UW revision Initial HTN Tx table + comorbid table

Question 1

HTN + no relevant comorbidity. 4 groups

Answer 1

ACEI
ARB
Thiazide
Calcium channel blocker (dihydropyridine)

Question 2

ACEI
ARB
Thiazide
Calcium channel blocker (dihydropyridine)

in what cases?

Answer 2

HTN + no relevant comorbidity

Question 3

HTN + CAD. 3

Answer 3

Consider BAB, ACEI/ARB

Question 4

Consider BAB, ACEI/ARB

In what case?

Answer 4

HTN + CAD.

Question 5

HTN + Chronic kidney disease (including diabetic nephropathy). 2

Answer 5

Consider ACEI/ARB

Question 6

Consider ACEI/ARB

in what case?

Answer 6

HTN + Chronic kidney disease (including diabetic nephropathy).

Question 7

HTN + HF. 6?

Answer 7

Consider ACEI/ARB, BAB, diuretic, SGLT-2 inhibitor, mineralcorticosteroid antagonist based on ventricular ejection fraction.

Question 8

Consider ACEI/ARB, BAB, diuretic, SGLT-2 inhibitor, mineralcorticosteroid antagonist based on ventricular ejection fraction.

in what case?

Answer 8

HTN + HF.

Question 9

BP >= 10-20 mmHg above goal?

Answer 9

Consider 2-drug therapy

Question 10

Consider 2-drug therapy?

Answer 10

BP >= 10-20 mmHg above goal

Question 11

Initial HTN management determined by what?

Answer 11

determined by the SEVERITY of the BP elevation and evidence of end-organ dysfunction.

Question 12

Initial goal for BP for lower risk individuals with uncomlicated HTN.

Answer 12

130-140/80-90 mmHg.

Question 13

BP goal varies on comorbidities and age.

If has comorbidities (eg HF, DM, CKD)?

Answer 13

might be lower target

Question 14

BP goal varies on comorbidities and age.

If has higher age (frail elderly)?

Answer 14

higher targets

Question 15

Baseline BP >=20/10 (systolic/diastolic) above goals. how many drugs?

Answer 15

2 drugs therapy (in addition to counseling on lifestyle changes)

Question 16

Baseline BP sBP<20 and/or dBP < 10 above goals. how many drugs?

Answer 16

1 drug therapy (in addition to counseling on lifestyle changes)

Question 17

Drug choice for comorbid conditions.
Coronary atherosclerosis.
–> angina pectoris?

Answer 17

BAB, CCB

Question 18

Drug choice for comorbid conditions.
Coronary atherosclerosis.
–> post-MI?

Answer 18

ACEI/ARB, BAB

Question 19

Drug choice for comorbid conditions.
HF with reduced ejection fraction?

Answer 19

ACEI or ARB, BAB, diuretic, aldosterone antagonists, dihydropyridine CCB.

Question 20

Drug choice for comorbid conditions.
Afib or Aflutter?

Answer 20

BAB, nondihydropyridine CCB

Question 21

Drug choice for comorbid conditions.
CKD?

Answer 21

ACEI or ARB

Question 22

Drug choice for comorbid conditions.
Gout?

Answer 22

Losartan, other ARB, CCB (avoid diuretics), ACEI

Question 23

Drug choice for comorbid conditions.
Osteoporosis?

Answer 23

Thiazide diuretic

Question 24

Drug choice for comorbid conditions.
Migraine?

Answer 24

BAB, CCB

Question 25

Drug choice for comorbid conditions.
Calcium kidney stones?

Answer 25

Thiazide diuretic

Question 26

Eg. left ventricle hypertrophy is considered as end-organ injury.

Answer 26

.

Question 27

HTN + left ventricle hypertrophy. Drugs? 4

Answer 27

ACEI/ARB, CCB, Thiazide

Question 28

Thiazides on uric acid?

Answer 28

raise uric acid level –> incr. risk of gout attact if patient has gout.

Question 29

What drug (alone) provide greatest reduction left ventricle hypertrophy?

Answer 29

ARB!!!!!!!!

2nd-CCB
3rd ACEI
4th diuretic

Question 30

What drug has uricosuric effects?

Answer 30

ATORVASTATIN