DHP CCBs

Answer 5

peripheral arterial vasodilation, dec SVR, dec BP
amlodipine (Norvasc)
nifedipine ER (Adalat, Procardia)
caripene IV
s/e: reflex tachycardia, peripheral edema, gingival hyperplasia

Question 6

non-DHP CCBs

Answer 6

control arrythmias, neg inotropes (dec contractility), neg chrnotropes (dec HR)
diltiazem (Cardizem, Diltzac, Tiazac)
verapamil (Calan, Covera, Verelon)
s/e: edema, HA, dizziness, gingival hyperplasia

Question 7

ACEi

Answer 7

dec vasoconstriction, dec aldosterone secretion
slow progression of kidney disease
benazepril (Lotensin)
enalapril (Vasotec)
lisinopril (Zestril, Prinivil)
quinapril (Accupril)
ramipril (Altace)
c/i in pregnancy - fetotoxicity
s/e: angioedema, cough, hyperkalemia

Question 8

Beta Blockers

Answer 8

lower BP and HR
beta-1 selective: atenolol, esmolol, metoprolol
s/e: mask hypoglycemia
non-selective: nadolol, propranolol (Inderal)
s/e: hyperglycemia
non-selective + alpha-1 blocker: carvedilol (Coreg), labetolol

Question 9

direct renin inhibitors

Answer 9

aliskiren
c/i in pregnancy or used w/ ACEi/ARB
s/e: angioedema, hyperkalemia

Question 10

Alpha-2 agonist

Answer 10

dec BP, dec secretion of norepi = lower SVR, lower HR
clonidine (Catapres)
guanfacine (Tenex)
methyldopa

Question 11

direct vasodilators

Answer 11

dilation of arteries, not veins
hydralazine (Apresoline)
minoxidil (Rogaine)

Question 12

Alpha-1 blockers

Answer 12

vasodilation of arteries and veins
not recommended by JNC8
doxazosin (Cardura)
prazosin (minipress)
terazosin
s/e: orthostatic hypotension, syncope

Question 13

hypertensive urgency

Answer 13

BP >180/120 w/o organ damage

tx: oral meds to lower BP

Question 14

hypertensive emergency

Answer 14

BP >180/120 w/ organ damage

tx. IV meds to lower BP 25% in first hour

Question 15

hypertension counseling

Answer 15

diuretics lower K - give K supplements
CCBs - avoid grapefruit
ACEi, ARB, aliskiren - c/i in pregnancy, hyperkalemia
beta blockers - mask hypoglycemia
clonidine - do not stop suddenly