Term
|
Definition
| blood pressure goal for general CAD prevention |
|
|
Term
|
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 |
|
|
Term
| 120/80 (after initial goal of 130/80 |
|
Definition
| blood pressure goal for patients with LVD |
|
|
Term
HCTZ
beta blocker (may mask the signs of hypoglycemia, beta 1 specific are preferred)
ACEi or ARB |
|
Definition
| first line therapy for hypertensive patients with diabetes |
|
|
Term
| ACEi or ARB but not ACEi and ARB together |
|
Definition
| therapy used in patients with microproteinuria or gross proteinuria |
|
|
Term
CrCl <60ml/min
SrCr >1.5
gross proteinuria |
|
Definition
| kidney disease can be diagnosed based on these three levels |
|
|
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) |
|
Definition
| therapy used for hypertensive patients with kidney disease |
|
|
Term
ACEi or ARB may decrease incidence
HCTZ or beta blockers may increase incidence |
|
Definition
| therapy for hypertensive patients with metabolic syndrome (prediabetic or at high risk for T2DM) |
|
|
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 |
|
Definition
| therapy for hypertensive patients with HF |
|
|
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) |
|
Definition
| therapy for hypertensive patients post MI |
|
|
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) |
|
Definition
| therapy for hypertensive patients with ischemic heart disease (stable angina or angina pectoris) |
|
|
Term
thiazide +/- ACEi (ARB if not tolerated)
do not lower BP precipitously after a stroke (BP goal of 160/100 until stable) |
|
Definition
| therapy for secondary stroke prevention |
|
|
Term
| non selective beta blocker |
|
Definition
| therapy for migraine, thyrotoxicosis, and essential tremor |
|
|
Term
|
Definition
| therapy for Reynaud's phenomenon |
|
|
Term
beta blocker or non DHP CCB
use extreme caution with the combination of both classes |
|
Definition
| therapy for patients with atrial tachyarrhythmia (atrial fibrillation, atrial flutter) |
|
|
Term
|
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 |
|
|
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 |
|
Definition
| patient characteristics of resistant hypertension |
|
|
Term
|
Definition
| goal BP for hypertension in pregnancy |
|
|
Term
1) methyldopa
2) labetolol or DHP CCB
avoid ACEi, ARB, renin antagonists, loop diuretics
thiazides - may continue if used prior to pregnancy |
|
Definition
1) first choice of drug for hypertension during pregnancy
2) alternative agents for hypertension during pregnancy |
|
|
Term
|
Definition
typically occurs post week 20 in primigravid women
BP >140/90 appearing post week 20 in the presence of proteinuria |
|
|
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 |
|
Definition
| treatment of pre-eclampsia |
|
|
Term
|
Definition
| BP of hypertensive urgency |
|
|
Term
captopril, clonidine, or labetolol
avoid precipitous BP reduction (avoid immediate acting DHP) |
|
Definition
|
|
Term
|
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) |
|
|
Term
MI or unstable angina
head trauma, CNS changes, stroke
abdominal pain, bruising, bloating |
|
Definition
| examples of target organ damage in HTN emergencies |
|
|
Term
|
Definition
1) goal BP 2-6 hours after a HTN emergency
2) goal BP 24-48 hours after a HTN emergency |
|
|
Term
sodium nitroprusside (may be dangerous in patients with kidney disease)
may be given instead IV hydralazine or IV beta blockers |
|
Definition
| 1st choice agent for HTN emergencies |
|
|
Term
| Systolic Hypertension in the Elderly Program (SHEP) |
|
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) |
|
|
Term
| Veterans Affairs Cooperative Study Group on Antihypertensive Agents |
|
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. |
|
|
Term
| Hypertension Outcomes Prevention Evaluation (HOPE) |
|
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) |
|
|
Term
|
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. |
|
|
Term
| Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trail (ALLHAT) |
|
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) |
|
|
Term
| ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) |
|
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 |
|
|
