Hypertension, Hypertensive Crisis & PAH Flashcards
What is 1st line for HTN treatment in stable Ischemic Heart Disease?
Beta Blockers
2nd line- DHP CCBs
What is 1st line for HTN treatment in HF?
avoid non CCBs; diuretics for fluid overload if preserved ejection fraction; ACEi/ARB for elevated BP; BB for elevated HR
What is 1st line for HTN treatment in CKD?
Stage 1 & 2 AND albuminuria - ACEi/ARB
Stage 3+ - ACEi/ARB
What is 1st line for HTN treatment in Cerebrovascular disease?
for secondary stroke prevention- ACEi/ARB, thiazide diuretic or combo
What is 1st line for HTN treatment in Diabetes?
-all
-if albuminuria then ACEi/ARB
What are the thiazide diuretics?
chlorthalidone, hydrocholorothiazide
What are the potassium-sparing diuretics?
amiloride, triamterene
What are the aldosterone antagonist diuretics?
Spironolactone, eplerenone
What does a patient have to be on before starting hydralazine or minoxidil?
diuretic and beta-blocker
due to AE’s of palpitations, tachycardia, chest pain, fluid retention, headache, hepatotoxicity
What are the central a2-agonists?
clonidine, methyldopa, guanfacine
-taper dose when stopping due to rebound HTN
What are the steps for management of resistant HTN?
- optimize 3-drug regimen (ACEi/ARB, CCB, and diuretic)
- sub thiazide-like diuretic (Chlorthalidone, indapamide)
- add mineralcorticoid receptor antagonist (Spironolactone, eplerenone)
- Beta-Blocker if HR > 70 bpm (if no; consider clonidine or guanfacine)
- add hydralazine
- sub minoxidil for hydralazine
What are the BP goals for treating hypertensive emergency?
Hour 1: decrease BP by a max of 25%
Hour 2-6: reduce BP <160/100-110
Hours 6-48: reduce BP to goal
What are the DHP CCBs used in treating hypertensive emergency?
Nicardipine
Clevidipine (CI in soy, egg allergies)
-both are IV, titratable
What are the vasodilators used in treating hypertensive emergency?
Nitroglycerin (nitrates are titratable, tolerance occurs, reflex tachycardia)
Nitroprusside
Hydralazine (IVP; not titratable)
What are the Beta Blockers used in treating hypertensive emergency?
Labetalol
Esmolol (Always adjunct; never monotherapy as only decrease HR and not BP)
What is the ACEi & a2 central agonist used in treating hypertensive emergency?
Enalalprilat (given IVP; beneficial for renin excess)
Clonidine (only PO)
What do patients with HTN emergency & acute decompensated HF w/pulmonary edema get?
-nitrates preferred
-avoid BBs + non-DHP CCBs
What do patients with HTN emergency & Aortic dissection get?
-BB + Vasoldilator combo (nicardipine, clevidipine, nitroprusside)
What do patients with HTN emergency & Acute coronary syndrome get?
-BBs, nitrates, nicardipine
-caution non-DHP CCBs, avoid BB if HR low, reduced EF, BP low, reactive airway disease or 2nd/3rd degree heart block
What do patients with HTN emergency & Acute kidney injury get?
-caution nitroprusside
-avoid enalaprilat
What do patients with HTN emergency & Eclampsia/severe pre-eclampsia get?
-hydralazine, labetalol or nicardipine
CI: enalalprilat + nitroprusside
What do patients with HTN emergency & stroke get?
-no nitrates
-nicardipine, clevidipine, labetalol
What CCBs are used in PAH if positive AVT?
Nifedipine LA 120-240 mg daily
Diltiazem LA 240-720 mg daily
amlodipine 20 mg daily
NO verapamil
What are the endothelin receptor antagonists?
Bosentan, Ambrisentation (selective for ETa), macitentan
