Term
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Definition
blood pressure goal for general CAD prevention |
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Term
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Definition
blood pressure goal for patients with high CAD risk (DM, chronic kidney disease, CAD, carotid artery disease, peripheral artery disease, or abdominal aortic aneurism) stable angina post MI >10% Framingham score |
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Term
120/80 (after initial goal of 130/80 |
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Definition
blood pressure goal for patients with LVD |
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Term
HCTZ beta blocker (may mask the signs of hypoglycemia, beta 1 specific are preferred) ACEi or ARB |
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Definition
first line therapy for hypertensive patients with diabetes |
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Term
ACEi or ARB but not ACEi and ARB together |
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Definition
therapy used in patients with microproteinuria or gross proteinuria |
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Term
CrCl <60ml/min SrCr >1.5 gross proteinuria |
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Definition
kidney disease can be diagnosed based on these three levels |
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Term
ACEi or ARB do not use if SrCr is >2.5 for males and >2 for females do not use if K>5 loop diuretics may be needed later in the disease (CrCl <30 generally) |
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Definition
therapy used for hypertensive patients with kidney disease |
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Term
ACEi or ARB may decrease incidence HCTZ or beta blockers may increase incidence |
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Definition
therapy for hypertensive patients with metabolic syndrome (prediabetic or at high risk for T2DM) |
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Term
use beta blocker (B1) or alpha-beta blocker + ACEi (ARB if not tolerated) aldosterone antagonists should be added if stage 3 or 4 HF or EF <40% loop diuretics if fluid overload occurs (peripheral edema, positional shortness of breath) thiazides may be added if additional control is needed hydralazine/isosorbide dinitrate has added benefits in blacks contraindicated: non-DHP, clonidine, alpha blockers |
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Definition
therapy for hypertensive patients with HF |
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Term
beta blocker (B1 preferred) + ACEi (ARB if not tolerated (patients should be hemodynamically stable before added a beta blocker) aldosterone antagonists may add benefit thiazides may add additional benefits if tolerated non-DHP may be used rather than beta blockers if contraindicated (unless HF is also present) |
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Definition
therapy for hypertensive patients post MI |
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Term
beta blocker (B1 preferred) is 1st choice long acting DHP CCB may be added long acting non DHP may be used instead of beta blocker if absolutely necessary use combination of beta blocker and non DHP very cautiously (heart block) |
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Definition
therapy for hypertensive patients with ischemic heart disease (stable angina or angina pectoris) |
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Term
thiazide +/- ACEi (ARB if not tolerated) do not lower BP precipitously after a stroke (BP goal of 160/100 until stable) |
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Definition
therapy for secondary stroke prevention |
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Term
non selective beta blocker |
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Definition
therapy for migraine, thyrotoxicosis, and essential tremor |
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Term
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Definition
therapy for Reynaud's phenomenon |
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Term
beta blocker or non DHP CCB use extreme caution with the combination of both classes |
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Definition
therapy for patients with atrial tachyarrhythmia (atrial fibrillation, atrial flutter) |
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Term
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Definition
hypertension not at goal despite concurrent use of 3 or more drugs from different classes (ideally one of them is a diuretic) 20-30% of patients with hypertension will have this |
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Term
older age high baseline blood pressure obesity excessive dietary salt intake chronic kidney disease diabetes left ventricular hypertrophy black race female sex residence in the southeast US |
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Definition
patient characteristics of resistant hypertension |
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Term
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Definition
goal BP for hypertension in pregnancy |
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Term
1) methyldopa 2) labetolol or DHP CCB avoid ACEi, ARB, renin antagonists, loop diuretics thiazides - may continue if used prior to pregnancy |
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Definition
1) first choice of drug for hypertension during pregnancy 2) alternative agents for hypertension during pregnancy |
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Term
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Definition
typically occurs post week 20 in primigravid women BP >140/90 appearing post week 20 in the presence of proteinuria |
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Term
delivery if not delivery then bed rest, limited activity, close monitoring drug therapy prior to delivery with goal DBP of 95-105 mmHg IV hydralazine commonly used |
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Definition
treatment of pre-eclampsia |
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Term
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Definition
BP of hypertensive urgency |
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Term
captopril, clonidine, or labetolol avoid precipitous BP reduction (avoid immediate acting DHP) |
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Definition
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Term
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Definition
those with evidence of acute organ target-organ damage and markedly elevated BP (>180/120) require immediate hospitalization lower MAP by 25% in minutes to hours (avoid precipitous drops in BP) |
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Term
MI or unstable angina head trauma, CNS changes, stroke abdominal pain, bruising, bloating |
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Definition
examples of target organ damage in HTN emergencies |
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Term
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Definition
1) goal BP 2-6 hours after a HTN emergency 2) goal BP 24-48 hours after a HTN emergency |
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Term
sodium nitroprusside (may be dangerous in patients with kidney disease) may be given instead IV hydralazine or IV beta blockers |
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Definition
1st choice agent for HTN emergencies |
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Term
Systolic Hypertension in the Elderly Program (SHEP) |
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Definition
Design: patients with isolated systolic BP >60 yo Drugs: chlorthalidone 12.5mg qd, then chlorthalidone 25mg qd, then add atenolol 25mg. Results: drug therapy reduced the incidence of cardiovascular events and stroke (beginning of the evidence that thiazides decrease morbidity and mortality) |
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Term
Veterans Affairs Cooperative Study Group on Antihypertensive Agents |
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Definition
Drugs: Randomized to: 1) placebo, 2) HCTZ 12.5-50mg qd, 3) atenolol 25-100mg/d 4) clonidine 0.2-0.6mg/d 5) captopril 25-100mg/d 6) prazosin 4-20 mg/d 7) diltiazem SR 120-360 mg/d Results: Race and age differences existed in response to drugs. HCTZ was the best in older blacks, captopril was the worst. This is the beginning of prejudice against ACEi in black patients. HCTZ was least effective in young whites. |
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Term
Hypertension Outcomes Prevention Evaluation (HOPE) |
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Definition
Drugs: ramipril 2.5-10mg/d vs. placebo Results: ACEi reduces the rates of death, MI, and stroke (made ACEi a first line therapy) |
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Term
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Definition
These two trials both compared DHP CCB to an ACEi in patients with diabetes. While patients receiving CCB had some small benefit, those receiving ACEi had lower rates of coronary events and death. |
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Term
Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trail (ALLHAT) |
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Definition
1) Completed in 2002, comparing chlorthalidone, amlodipine, and lisinopril as well as comparisons of hyperlipidemia treatment modalities. Outcome: thiazides are superior to ACEi or CCB in preventing coronary outcomes, and should be considered first line therapy for HTN. 2) The doxazosin vs. chlorthalidone arm was stopped. Those receiving doxazosin had 25% more cardiovascular events and were twice as likely to be hospitalized for congestive heart failure as those receiving chlorthalidone. (alpha blockers aren't used as 1st line therapy b/c of this trial) |
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Term
ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) |
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Definition
1) established that telmisartan reduces morbidity and mortality in a broad cross section of patients at high risk for heart and vascular events, to an extent similar to that of the ACEi ramipril. In addition, it demonstrated that telmisartan is somewhat better tolerated than ramipril. 2) the combination of ramipril and telmisartan resulted in increased incidence of renal failure and dialysis that either agent alone. 3) the results of this trial is that many clinicians feel that ACEi/ARB combo should no longer be used |
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