Hypertension Flashcards
Classification stages
Pre-HTN 120-139/80-89
Stage 1: 140-159/90-99 : one first line drug
Stage 2: 160/100 or greater : two first line drugs
Goals
< 140/90 for most pts
< 140/80 for diabetics according to ADA 2013
First-line options
ACEI or ARB, DHP-CCB, or thiazide diuretic
ACEI’s
lisinopril, captopril, enala, rami, trandoloa
compelling indications: DM, CKD, HF, post-MI, high CAD risk, stroke
Contraindications: bilateral renal artery stenosis, pregnancy, angioedema
ADE: increasing Cr (monitor 7-10 days after initiating or increasing), hyperkalemia (monitor), andioedema, cough
ARBs
losartan, irbesartan, cade, olme, telmi
compelling indications: HF, DM, CKD
Contral & ADE same as ACEI but no cough
aliskiren
Renin inhibitor
Contra: pregnancy, don’t use w/ACEI or ARB in pts with DM
ADR: angioedema, hyperkalemia if used with ACEI
High fat meals decrease absorption
Cardioselective B-Blockers
B-1 antagonist activity only
atenolol, bisoprolol, betaxolol, metoprolol tartrate/succinate, nebivolol
alpha-1 antagonist B-Blockers
peripheral vasodilation. more effective antihypertensive than others.
carvedilol, labetalol
ISA b-blockers
intrinsic sympathomimetic activity; resting heart rate is not lowered as much with these. not usually used for HTN
acebutolol, penbutolol, pindolol
B-Blockers
Compelling indications: HF (with ACE), post-MI (first 3 years), high CAD risk, DM
Contraindications: SA or AV node dysfunction, decompensated HF, severe bronchospastic disease
ADE: bradycardia, heart block, exercise intolerance, sexual dysfunction
thiazide diuretics
HCTZ, chlorthalidone, metolazone, indapamide
ADR: hypokalemia, hyponatremia (monitor 7-10 days after starting)
do not use if GFR < 30
Loop diuretics
furosemide, bumetandie, torsemide, ethacrynic acid
Use: HTN in pts with CKD and HF
ADR: hypo K, Na, and Mag (monitor w/sCr 7-10 days after)
metolazone
thiazide diuretic
indapamide
thiazide diuretic
bumetanide
loop diuretic
ethacrynic acid
loop diuretic
K sparing diuretics
triamterene, amiloride
used in combo with thiazide for K balance
Avoid if CrCl < 10.
Monitor sCr and K 7-10 days after
Dihydropyridine CCBs
amlodipine, felodipine, nifedipine, nicardipine
also improves anginal sxs
ADR: peripheral edema
non-DHP CCBs
verapamil, diltiazem negative inotropic effects used for HTN when concomitant conditions (atrial fib, stable angina) Contra: heart block, sick sinus syndrome ADR: bradycardia, constipation CYP P450 inhibitors don't use with EF < 40% use with caution in pts on B-blockers
a1-blockers
terazosin, doxazosin, prazosin
Reserved for male w/concomitant benign prostatic hyperplasia
ADR: dizziness and orthostatic hypotension
aldosterone receptor blockers
spironolactone, eplerenone used for HTN in HF Contra: anuria, acute renal insuf, hyperkalemia ADR: hyperkal, gynecomastia with spirono monitor k and scr 7-10 days after
central a2-agonists
clonidine, methyldopa, guanfacine
for hypertensive urgency
rebound htn if withdrawn too quickly
avoid in HF
hydralazine
vasodilator
may be beneficial for HF
ADR: tachycardia (use with b-blocker), lupuslike syndrome
minoxidil
vasodilator
ADR: fluid retention (use with diuretic), pericardial effeusion, hirsutism
post-MI
ACEi, b-blocker (3 years), aldosterone antagonist
ACS initial tx
b-blocker and ACEI
stable angina
first: b-blocker
alternate: long-acting CCB
asymptomatic HF
ACEI and b-blockers
symptomatic HF
ACEI, b-blockers, ARB, aldosterone antag (with loop)
CKD
goal = < 130/80
ACEI or ARB
rise is sCr up to 30% is acceptable
Recurrent stroke prevention
thiazide diuretic, ACEI
agents for hypertensive urgency
> 180/120
captopril, clonidine, labetalol