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What is considered normal blood pressure?
- <120 mmHg systolic
- <80 mmHg diastolic
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What is considered prehypertension?
- 120 - 139 mmHg systolic
- 80 - 89 mmHg diastolic
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What is considered Stage 1 HTN?
- 140 - 159 mmHg systolic
- 90 - 99 mmHg diastolic
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What is considered Stage 2 HTN?
- at least 160 mmHg systolic
- at least 100 mmHg diastolic
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What drugs can cause secondary HTN?
- adrenocorticosteroids
- antidepressants
- NSAIDs
- decongestants
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What is the goal BP for uncomplicated HTN?
< 140/90
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What is the goal BP for HTN with DM, chronic kidney disease, CAD, high CAD risk, or heart failure?
< 130/80
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Which class of antihypertensives is good to use in all compelling indications?
ACE inhibitors
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Which class of antihypertensives is not good to use in patients with heart failure?
CCBs
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Which classes of antihypertensives are not good to use in pts with hx of MI?
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What classes of antihypertensives are not good to use in pts with high coronary disease risk?
- ARBs
- aldosterone antagonists
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What class of antihypertensives are not good to use in pts with DM?
aldosterone antagonists
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What classes of antihypertensives are not good to use in pts with chronic kidney disease?
- diuretics
- B-blockers
- CCBs
- aldosterone antagonists
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What classes of antihypertensives are not good to use in pts with recurrent stroke?
- B-blockers
- ARBs
- CCBs
- aldosterone antagonists
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How long should you wait before increasing the dose of antihypertensives?
1-2 mo, if pt is compliant, there is at least some response, and there are no intolerable SE
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How often should you follow up on pts once their HTN is controlled?
every 3-6 months
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What are the names of the loops?
- bemetanide
- ethacrynic acid
- furosemide
- torsemide
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What is the most common use of loops?
heart failure
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What are the names of the thiazide diuretics?
- chlorothiazide
- hydrochlorothiazide
- metolazone
- chlorthalidone
- indapamide
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What are the most used drugs for HTN?
thiazide diuretics
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What is the best thiazide diuretic for HTN?
chlorthalidone
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What is the most prescribed thiazide for HTN?
HCTZ
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What are the names of the potassium-sparing diuretics?
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What are the names of the aldosterone antagonist diuretics?
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What are aldosterone antagonist diuretics used for most?
heart failure
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What are the names of the carbonic anhydrase inhibitor diuretics?
acetazolamide
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When should electrolytes be monitored when starting loop/thiazide diuretics?
in 4 wks
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When should electrolytes be monitored when starting aldosterone antagonist diuretics?
in 1 wk
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What diuretics are used for recurrent stroke prevention?
thiazides
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Which diuretics are favored for use in chronic renal failure?
loops (because they don't increase K+, which is already high in renal failure)
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Which diuretics are favored for use in osteoporosis prevention?
thiazides (because they increase Ca levels)
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Which diuretics are favored for use in cirrhosis?
aldosterone antagonists
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What are the unfavorable effects of diuretics?
- hyperkalemia
- renal insufficiency
- gout
- dyslipidemia
- diabetes (high dose)
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Which diuretics should not be used in hyperkalemia?
- potassium-sparing
- aldosterone antagonists
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Which diuretics should be used with caution in sulfa allergy?
-
Which diuretics cause photosensitivity?
- thiazides
- potassium-sparing
- aldosterone antagonists
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Which diuretics can cause gynecomastia/hirsutism?
- potassium-sparing
- aldosterone antagonists
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Which diuretics can cause depression?
carbonic anhydrase inhibitors
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Which diuretics can cause ototoxicity?
loops
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Which diuretics can cause urolithiasis?
carbonic anhydrase inhibitors
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What are the names of the B-blockers?
- acebutolol
- atenolol
- betaxolol
- bisoprolol
- carteolol
- carvedilol
- labetalol
- metoprolol
- nadolol
- nebivolol
- penbutolol
- pindolol
- propranolol
- timolol
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Which B-blockers have intrinsic sympathomimetic activity (ISA)?
- Acebutolol
- carteolol
- penbutolol
- labetolol
- pindolol
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Which B-blockers also have alpha activity?
-
Which B-blockers are beta1 selective?
- acebutolol
- atenolol
- betaxolol
- bisoprolol
- metoprolol
- nebivolol (< 10mg)
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What are the compelling indications for B-blockers?
- heart failure
- post-MI (not with ISA)
- high-risk coronary disease
- diabetes
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What conditions favor use of B-blockers?
-
What do B-blockers do?
inhibit chronotropic, inotropic, and vasodilator responses
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What conditions are contraindicated for B-blockers?
- bronchospastic diseases (asthma, COPD)
- heart block or bradycardia
- peripheral vascular disease
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What are the SE of B-blockers?
- hypotension
- bradycardia/heart block
- bronchospasm
- aggravation of acute heart failure
- fatigue
- decreased exercise tolerance
- depression
- impotence
- peripheral vasoconstriction
- glucose and lipid abnormalities
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What are the names of the CCBs?
- amlodipine
- felodipine
- isradipine
- nicardipine
- nifedipine
- nisoldipine
- diltiazem
- verapamil
-
Which CCBs are non-dihydropyridines?
-
Which CCBs decrease HR, and therefore should not be used in heart block or heart failure?
-
What conditions favor use of CCBs?
- tachycardia
- a-fib (non-DHP: diltiazem, verapamil)
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What are the SE of DHP CCBs?
- peripheral edema
- palpitations
- angina
- headache
- dizziness
- nausea
- gingival hyperplasia
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What are the SE of non-DHP CCBs?
- peripheral edema
- headache
- dizziness
- nausea
- constipation
- bradycardia
- gingival hyperplasia
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What warning is associated with CCBs?
do not stop abruptly: risk of rebound HTN/angina
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In which conditions are CCBs contraindicated?
- arrhythmias
- hypotension
- heart failure
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What warning is associated with B-blockers?
do not stop abruptly
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What are the names of the ACE inhibitors?
- captopril
- benazepril
- enalapril
- moexipril
- quinapril
- ramipril
- fosinopril
- lisinopril
- perindopril
- trandolapril
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What is the preferred antihypertensive for pts with diabetes?
ACE inhibitors
-
In which conditions are ACE inhibitors contraindicated?
- PREGNANCY
- bilateral renal artery stenosis
- angioedema from previous ACEI
- hyperkalemia (caution)
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What are the SE of ACE inhibitors?
- hypotension
- dry cough (swith to ACE w/ lower incidence)
- insomnia
- headache
- dizziness
- angioedema (DO NOT use another ACE)
- rash (captopril in sulfa allergy)
- hyperkalemia
-
What are the names of the ARBs?
- candesartan
- eprosartan
- irbesartan
- losartan
- olmesartan
- telmisartan
- valsartan
-
What are the compelling indications for the use of ARBs?
- heart failure
- diabetes
- chronic kidney disease
-
What conditions favor the use of ARBs?
- proteinuria
- DM nephropathy
- ACEI-induced cough
-
In what conditions are ARBs contraindicated?
- PREGNANCY
- bilateral renal artery stenosis
- ACEI-induced angioedema
-
What are the SE of ARBs?
- hypotension
- dizziness
- hyperkalemia
- cough
-
What are the names of the alpha1 receptor blockers?
- alfuzosin
- doxazosin
- prazosin
- terazosin
- tamsulosin (NOT for HTN)
-
What are the best alpha1 blockers to use for HTN?
-
In what conditions are alpha blockers contraindicated?
- elderly
- concurrent use of PDE-5 inhibitors
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What are the names of the alpha2 agonists?
-
Where do alpha1 agents act?
in the periphery
-
Where do alpha2 agents act?
centrally
-
What conditions favor the use of alpha2 agonists?
- pregnancy/breastfeeding (methyldopa)
- drug addiction (clonidine)
-
What warning is associated with alpha2 agonists?
do not stop abruptly
-
What are the SE of alpha2 agonists?
- sedation
- dry mouth
- withdrawal HTN (clonidine more)
- edema
- hepatic and autoimmune disorders (methyldopa)
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What antihypertensives should be used in pregnant women with chronic HTN?
-
What antihypertensives should be used in gestational HTN with no proteinuria?
-
What antihypertensives should be used in preeclampsia (includes proteinuria and/or edema)?
- Mg SO4 IV for seizure prophylaxis
- IV labetalol
- IV nicardipine
-
What should be used in pts with migraine?
B-blockers (esp non-selective)
-
What should not be used in pts with asthma or COPD?
B-blockers (esp non-selective)
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What should not be used in pts with depression?
- B-blockers
- alpha2 agonists
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What should not be used in pts with bradycardia or AV block?
-
What should be used in pts with tachycardia or a-fib?
-
What should be used in pts with DM?
-
What should be used in pts who are pregnant?
-
What should not be used in pts who are pregnant?
-
What should be used in pts with osteoporosis?
thiazides
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What should be used in pts with renal insufficiency?
-
What should not be used in pts with renal insufficiency?
- potassium-sparing
- thiazides (don't work well)
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