Renal hypertension III Flashcards
what are the advantages of diuretics in patients with HTN?
- lower CV morbidity and mortality
- effective in both caucasians and AAs
- cost effective
what are the disadvantages of diuretics in patients with HTN?
- monitoring for adverse effects on serum potassium / glucose / lipids
- reduced GFR
- hyperglycemia / metabolic abnormalities (high doses)
creatinine clearance greater than 30 - what type of diuretic? less than 30?
- greater than 30: thiazide
- less than 30: loop
amlodipine
nifedipine
nicardipine
what type of CCBs?
DHP
verapamil
diltiazem
what type of CCBs?
NDHP
what are the advantages of CCBs in patients with HTN?
- reduced CV morbidity / mortality in ISH
- antianginal
- pts with contraindications to other drugs
what are the disadvantages of CCBs in patients with HTN?
- conduction abnormalities (NDHBs)
- edema (high doses)
ACE inhibitors are preferred in patients with what symptoms / conditions?
- HF due to systolic dysfunction
- DM and proteinuria
- post MI with low EF
what are the limitations of ACE inhibitors?
- cough
- hyperkalemia
- low efficacy in AAs
what are the advantages of ARBs?
- lower cough
- for pts who cannot tolerate ACE inhibitors
- uricosuric
what is the main limitation of ARBs?
hyperkalemia
what are the limitations of beta blockers for HTN?
- lower insulin sensitivity
- higher TGs
- lower HDL
- bad for reactive airway disease
what are the advantages of alpha blockers in HTN?
- high cholesterol
- BPH
what is the main limitation of alpha blockers for HTN?
first dose syncope
what are the centrally acting a2 agonists in patients with HTN?
- clonidine
- methyldopa
what is the main limitation of centrally acting a2 agonists?
rapid rebound HTN with abrupt withdrawal (avoid noncompliant pts)
all ages WITHOUT CKD - what antihypertensive agent(s) do you start with in black and non-black patients?
- black: thiazide or CCB
- nonblack: thiazide, ACEI / ARB, or CCB
all ages WITH CKD - what antihypertensive agent(s) do you start with in black and non-black patients?
all races: ACEI / ARB
what antihypertensive agent class is helpful in slowing demineralization in osteoporosis?
thiazide
ACEIs should not be used in patients with what condition?
angioedema
your patient just started a new BP pill and is now presenting with depression. which medication class could have this side effect?
beta blockers
pt presents iwth HTN (not on medication) and hypokalemia this is concerning for
primary aldosteronism
pt present with HTN and (not on medication) and hypercalcemia. this is concerning for?
hyperparathyroidism
in what situation can you start 2 antiHTN drugs at once?
- SBP over 160/100
- above goal SBP by over 20 or DBP over 10
how does PAD risk compare to that in ischemic HD?
equivalent
what medication should be used in PAD?
aspirin
HTN in children is defined as BP in what percentile or greater?
95th percentile or greater
is uncomplicated HTN a contraindication to physical activity?
NO
what is the maximum initial decrease in DBP that can be done in treatment of hypertensive emergencies?
25%
what is the limiting factor in nitroprusside use?
cyanide toxicity
does hydralazine increase or decrease cardiac work?
increase
stroke patients are eligible for lytic therapy if their BP is under what value?
185/110
you cannot treat ischemic stroke with thrombolytic therapy unless the BP is over what value?
220/120
