UW revision Initial HTN Tx table + comorbid table 03-15 (1) Flashcards
HTN + no relevant comorbidity. 4 groups
ACEI
ARB
Thiazide
Calcium channel blocker (dihydropyridine)
ACEI
ARB
Thiazide
Calcium channel blocker (dihydropyridine)
in what cases?
HTN + no relevant comorbidity
HTN + CAD. 3
Consider BAB, ACEI/ARB
Consider BAB, ACEI/ARB
In what case?
HTN + CAD.
HTN + Chronic kidney disease (including diabetic nephropathy). 2
Consider ACEI/ARB
Consider ACEI/ARB
in what case?
HTN + Chronic kidney disease (including diabetic nephropathy).
HTN + HF. 6?
Consider ACEI/ARB, BAB, diuretic, SGLT-2 inhibitor, mineralcorticosteroid antagonist based on ventricular ejection fraction.
Consider ACEI/ARB, BAB, diuretic, SGLT-2 inhibitor, mineralcorticosteroid antagonist based on ventricular ejection fraction.
in what case?
HTN + HF.
BP >= 10-20 mmHg above goal?
Consider 2-drug therapy
Consider 2-drug therapy?
BP >= 10-20 mmHg above goal
Initial HTN management determined by what?
determined by the SEVERITY of the BP elevation and evidence of end-organ dysfunction.
Initial goal for BP for lower risk individuals with uncomlicated HTN.
130-140/80-90 mmHg.
BP goal varies on comorbidities and age.
If has comorbidities (eg HF, DM, CKD)?
might be lower target
BP goal varies on comorbidities and age.
If has higher age (frail elderly)?
higher targets
Baseline BP >=20/10 (systolic/diastolic) above goals. how many drugs?
2 drugs therapy (in addition to counseling on lifestyle changes)
Baseline BP sBP<20 and/or dBP < 10 above goals. how many drugs?
1 drug therapy (in addition to counseling on lifestyle changes)
Drug choice for comorbid conditions.
Coronary atherosclerosis.
–> angina pectoris?
BAB, CCB
Drug choice for comorbid conditions.
Coronary atherosclerosis.
–> post-MI?
ACEI/ARB, BAB
Drug choice for comorbid conditions.
HF with reduced ejection fraction?
ACEI or ARB, BAB, diuretic, aldosterone antagonists, dihydropyridine CCB.
Drug choice for comorbid conditions.
Afib or Aflutter?
BAB, nondihydropyridine CCB
Drug choice for comorbid conditions.
CKD?
ACEI or ARB
Drug choice for comorbid conditions.
Gout?
Losartan, other ARB, CCB (avoid diuretics), ACEI
Drug choice for comorbid conditions.
Osteoporosis?
Thiazide diuretic
Drug choice for comorbid conditions.
Migraine?
BAB, CCB
Drug choice for comorbid conditions.
Calcium kidney stones?
Thiazide diuretic
Eg. left ventricle hypertrophy is considered as end-organ injury.
.
HTN + left ventricle hypertrophy. Drugs? 4
ACEI/ARB, CCB, Thiazide
Thiazides on uric acid?
raise uric acid level –> incr. risk of gout attact if patient has gout.
What drug (alone) provide greatest reduction left ventricle hypertrophy?
ARB!!!!!!!!
2nd-CCB
3rd ACEI
4th diuretic
What drug has uricosuric effects?
ATORVASTATIN
