Hypertension guidelines algorithm

Question 1

What is the first step of treatment for any adult aged 18 or older with hypertension?

Answer 1

Implement lifestyle modifications, set BP goal, initiate BP lowering medication based on an algorithm

Question 2

What are blood pressure goals for hypertensive patients aged 60 years or older Who do not have diabetes or CKD?

Answer 2

150/90

Question 3

What are blood pressure goals for hypertensive patients who are under the age of 60 years old Who do not have diabetes or CKD?

Answer 3

140/90

Question 4

What are blood pressure goals for hypertensive patients who have diabetes or CKD?

Answer 4

Blood pressure goes for all patients with CKD or diabetes of all ages are 140/90.

Question 5

What are the first line drug of choice for hypertensive, non-black patients?

Answer 5

Initiate thiazides, ACEI, ARB, or CCB, alone or in a combo.

Question 6

What is the first line drug of choice for hypertensive clients who are African-American?

Answer 6

Initiate thiazide or CCB alone or in a combo.

Question 7

What is your second step in treating a hypertensive client if blood pressure goals are not met after reviewing lifestyle modifications, and prescribing initial medication?

Answer 7

Reinforced lifestyle and adherence. Titrate medication to maximum doses or consider adding another medication. A CEA, ARB, CCB, Dyazide.

Question 8

What do you do with a hypertensive client who is not responding to lifestyle changes and modified medication prescriptions?

Answer 8

Reinforced lifestyle and adherence.
Add a medication class not already selected, such as,
Beta blocker
Aldosterone antagonist
And titrate above medication to the maximum dosing.

Question 9

What do you do with a hypertensive client that is not responding to lifestyle modification, constant reinforcement, and three different medications that have been titrated

Answer 9

Reinforce lifestyle changes in adherence. Titrate all meds to maximum doses, add another medication and/or referred to hypertension specialist.

Question 10

What are the initial drugs of choice for hypertension?

Answer 10

Ace Inhibitors (ACEI)
Angiotensin receptor blocker (ARB)
Thiazide diuretic
Calcium channel blocker (CCB)

Question 11

When treating hypertensive clients what is the JNC8 hypertension guideline strategy A?

Answer 11

Start one drug, titrate to maximum dose, and then add a second drug

Question 12

When treating hypertensive clients what is the JNC8 hypertension guidelines strategy B?

Answer 12

Start one drug, then add a second drug before achieving max dose of first drug.

Question 13

When treating hypertensive clients what is the JNC8 hypertension guidelines strategy C?

Answer 13

Begin to drugs at same time, as separate pills or combination pill. Initial combination therapy is recommended if BP is greater than 20/10 MM Hg above goal.

Question 14

According to the JNC8 hypertension guidelines, what are necessary lifestyle changes?

Answer 14

Smoking cessation.
Control blood glucose and lipids.
Diet
   Eat healthy (DASH diet)
   Moderate alcohol consumption
   Reduce sodium intake to no more than 2400 mg    per day
Physical activity
   Moderate to vigorous activity 3 to 4 days a week averaging 40 minutes per session

Question 15

Beto one selective beta blockers are possibly safer in patients with which diseases?

Answer 15

COPD
Asthma
Diabetes
PVD

Question 16

What are the most common beta blockers?

Answer 16

Metoprolol
Bisoprolol
Betaxolol
Acebutolol

Question 17

According to the JNC8 hypertension guidelines what is the treatment for compelling indications of :
Heart failure

Answer 17

ACEI/ARB
Beta blocker
diuretic
Spironolacton

Question 18

According to the JNC8 hypertension guidelines what is the treatment for compelling indications of :
Post MI/Clinical CAD

Answer 18

ACEI/ARB and beta blocker

Question 19

According to the JNC8 hypertension guidelines what is the treatment for compelling indications of :
CAD

Answer 19

ACEI
Beta blocker
Diuretic
CCB

Question 20

According to the JNC8 hypertension guidelines what is the treatment for compelling indications of :
Diabetes

Answer 20

ACEI/ARB
CCB
Diuretic

Question 21

According to the JNC8 hypertension guidelines what is the treatment for compelling indications of :
CKD

Answer 21

ACEI/ARB

Question 22

According to the JNC8 hypertension guidelines what is the treatment for compelling indications of :
Recurrent stroke prevention

Answer 22

ACEI

Diuretic

Question 23

According to the JNC8 hypertension guidelines what is the treatment for compelling indications of :
Pregnancy

Answer 23

Labetalol (1st line)
Nifedipine
Methyldopa

Question 24

What are the agents of choice for the drug class

Diuretics

Answer 24

Hydrochlorothiazide 12.5 - 50 mg

Indapamide 25 - 50 mg

Triamterene 100 mg

(K+ sparing)
Spironolactone 25 - 50 mg

Amiloride 5/10 mg

Triamterene 100 mg
Furosemide 20-80 mg twice daily
Torsemide 10-40mg

Question 25

What are issues to be aware of with diuretics?

Answer 25

Monitor for hypokalemia.
Most SE are metabolic in nature.
Most effective when combined with ACEI
Stronger clinical evidence with chlorthalidone.
Spironolactone because Gynomastia or hyperkalemia
Loop diuretics may be needed when GFR is less than 40 ML/minute