PHRD6085 Pharmacotherapy Lecture 5 - Hypertension Overview (Part 1)
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criteria needed to dx hypertension
elevated value from the average of 2+ measurements, present during 2+ clinical encounters
overall goal of treating HTN
reduce hypertesnion-associated morbidity & mortality from CV events
evidence from clinical trials show that antihypertensive drug therapy substantially reduces...
risks of CV events and death in patients with high BP
stage 1 HTN BP
stage 2 HTN BP
according to ASH-ISH, at what age should the goal BP be <140/90mmHg?
under 80 years
according to JNC8, at what age should the goal BP be <140/90mmHg?
under 60 years
according to the ADA, what is the goal BP value for pts w/ diabetes?
according to KDIGO, what is the goal BP value for pts w/ CKD (nondialysis) who have persistent urine albumin excretion of >30mg/24hr?
SBP reduction due to weight loss
5-20mmHg per 10kg loss
SBP reduction due to use of DASH-type diet
SBP reduction due to reduced salt intake
SBP reduction due to increased physical activity
SBP reduction due to moderation of alcohol intake
salt intake recommendation
reduce daily dietary sodium intake to 1.5g/day sodium (3.8g/day NaCl)
physical activity recommendation
regular aerobic physical activity at least 30min/day, most days of the week
alcohol intake moderation recommendation
- 2 drink equivalents/day in men
- 1 drink equivalent/day in women & lighter-weight persons
which anti-HTN drug is NOT a first-line option for general CV event prevention?
first-line tx for a black patient with stage 1 HTN, no compelling indication, and under 80yo
CCB or thiazide
first-line thx for a patient w/ stage 2 HTN under 80yo
- 2 drug combo:
- [thiazide or CCB] + [ACEi or ARB]
list 6 compelling indications
- 1) HF w/ reduced ejection fraction
- 2) post-MI
- 3) coronary artery disease (CAD)
- 4) diabetes mellitus
- 5) CKD
- 6) recurrent stroke prevention
standard therapy in pts w/ heart failure w/ reduced ejection fraction (HFrEF)
- 3-drug tx:
- 1) diuretic (dec edema)
- 2) ACEi or ARB (dec CV risk)
- 3) beta-blocker (inc EF)
name a drug and starting dose for HFrEF tx
- bisoprolol - 1.2mg QD
- carvedilol - 3.125mg BID
- metoprolol XL - 12.5-25mg QD
target dose of metoprolol XL in HFrEF
tx for pt post-MI
beta-blocker, then add ACEi shortly after
- BB reduces myocardium stimulation
- ACEi promotes cardiac remodeling
tx for pt w/ CAD
- (same as post-MI)
- beta-blocker, then add ACEi shortly after
add-on tx CCB (ischemia) or thiazide (lower BP)
tx for pt w/ diabetes mellitus (DM)
ACEi or ARB
add-on diuretic or BB
tx for pt w/ CKD
ACEi or ARB
proven to reduce rate of CKD progression + dec BP
tx for recurrent (ischemic) stroke prevention
- ACEi + thiazide
age considered "elderly"
what are older patients often at risk for when anti-HTN tx is started?
first-line tx for pts 60+
CCB or thiazide
how to avoid orthostatic HTN risk in eldery
- avoid volume depletion
- slow dose titration
BP goal in elderly
(unless has DM or CKD)
What would you like to do?
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