either changes in cardiac output (CO) or total peripheral resistance (TPR)

increases in CO are commonly due to increased fluid retention and sodium intake; increases in TPR are commonly due to increased RAAS activity

(1) increased vasoconstriction

(2) increased release of aldosterone causing sodium and water retention in the nephrons

(3) increased ADH release due to high sodium levels which increases blood volume and pressure

systolic pressure greater than 140mmHg and diastolic pressure greater than 90mmHg on two separate occasions; patients with BP controlled with medication therapy are still considered hypertensive

stage I: systolic pressure 140-159mmHg and diastolic pressure 90-99mmHg

stage II: systolic pressure greater than 160mmHg and diastolic pressure greater than 100mmHg

work in the kidneys to decrease fluid volume thereby decreasing CO

indicated for HTN, HF, edema

increase sodium and chloride excretion in the distal renal tubules (e.g. hydrochlorothiazide (Hydrodiuril)

may lead to hypokalemia, dehydration, orthostatic hypotension and are dosed in the AM due to urinary frequency

these are a first-line antihypertensive therapy for most patients, but has decreased efficacy in patients with decreased renal function

prevent absorption of sodium and chloride in the proximal and distal renal tubules and loop of Henle to keep out of the bloodstream (e.g. furosemide (Lasix)

may lead to hypokalemia, dehydration, orthostatic hypotension and are dosed once or twice daily

increase sodium and water excretion and decrease potassium excretion in the distal renal tubules (e.g. spironolactone (Aldactone)

may cause hyperkalemia, dehydration, orthostatic hypotension, gynecomastia and are NOT indicated in patients with chronic kidney disease

dosed once to twice daily and patients should avoid potassium-containing salt substitutes

the "lol" class; works to influence heart rate and

indicated for HTN, MI, HF, angina, and dysrhythmias

side effects include hypotension, bradycardia, heart block, HF, dizziness, fatigue, masked hypoglycemia, depression, and impotence

these should be taken with food or after meals as they are better absorbed at lower pH

HTN emergency and/or arrhythmias due to abrubt discontinuation of beta blockers, calcium channel blockers, and central acting alpha agonists

doses MUST be titrated 1-2 weeks prior to discontinuation and patients should be closely monitored

act specifically on the heart's B1 receptors to decrease HR and contractility (e.g. atenolol (Tenormin), metoprolol tartrate (Lopressor), metoprolol succinate (Toprol XL), and carvedilol (Coreg)

atenolol should be dose-adjusted in renal dysfunction and metoprolol should be dose-adjusted in hepatic dysfunction

metoprolol succinate is extended release and should be dosed once daily; metoprolol tartrate is used in acute MI

act on B1 receptors in the heart to decrease HR and contractility and act on B2 receptors in the lungs leading to vasoconstriction and bronchoconstriction (e.g. propanolol (Inderal LA)

propanolol is chosen for migraine prophylaxis and causes the most depression due to lipophilic activity; due to B2 receptor activity, this is not a good choice for asthma sufferers

the "il" class; inhibit the conversion of angiotensin-I to angiotensin-II, resulting in decreased TPR via reduced vasoconstriction and reduced aldosterone release  

indicated for HTN, HF, acute MI, and diabetic nephropathology

 side effects include hypotension, hyperkalemia, acute renal failure, angioedema, dry-hacking cough due to bradykinin accumulation in the lungs

black box warning for pregnancy due to hx of miscarriages

creatinine must be monitored and an increase greater than 35% indicates renal failure; this class is often combined with thiazide diuretics

the "sartan" class; works in the RAAS as an angiotensin-II receptor antagonist blocking the binding of angiotensin-II to the AT1 receptor sites in blood vessels, resulting in decreased TPR; also blocks aldosterone secretion

indicated for HTN, HF, CVA, and diabetic nephropathology; side effects include hypotension, angioedema, and hyperkalemia

contraindicated in impaired renal and hepatic function and has a black box warning for pregnancy

works in the RAAS to directly inhibit renin and to inhibit the conversion of angiotensinogen to angiotensin-I, resulting in decreased TPR (e.g. aliskirin (Tekturna)

side effects include cough and angioedema and has a black box warning for pregnancy

include dihydropyridines and non-dihydropyridines

BP and HR must be monitored, especially when used along with beta-blockers

these are an effective antihypertensive treatment in African Americans

cause relaxation of cardiac and vascular smooth muscle by blocking flow of calcium which decreases BP (e.g. amlodipine (Norvasc), felodipine (Plendil), nifedipine (Procardia)

indicated for HTN and angina and side effects include peripheral edema and gingival hyperplasia (with felodipine and nifedipine)

doses should be titrated in the elderly and those with hepatic diseases; grapefruits cannot be consumed with felodipine or nifedipine

contraindicated in SHF (felodipine and nifedipine)

cause slower AV-node conduction and decreased HR by blocking the flow of calcium which decreases blood pressure (e.g. diltiazem (Cardizem, Dilacor XR, Cardizem CD, Cartia XT, Tiazac) and verapamil (Calan SR)

indicated for HTN, angina, DHF, atrial fibrillation and side effects include bradycardia, AV block, peripheral edema, gingival hyperplasia (diltiazem), and constipation (verapamil)

should not be used with beta blockers and digoxin

the "osin" class; decrease TPR by inhibiting alpha-1 receptors in the peripheral vessels and bladder leading to vasodilation and vessel relaxation

indicated for HTN and BPH

A "first-dose effect" may occur with severe side effects (dizziness, palpitations, orthostatic hypotension) after medication initiation then gradually decrease severity; should be taken at hs to prevent

this medication is considered an "add-on" as it is not typically started as a single therapy

acts on alpha-2 receptors in the vasomotor center of the brain to decrease TPR and HR (e.g. clonidine (Catapres)

side effects include skin irritation (patch), dry mouth, sedation/drowsiness, constipation

tablets are dosed every 12 hours and the patch is dosed once weekly

the patch is contraindicated in recent MI

<100mg/dL in patients with CAD, DM, PAD, abdominal aortic aneurysm, and CVD

<130mg/dL in patients without heart disease but have two or more risk factors: smoking, age (men 45 and up; women 55 and up), HTN, HDL<40mg/dL, and positive family history of heart disease in a member age 50 or below

HDL 60mg/dL and up is a negative risk factor

<160mg/dL in patients with 0-1 risk factor

"statin" drug class; inhibits cholesterol formation in the liver and decreases the amount of cholesterol circulating in the bloodstream

indicated for dyslipidemia and side effects include headache, rhabomylosis (muscle breakdown), myopathy (muscle pain); dosed at night for most effectiveness

contraindicated in liver disease and LFTs should be assessed prior to starting and q6wk after along with CPK levels; do not use gemifibrozil with rosuvastatin and do not use with fibrates, niacin, antibiotics, and amiodarone

this class causes the largest LDL reduction, but does not increase HDLs; cannot be consumed with grapefruit

"fibr" class of drugs; effective for decreasing triglycerides and is indicated in dyslipidemia

side effects include rash, diarrhea, decreases in WBC count, and myalgia

it is contraindicated in hepatic disease, gallbladder disease, and severe renal disease

binds to bile acids in the intestine to excrete in stool; indicated in dyslipidemia (e.g. cholestyramine (Questran) and cosevelam (Welchol)

many GI side effects are noted and it may interfere with fat soluble vitamin absorption; dosed once or twice daily with meals

do not use in patients with elevated triglycerides as an increase is noted

decreases absorption of cholesterol in the small intestine and indicated for dyslipidemia (e.g. ezetimibe (Zetia)

side effects include diarrhea, myalgia and are contraindicated in liver disease

ACE inhibitors

Spironolactone 

Beta blockers (e.g. carvediolol (Coreg) and metoprolol succinate (Toprol XL)

Note: all HF patients should be on an ACE-I and beta blocker unless contraindicated

works by several mechanisms, first causing increased ventricle contraction and secondly increasing parasympathetic activity which decreases HR; indicated in patients with systolic HF and atrial fibrillation

side effects include diarrhea, headache, bluish-green halos, arrhythmias; these side effects are indicative of toxicity

contraindications are hypokalemia, diastolic HF, AV block, and ventricular arrhythmia

digoxin improves symptoms but doesn't necessarily improve mortality

relaxes smooth muscle on vascular walls, primarily venous activity; side effects include headache, hypotension, dizziness, and lightheadedness

contraindicated in conjunction with ED medications

patients should be advised to contact MD after 3 sublingual doses, 5 minutes apart if angina does not cease

topical, oral, and ointment may lead to tolerance and should be allowed "free period"

primary and secondary prevention of acute MI, acute coronary syndromes, secondary prevention of atherosclerotic stroke, PAD

side effects include bleeding, ulcers, thrombocytopenia; aspirin is contraindicated in children and teens due to risk of Reye's Syndrome

treatment or prevention of VTE, stroke in patients with atrial fibrillation, acute MI

side effects include heparin-induced thrombocytopenia and bleeding; should monitor APTT with heparin and PT/INR with warfarin