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criteria needed to dx hypertension
elevated value from the average of 2+ measurements, present during 2+ clinical encounters
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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
-
prehypertension BP
(120-139)/(80-89)
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stage 1 HTN BP
(140-159)/(90-99)
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stage 2 HTN BP
 160/ 100
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according to ASH-ISH, at what age should the goal BP be <140/90mmHg?
under 80 years
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according to JNC8, at what age should the goal BP be <140/90mmHg?
under 60 years
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according to the ADA, what is the goal BP value for pts w/ diabetes?
<140/80
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according to KDIGO, what is the goal BP value for pts w/ CKD (nondialysis) who have persistent urine albumin excretion of >30mg/24hr?
<130/80
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SBP reduction due to weight loss
5-20mmHg per 10kg loss
-
SBP reduction due to use of DASH-type diet
8-14mmHg
-
SBP reduction due to reduced salt intake
2-8mmHg
-
SBP reduction due to increased physical activity
4-9mmHg
-
SBP reduction due to moderation of alcohol intake
2-4mmHg
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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
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which anti-HTN drug is NOT a first-line option for general CV event prevention?
beta-blockers
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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
200mg daily
-
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
- thiazide
- OR
- ACEi + thiazide
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age considered "elderly"
80+yo
-
what are older patients often at risk for when anti-HTN tx is started?
orthostatic hypotension
-
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
<150/90mmHg
(unless has DM or CKD)
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