Therapeutics of Hypertension Flashcards
what is a common cause of secondary hypert
sleep apnea
which race/ethnicity is hypert higher in?
non-hispanic black adults
T/F starting at 115/75, risk of CVD doubles ever 20/10 increase
true
what is weight losses impact on SBP?
-5
what is a heart-healthy diets impact on SBP?
-11
what is sodium reductions impact on SBP?
-5-6
what is potassium supplementations impact on SBP?
-4-5
what is exercise’s impact on SBP?
-5-8
how would drinking no more than 2 for men and 1 for women standard drinks per day impact SBP?
-4
what does the ASCVD risk assessment tell us?
identify/interpret the score criteria
10 year risk of a cardiovascular complication
less than 5%: low risk
5-7.45%: borderline
7.5-20%: intermediate
over 20%: high risk
according to the ADA, people with diabetes and hypertension should aim to target their blood pressure to be?
less than 130/80
according to ACC/AHA guidelines, anyone with a comorbidity or over the age of 65 should aim to have a blood pressure of?
less than 130/80
if pt has a BP of <130/80, what is the guideline?
no change, reassess in 1 year
if pt has BP of 120-129/80, what is the guideline?
nonpharm therapy, reassess in 3-6 months
if pt has BP of 130-139/80-89, what is the guideline?
if ASCVD less than 10%, nonpharm therapy and reassess in 3-6 months
if more than 10%, nonpharm therapy plus BP med and reassess in 1 month
if pt has BP of 140/90, what is the guideline?
nonpharm therapy and BP med and reassess in 1 month
what are the first line treatment for HTN?
thiazide diuretics, CCBs, and ACE-I/ARBs
based on the reviewed study, which drug showed the best results for reducing SBP?
chlorthalidone
based on the reviewed study, which drug showed the best results for reducing DBP?
Amlodipine
based on the reviewed study, how did chlorthalidone, amlodipine, and lisinopril compare towards preventing a cardiac event?
they all had the same effect on outcome
based on the reviewed study, what was the concluding drug of choice to treat HTN?
thiazide-diuretics
what are the SEs of thiazide diuretics?
hyponatremia, hypomagnesemia, hypokalemia, hyperuricemia, hypercalcemia
what should we monitor with pts taking thiazide diuretics?
BP, electrolytes, renal function
if a pt has hypertension and CKD, which HPT drug would be most beneficial?
ACE-Is
if a pt has hypertension and left ventricular dysfunction, which HPT would be most beneficial?
ACE-Is
what are the SEs of ACE-Is?
hypotension, hyperkalemia, angioedema, increased serum creatinine, dry cough
when are ACE-Is contraindicated as treatment for HPT?
pregnancy or bilateral renal artery stenosis
what should we monitor for with pts using ACE-Is?
BP, renal function, and potassium
why can ACE-Is potentially cause angioedema?
ACE-Is block degradation of bradykinin which increases as a result
which ACE-Is are used once daily? (rest are 2+ more daily)
Fosinopril
Lisinopril
Perindopril
The place in therapy and clinical benefits of ARBs is similar to ACE-Is. what is a SE ARBs don’t cause that ACE-Is can?
cough
what are SEs from Non-DHP CCBs?
bradycardia
worsening HF (more with verapamil)
hypotension
constipation (more with verapamil)
what are drug-drug interactions of Non-DHP CCBs?
may increase concentration of other Cyp3A4 substrates such as simvastatin and lovastatin
Cardizem SR is given how often?
BID
Cardizem CD is given how often?
QD
Verapamil IR is given how often?
TID
Verapamil SR/ER is given how often?
QD
what place in therapy do we use aldosterone receptor antagonists?
add-on therapy for hypertension
heart failure
SEs of aldosterone receptor antagonists?
hyperkalemia
gynecomastia (spironolactone)
dizziness
what adverse effect can hydralazine cause?
drug-induced lupus-like syndrome
first line therapy for HPT is typically thiazide, CCB, ACE-I, or ARB. However, for pts with heart issues, what therapy is recommended?
Beta-blocker with an ACE-I or ARB
how do you classify resistant hypert?
BP above goal using 3 diff drug classes including a diuretic
which drugs can be given IV in hypertension emergencies?
nicardipine, sodium nitroprusside, nitroglycerine, hydralazine, esmolol, labetalol, enalapril, and phentolamine
which drug is the treatment of choice for chronic HPT in pregnancy?
what are alternative treatments?
methyldopa
labetalol, CCBs, BBs (excluding atenolol)
when do we treat children with HPT?
SBP and/or DBP greater than the 95th percentile for sex, age, and height on at least 3 occasions
