<120 and

<80

120-139 or

80-89

lifestyle modifications

140-159 or

90-99

Lifestyle mods.

Thiazide diuretic for most - may consider ACEI, ARB, BB, CCB (compelling indictions)

>160 or

>100

Secondary causes of HTN

• Renal parenchymal dz
• Renovascular dz
• Drugs
• Primary aldosteronism
• Sleep apnea
• Renin-producing tumors
• Endocrine: hyper/hypothyroid, acromegaly, Cushing's, hyperparathyroidism (high Ca), CAH, pheochromocytoma
• Corarctation of aorta

NSAIDS

estrogens (OCPs)

appetite suppressants

corticosteroids

sympathomimetics

• Eyes - AV nicking, cotton wool spots, scotoma, hemorrhages.
• CNS - stroke (hemorrhagic, ischemic)
• Heart - CAD, LVH, CHF, MI.
• Peripheral vascular dz, aortic dissection.
• Kidney - nephrosclerosis, decreased GFR --> renal failure.

• low HDL, high LDL
• age >45 for men, >55 for women
• smoking
• DM
• obesity
• Fam hx premature MI or sudden cardiac death (M<55, F<65)
• sedentary
• low GFR (?)

When dx HTN, do these labs.  Why?

• Lytes - K & Na screen for hyperaldo; baseline before drug therapy 
• Ca - hyperparathyroidism
• BUN, Cr - end organ damage and secondary causes of HTN
• Urine dip - end organ, secondary causes, DM screen
• Lipids - additional risk factors
• Fasting glucose - Cushing's and additional risk factors
• ECG - baseline; LVH (poor sensitivity, good specificity)
• Hct - would pick up late kidney dz
• Urine microalbumin (optional) - early sign of kidney dz
• Echo (optional) - LVH
• Uric acid (optional) - get a baseline before using thiazide diuretic

• cough
• orthostatic hypotension (especially if volume depleted, eg on diuretic)
• angioedema
• hyperkalemia
• increased Cr (occasionally) --> usually tolerated b/c of benefits

bradycardia

AV block

CHF

constipation

edema

Non-dyhydropyridines affect cardiac conduction system.

Edema

Headache

relfex tachycardia (can counteract with BB)

Amlodipine has greater effect on peripheral vasculature than cardiac conduction system.

hypokalemia

hyperuricemia

hyponatremia

worsened glycemia control

photosensitivity (due to sulfur moiety)

*Must monitor K!!

side effects of alpha blockers

hypotension, lightheadedness (1st dose effect)

fluid retention, edema

side effects of beta blockers

bradycardia

depression

heart block

heart failure

bronchospasm (esp propranolol)

verapamil, diltiazem or beta blocker

beta blocker

ACEI

Tx of isolated systolic HTN?

Unique to older pts - due to stiffening of arteries.

Treating decreases incidence of stroke.

1st line drug: HCTZ (well tolerated, cheap).

Monitor for decreased DBP --> risk of dizziness, decreased filling of coronaries during diastole.

delayed femoral pulse,

discrepency in BP between 2 arms

Hypotension - HCTZ causes volume depletion --> activation of RAAS --> vasoconstriction --> maintain BP.  If give ACEI, leads to decreased AII --> peripheral vasodilation --> may cause hypotension.

Both cause bradycardia, heart block, heart block, hypotension.

SHOULD NOT BE USED TOGETHER.