PHRD6085 Pharmacotherapy Lecture 5 - Hypertension Overview (Part 1)

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daynuhmay
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281601
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PHRD6085 Pharmacotherapy Lecture 5 - Hypertension Overview (Part 1)
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2014-08-29 01:09:02
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Hypertension
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Hypertension
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  1. criteria needed to dx hypertension
    elevated value from the average of 2+ measurements, present during 2+ clinical encounters
  2. overall goal of treating HTN
    reduce hypertesnion-associated morbidity & mortality from CV events
  3. evidence from clinical trials show that antihypertensive drug therapy substantially reduces...
    risks of CV events and death in patients with high BP
  4. prehypertension BP
    (120-139)/(80-89)
  5. stage 1 HTN BP
    (140-159)/(90-99)
  6. stage 2 HTN BP
    160/100
  7. according to ASH-ISH, at what age should the goal BP be <140/90mmHg?
    under 80 years
  8. according to JNC8, at what age should the goal BP be <140/90mmHg?
    under 60 years
  9. according to the ADA, what is the goal BP value for pts w/ diabetes?
    <140/80
  10. 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
  11. SBP reduction due to weight loss
    5-20mmHg per 10kg loss
  12. SBP reduction due to use of DASH-type diet
    8-14mmHg
  13. SBP reduction due to reduced salt intake
    2-8mmHg
  14. SBP reduction due to increased physical activity
    4-9mmHg
  15. SBP reduction due to moderation of alcohol intake
    2-4mmHg
  16. salt intake recommendation
    reduce daily dietary sodium intake to 1.5g/day sodium (3.8g/day NaCl)
  17. physical activity recommendation
    regular aerobic physical activity at least 30min/day, most days of the week
  18. alcohol intake moderation recommendation
    •  2 drink equivalents/day in men
    • 1 drink equivalent/day in women & lighter-weight persons
  19. which anti-HTN drug is NOT a first-line option for general CV event prevention?
    beta-blockers
  20. first-line tx for a black patient with stage 1 HTN, no compelling indication, and under 80yo
    CCB or thiazide
  21. first-line thx for a patient w/ stage 2 HTN under 80yo
    • 2 drug combo:
    • [thiazide or CCB] + [ACEi or ARB]
  22. 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
  23. 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)
  24. name a drug and starting dose for HFrEF tx
    • bisoprolol - 1.2mg QD
    • carvedilol - 3.125mg BID
    • metoprolol XL - 12.5-25mg QD
  25. target dose of metoprolol XL in HFrEF
    200mg daily
  26. tx for pt post-MI
    beta-blocker, then add ACEi shortly after 

    • BB reduces myocardium stimulation
    • ACEi promotes cardiac remodeling
  27. 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)
  28. tx for pt w/ diabetes mellitus (DM)
    ACEi or ARB

    add-on diuretic or BB
  29. tx for pt w/ CKD
    ACEi or ARB 

    proven to reduce rate of CKD progression + dec BP
  30. tx for recurrent (ischemic) stroke prevention
    • thiazide 
    • OR
    • ACEi + thiazide
  31. age considered "elderly"
    80+yo
  32. what are older patients often at risk for when anti-HTN tx is started?
    orthostatic hypotension
  33. first-line tx for pts 60+
    CCB or thiazide
  34. how to avoid orthostatic HTN risk in eldery
    • avoid volume depletion
    • slow dose titration
  35. BP goal in elderly
    <150/90mmHg

    (unless has DM or CKD)

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