Lecture 3 Hypertension Flashcards
What are the thresholds for initiating drug therapy Hypertension
High risk (Based on SPRINT)
Initiation: >130s
Goal: <120S
Low risk (no target organ damage or CV risks)
Initiation: >160S.>100D,
Goal: <140S. <90D
Diabetes
Initiation: >130S. >80D.
Goal: <130S. <80D
All others
Initiation: >140S. >90D
Goal <140S. <90D
What was SPRINT
Randomized, controlled, open label, conducted in us
Does a lower systolic BP goal (<120mmHg) reduce clinical events more than standard goal (<140mmHg)
Inclusion criteria for defining high risk patient
- Age >50 years
- Baseline systolic BP 130-180mmHg
- High risk:
A. >75 years
B. Clinical cardiovascular disease
C. Subclinical CVD
D. CKD
E. 10 year FRS >15%
Had to have any from 3.A-E
Sprint trial excluded those with….
Prior stroke
DM
CHF
Standing SBP <110
EGFR <20
Reside in nursing home
What are the useful dual combination for additive hypotension effect
Column 1: ACEi, ARB, BB
Column 2: CCB, Thiazide diuretic
Combine agent from column 1 with any in column 2*
* do not combine Column 1**
*** can combine column 2 **
Standard drug lowers BP by about how much percent
10%
T/F Patients can dose meds based on schedule preference
True
First line treatment of adults with systolic/diastolic hypertension without other compelling indications
HEALTHY BEHAVIOUR MANAGMENT
Thiazide (long acting), ACEi,ARB,CCB, BB, Single pill combination
T/F BBs are indicated as first line therapy for age 60 and above
False
T/F RAS inhibitors are contraindicated in pregnancy and caution is required in prescribing to women of child bearing potential
True
Thiazide diuretics, drugs, usual dosage
Hydrochlorothiazide - 12.5-25mg daily
Indapamide - 0.625- 2.5 mg daily
Chlorothalidone - 12.5-25mg daily
ACEi, drugs, usual dosage
Perindopril - 4.8mg daily
Ramipril - 2.5-20mg daily
Lisinopril - 5-40mg daily
Enalapril- 2.5-40mg
ARB, drug class, usual dosage
Telmisartan - 20-80mg daily
Irbersartan - 75-300mg daily
Valsartan- 80-320mg daily
Candesartan- 8 -32 mg daily
Calcium Channel Blocker, drugs, usual dosage
Amlodipine - 2.5-10mg daily
Diltiazem - 120-360mg daily
Beta-Blockers drugs, usual dose
Bisoprolol- 2.5-10mg daily
Metoprolol- 12.5-100mg bid
Thiazide diuretics drugs, half life, common dose.
Chlorthalidone: thiazide like, 45hr-60hrs, 12.5-25 mg qam
Indapamide: thiaizide like, 14-8hr, 1.25-2.5 mg qam
Hydrochlorothiazide: thiazide type, 6-15hr, 12.5-25mg qam
T/F, chlorothalidone is a less potent, longer acting drug than hydrochlorothiazide
False
Long acting CCB’s (DHP-CCB and NDHP-CCB)
DHP- CCB : amlodipine most common (nifedipine XL also used)
NDHP -CCB: can be used if higher heart rate present , diltiazem much more common than verapamil
What is the most common beta blocker used
Bisoprolol 2.5-10mg daily
What is the standard first line therapy for patients with heart failure and reduced ejection fraction
ACEi or ARB, then add a Beta blocker. Add on after standard pharmacotherapy includes mineral corticosteroid receptor antagonists. (Avoid non DHP-CCB)
First line therapy for patients with heart failure with preserved ejection fraction
Beta blocker, or ACEi or ARB. Diuretic if edema present
First line therapy for stable ischemic heart disease
Beta blocker then add ACEi or ARB.
Add on therapy: include CCB (if angina), and thiazide or mineral corticosteroid receptor antagonist
First line therapy for patients with diabetes
ACEi, ARB, CCB or thiazide
First line therapy for patients with chronic kidney disease
ACEi or ARB
First line therapy for patients with secondary stoke prevention
Thiazide or thiazide with ACEi
Treatment of hypertension in associated with diabetes mellitus summary
Diabetes with nephropathy and or CVD or CV risk factors -> ACEi or ARB
Diabetes without nephropathy -> 1. ACEi or ARB. 2 DHP-CCB or thiazide like diuretic
2- drug combinations : RAASi + DHP-CCB
Once first line drugs/ combos considered, if BP still not at target, use one or more of the following :
Low dose spirnolactone ( 12.5-50mg/day)
Alpha blocker
Furosemide
Clonidine
Hydralazine
