Hypertension medications, Fully-subsidised option Flashcards
ACE inhibitors
Cilazapril
500 micrograms – 1 mg, once daily, adjusted according to response. Maximum 5 mg daily.
Quinapril
10 mg, once daily. Maintenance dose, 20 – 40 mg, daily in divided doses.
Enalapril
5 mg, once daily. Maintenance dose 20 mg, once daily, maximum 40 mg daily.
Lisinopril
10 mg, once daily. Maintenance dose 20 mg, once daily, maximum dose 80 mg, once daily.
If PVD is present an ACE inhibitor should be considered to slow disease progression, or a calcium channel blocker to vasodilate the peripheral arteries.
Angiotensin-II receptor blockers (ARBs)
Candesartan
8 mg, once daily, initially and as maintenance dose.
Can be increased at two - four week intervals if necessary to a maximum of 32 mg, daily.
Losartan
50 mg, once daily. Less if aged > 75 years.
Can be increased to 100 mg, once daily, after several weeks.
ACE inhibitors and ARBs should not be prescribed concurrently without the recommendation of a Diabetologist or Nephrologist.
Females of child bearing age should also not be treated with ACE inhibitors or ARBs due to the risk of foetal abnormalities
Losartan lowers serum concentration of urate in hypertensive subjects through a significant uricosuric action.
- result from the inhibition of urate/anion transport in brush-border cells of the renal proximal tubules.
Calcium channel blockers
Felodipine
5 mg, once daily in the morning (2.5 mg in older pts).
Maintenance dose, 5 – 10 mg, once daily.
Amlodipine
5 mg, once daily. Maximum dose 10 mg, once daily.
Diltiazem
120 – 180 mg, modified release, once daily,
increased if necessary every two weeks to a maximum of 240 - 360 mg, daily.
Diuretics
Chlortalidone
12.5 – 25 mg, once daily in the morning.
Electrolytes and kidney function should be assessed before increasing the dose to 25 mg.
Indapamide
2.5 mg, once daily in the morning
Bendroflumethiazide
2.5 mg, once daily in the morning
Pts taking diuretics should have their serum electrolytes monitored as hypokalaemia and hyponatraemia are known adverse effects.
Thiazide should also be prescribed with caution in younger pts as they can potentially increase the incidence of new-onset diabetes, particularly in high doses or when combined with a beta-blocker
Beta-blockers
Metoprolol succinate
47.5 mg, once daily. Increased if necessary.
Maximum, 190 mg daily (slow release formulation).
Atenolol
25 – 50 mg, once daily
Celiprolol
200 mg, once daily in the morning. Maximum 400 mg daily.
Bisoprolol
5 mg, once daily in the morning, increasing to a maximum of 20 mg daily.
Beta-blockers are no longer recommended as an initial Rx
Beta-blockers do not reduce the risk of stroke as much as other antihypertensive medicines and are generally poorly tolerated
However, for people with IHD or HF they may be a good treatment choice .
Beta-blockers may also be appropriate for some younger people who;
- are intolerant to ACE inhibitors or ARBs,
- females who may become pregnant, or
- where there is evidence of sympathetic drive causing hypertension, e.g. stress.
If a beta-blocker is started, then a calcium channel blocker, or an ACE inhibitor/ARB is the preferred second-line treatment.
ACE inhibitors with diuretics
Cilazapril + hydrochlorothiazide
5/12.5 mg, once daily
Quinapril + hydrochlorothiazide
10/12.5 mg, once daily. If necessary increased to 20/12.5 mg, once daily.
Spironolactone
25 mg, once daily, in the morning – some clinicians start with 12.5 mg) may be appropriate, if serum potassium is ≤ 4.4 mmol/L.
If the pt’s renal function is impaired there is an increased risk of hyperkalaemia and hyponatremia.
Serum sodium and potassium should be monitored after one week, then every three months for the first year.
If the patient’s serum potassium is > 4.5 mmol/L consider an increased dose of a thiazide diuretic in preference to spironolactone.
An alpha- or beta-blocker may be considered if hypertension continues to be resistant, particularly in males.
