Hypertension Medications Flashcards by Beth Cocker

Consequences of uncontrolled HTN

Stroke
Heart failure
Erectile dysfunction
Vision loss
Heart attack
Kidney disease/failue

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Steps for picking the right agents

Safety
Tolerability
Effectiveness
Price 
Simplicity (once daily dosing)

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Thiazides Drugs

HCTZ
Chlorthalidione
Indapamide

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Thiazide Benefits

- Great HTN BP lowering
Proven benefits in CV morbidity and mortality
Once daily
Cheap
Can be combine with other meds

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Thiazides are not effective when?

CrCl is less than 30 mL/min

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Thiazide ADR Profile

Hypokalemia
Hyponatremia
Hypomagnesemia
Increased frequency of urination
Hyperuricemia (gout)
Volume depletion

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Thiazide CI

Lower than normal K, Na, Mg
Sulfa allergy
Existing severe/uncontrolled gout

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Calcium Channel Blockers

Non-DHP (verapamil and diltiazem)

DHP (amlodipine, felodipine, nifedipine)

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NonDHP Use

Cardio-selective

Good for A fib

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DHP Use

Peripherally selective
Better for essential HTN to reduce CV events
- Once daily and cheap

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NonDHP ADRs

Bradycardia
Constipation
HA

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DHP ADRs

Edema

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NonDHP CI

Low pulse
HF
AV block
Sick sinus syndrome

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DHP CI

Existing edema

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Calcium Channel Blocker CI

Clarithromycin

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ACEi/ARB Benefits

QD to BID dosing
Cheap
CV morbidity and mortality benefit

ACEi/ARB downside

Low renin activity (black population) leads to lower BP effects

ACEi/ARB ADRs

Hyperkalemia
Angioedema
Cough
Transient increase in SCr

Beta Blockers ADRs

Bradycardia
Dysrhythmias
Fatigue/lethargy

Beta Blockers CI

AV block
Bradycardia
Severe asthma/COPD (edema)

Changeable HTN Risk Factors & Non-changable

Weight
High sodium
Alcohol
Lack of physical activities
Smoking
Stress
Non-changable: Aging, Race Family History Gener

JNC 8 Guidelines for Less than 60

Goal: less than 140/90

JNC8 Guidelines for greater than 60

Goal: less than 150/90

JNC8 Guidelines for CKD

Goal: less than 140/90

First-line: ACEi/ARB

JNC8 Guidelines for DM

Goal: less than 140/90 | First-line: ACEi/ARB

JNC8 Initial Treatment for Non-black population +/- DM

Thiazide CCB ACEi/ARB

JNC8 Initial Treatment for black population +/- DM

Thiazide CCB

ASH/ISH Guidelines Pre-HTN

SBP 120-139 mmHg | DBP 80-89 mmHg

ASH/ISH Guidelines Stage 1

SBP 140-159 mmHg | DBP 90-99 mmHg

ASH/ISH Guidelines Stage 2

SBP greater than 160 mmHg | DBP greater than 100 mmHg

ASH/ISH Guidelines Essential HTN less than 80

Goal: less than 140/90 | Including DM, CKD, CAD

ASH/ISH Guidelines Essential HTN greater than 80

Goal: less than 150/90 | Excluding DM and CKD

ASH/ISH Guidelines First line Option for White/non-black less than 60

Initial: ACEi/ARB

ASH/ISH Guidelines First line Option for White/non-black greater than 60

Initial: CCB or thiazide then ACEi/ARB

ASH/ISH Guidelines First line Option for blacks all ages

Initial: CCB or thiazide

***Secondary CAD BP Recommendations

AHA/ACCF and ACP/ACC | Recommend starting with a beta blocker + ACEi/ARB

***Secondary DM Recommendation

ADA recommends taking one or more medications at night

***Secondary CKD Recommendation

KDIGO recommends  BP with or without DM but with INCREASED urine albumin excretion >30 mg/24 hr): less than 130/80 (ACEi/ARB)  BP with or without DM with NORMAL urine albumin excretion >30 mg/24 hr): less than 140/90

Increase or Add-On Therapy?

Either but it is 5X more effective to add another agent than to just increase a dose