Hypertension Therapeutics - Dr. Singh Flashcards
What are the blood pressure goals for a diabetic person age 40?
< 140/90
What are the blood pressure goals for someone age 65, without diabetes?
< 150/90
What are the blood pressure goals for someone age 70 with diabetes?
< 140/90
What are the blood pressure goals for someone with chronic kidney disease, any age?
< 140/90
How are the JNC -7 and 8 guideline different?
There is no cutoff for the elderly w/o diabetes/kidney disease (still 140/90 is goal in JNC -7). The BP goals for diabetes and kidney disease patients in JNC-7 were also more aggressive. JNC-8 more lenient.
What is a hypertensive crisis?
180/120
What is resistance hypertension?
4 or more drugs for BP, regardless of BP
OR
3 different classes of BP meds, one of them being a diuretic, for 140/90
How do you manage hypertension in pediatric populations?
95 percentile
all classes, no ACE’s and ARBS for sexually active girls
How do you manage hypertension for a pregnant woman?
Not ACE’s, not ARBs
Methyldopa (beta blockers, except for atenolol)
What does the mean arterial pressure tell us?
It tells us about organ perfusion. It is a measure of SBP x 1/3 plus DBP x 2/3. If the number is below 70, then we need to worry about organ perfusion.
What increases stroke volume?
Contractility and preload
What decreases stroke volume?
Afterload
What did the ACCORD trial find?
That intensive and non-intensive treatments in diabetes patients had the same results, except in non-fatal stroke (where intensive therapy was more useful)
What is a difference in the JNC-8 guidelines compared to CHEP guidelines?
CHEP is more severe for diabetes (130/80) and more severe for the elderly (after age 80, it is 150/90)
Do beta-blockers have a big place in anti-hypertensive therapy?
No.
What are the different recommendations based upon white or African American race?
Non-African American: Thiazide, ACE, ARB, CCB
African American: Thiazide, CCB
When is the main time that we use loop diuretics?
To get rid of fluid
in small white females, hyponatremia is often seen as a side effect of which medication?
Thiazide diuretics
As GFR decreases, what lab value goes up?
There is a bump in SrCr. After kidneys normalize, SrCr goes down.
How do you manage hypertension for someone with chronic kidney disease?
ARBs
How do you manage hypertension for someone who has had a stroke?
ARBs
If someone has had angioedema with an ACE inhibitor, what medication should they try next?
Not an ARB - same risk!
How do you manage hypertension for someone with chronic kidney disease?
ACE I’s
How do you manage hypertension for someone who has had a stroke?
ACE I’s
If someone has had angioedema with an ACE inhibitor, what medication should they try next?
Not an ARB - same risk!
How do you manage hypertension for someone with T2DM with nephropathy?
ARBs
What do CCB cause on smooth muscle?
They inhibit contraction, and so cause relaxation of smooth muscles.
What are the non-dihydropyrides, and when are they contraindicated? Which is a more potent vasodilator? Which has a side effect of constipation? What enzyme do they inhibit?
Verapamil and diltiazem. They can worsen heart failure. Diltiazem is a more potent vasodilator, and verapamil can cause constipation. Inhibit 3A4 metabolism.
What did the ALLHAT trial find?
Lowering of systolic BP
Lowering of DBP
Basically, that thiazides should be drug of choice for HTN
SBP - chlorthalidone lowered the most
DBP - amlodipine lowered the most
Less stroke in chlorthalidone group vs lisinopril
Chlorthalidone better in black vs. non-black population overall
Chlorthalidone was better in both black and non-black populations in new-onset heart failure.
Decreased rates of combined cardiovascular disease and stroke vs. lisinopril.
What are the dihydropyridines? How do you change the dose when taking simvastatin?
Amlodipine and nifedipine. There is 3A4 inhibition, so cannot take a dose of simvastin higher than 20mg with 10mg amlodipine daily.
What did the ACCOMPLISH trial find?
They found that benazepril and amlodipine were better than benazepril and HCTZ, but they should have used chlorthalidone.
When would you use a beta-blocker? SE’s problems? CI’s?
Heart failure, MI, coronary artery disease. SE’s should get better over time (empower patient)
Should not use beta-blocker for bradycardia, uncontrolled asthma or COPD (reactive component), cariogenic shock, or heart block
What did the LIFE trial find?
losartan superior to atenolol
