review

• systolic BP (pressure taken when heart is contracting) <120mmHg
• diastolic BP (pressure taken when heart is realxing) <80mmHg

SBP>140 and DBP>90mmHg or any condition that requires antihypertensive tx.

JNC-VII

True

• renovascular disease
• primary aldosteronism
• cushing syndrome
• pheochromocytoma
• aortic coarctation
• drugs (steroids and estrogens, alcohol, cocaine, cyclosporine, tacrolimus, sympathomimetics, erythropoietin, licorice, MOA inhibitors, tricyclic antidepressants, NSAIDS)

• SBP: 120-139 or
• DBP: 80-89mmHg
• if pt. has no compelling indications, then no drug tx. needed yet

• SBP: 140-159 or
• DBP: 90-99
• initiate tx. with: thiazide diuretics, or ACEI,ARB,BB,CCB or combos

• SBP: >or equal to 160 or
• DBP: > or equal to 100
• initiate tx. with 2 drug combos (most of the time a thiazide and ACEI or ARB or BB or CCB)

True

<130/80

• HTN
• smoking
• obesity (BMI>30)
• physical inactivity
• dyslipidemia
• DM
• microalbuminuria or GFR<60
• age (>55 for M; >65 for F)
• family history or premature cardiovascular disease (M<55;F<45 years old)

• Heart (left ventricular hyperthrophy, angina or prior MI, prior coronary revascularization, HF)
• Brain (sroke or transient ischemic attack)
• Kidney (chronic kideny disease or end stage renal disease)
• Vascular system (peripheral arterial disease)
• Eyes (retinopathy)

• lifestyle modifications:
• loose weight, limit alcohol intake, increase exercise, decrease sodium intake, maintain enough of intake of potassium, magnesium, and calcium, stop smoking, decrease cholesterol and saturated fat intake

DASH diet (dietary approaches to stop HTN)

thiazide diuretics

True

inhibit sodium reabs. in distal tubule which will cause increased excretion of sodium, water, potassium, and hydrogen

Look at pg. 164

• take early to avoid nocturia
• use sunblock
• may increae blood sugar
• report muscle cramps (may indicate decreased potassium levels)

steroids, NSAIDs blunt effect of thiazides, class IA or III antiarrhythmic(that prolong QT) may cause torsade de pointes with diuretic induced hypokalemia, probenecid and lithium

inhibit sodium and chloride reabs. in ascending loop of henle, which causes increased exprection of water, sodium, chloride, magnesium, and calcium

• bumetanide (Bumex)
• furosemide (Lasix)
• torsemide (Demadex)
• look at pg. 164

• take early to avoid nocturia
• sunblock
• may increase blood sugar in pt. with DM
• report musle cramps (hypokalemia)
• hypotension (rise slowly)

aminoglycosides(may percipitate ototoxicity), NSAIDS, class IA or III antiarrhythmics, probenecid

interfere with potassium and sodium exchange in distal tubule, decrease calcium excretion and increase magnesium loss

• amiloride (Midamor)
• triamterene (Dyrenium)

• take early in day and after meals
• avoid foods high in potassium (hyperkalemia)
• may increase blood sugar
• sex dysfunction is possible

• ACEI may increase hyperkalemia
• indomethacin and cimetidine

• competes with aldasterone for receptor sites in distal tubule, incerease sodium and water excretion and conserving potassium
• SE: hypotension, report new fluid retention
• DI: otc sympathomimetics, tricyclic antidepressants
• -avoid in pt. with pheochromocytoma, CHF, angina,cerebrovascular disease

• decrease sympathetic outflow to cardiovascular system by agonistic activity on alpha 2 receptor
• ex: clonidine (Catapres)
• methyldopa (Aldomet)
• guanabenz acetate (Wytensin)
• guanfacine (Tenex)

• SE: hypotension, fluid retention, flu symptoms with methyldopa, exercise sedation precautions
• DI: use cautiously with other sedating drugs, caution use in pt. with CVA, recent MI, angina..

• MOA: block alpha1 which cause vasodilation of arteries and veins
• Ex: doxazosyn (Cardura), prazosin(Minipres), terazosin(Hytrin)
• SE: hypotension, dizzy, priapism
• DI: NSAIDS

• MOA:block secretion of renin, decrease cardiac contractility, decrease HR
• Ex. drugs end on -olol pg.168
• SE: hypotension,decreased exercise tolerance, bronchospasm, bradycardia,hypogalcemia
• DI: nondihydropyridines may increse effect(toxicity) of BB

• hydralazine(Apresoline), minoxidil(Loniten)
• Counseling: hypotension, hirsutism(with monoxidil),report weight gain
• DI: use in caution in pt. with pulmonary HTN,renal failure CHF,CAD,or recent MI

inhibit influx of calcium ions through channels in vascular smooth muscle, thus relax coronary and peripheral arteries

• diltiazem(Cardizem)
• verapamil(Calan,Isoptin..)
• SE: gingivial hyperplasia,constipation(verapamil),hypotension

• amlodipine(Norvasc)
• nifedipine(Procardia,Adalat)
• others on pg169
• SE:ankle edema,flush,gingivial hyperplasia

• use in caution in pt. on BB and nondihydropyridines-may increase CHF and bradycardia
• caution in pt. with disturbances in SA and AV node
• avoid grape fruit juice

• MOA: ACEI-inhibit conversion from angiotensin 1 to 2
• ARBS-inhibit binding of angiotensin II to angiotensin II receptors
• ex. are on pg.170
• PC: dizzy,hypotension,swelling,hyperkalemia
• Interactions: NSAIDS,potassium drugs will increase risk of hyperkalemia, avoid in pt. with bilateral renal artery stenosis or stenosis in single kidney, avoid in pregnancy

• MOA:inhibit human renin, thus decrease plasma renin activity and inhibit conversion of angiotensin to angio.-1
• ex. aliskiren(Tekturna)
• PC:hypotension, diarrhea, swelling
• Interactions: cyclosporine,potassium drugs may increase risk of hyperkalemia, ketokonazole, avoid in preganant women

true

• BP>180(SBP) or >120(DBP) with acute or ongoing target organ damage
• goal is to reduce mean arterial pressure by no more than 25% within min to hrs (reach BP of 160/100 within 2-6hrs)
• tx: pg 173

• accelerated elevations in BP in absence of new or progressive target organ damage, thus immediate lowering of BP is not required
• ex. of drugs used is on pg.173