Term
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Definition
Older > younger;
Men > women if <45 yrs old;
Men = women b/w 45-55 yrs old;
Men < women if >55 yrs old;
African Americans > Caucasians > Mexican Americans; |
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Term
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Definition
| persistent, elevated arterial blood pressure |
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Term
| Mean Arterial Pressure (MAP) |
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Definition
= 1/3 * SBP + 2/3 * DBP;
average pressure through cardiac cycle |
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Term
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Definition
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Term
|
Definition
determines SYSTOLIC BP;
Determined by: stroke volume, heart rate, venous capacitance |
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Term
| Total Peripheral Resistance (TPR) |
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Definition
determines DIASTOLIC BP;
determined by:
contraction, dilation of arterioles |
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Term
| Essential HTN = Primary HTN |
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Definition
NO IDENTIFIABLE cause;
90-95% of all cases |
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Term
|
Definition
HTN with an identifiable cause;
Renal: increased renin secretion due to stenosis or decreased perfusion from inflammatory or fibrotic changes in renal vessels;
Endocrine: primary aldosteronism, Cushing's syndrome, pheochromocytoma;
Vascular: narrowing/constricting of aorta;
Pregnancy: increased estrogen;
Drug-induced: corticosteroids, OCPs/estrogen, alcohol, amphetamines, NSAIDs, cylcosporine & tacrolimus (calcineurin inhibitors), decongestants, eryhtropoiesis stimulating agents (eryhtropoietin, darbapoietin), thyroid hormone excess, cocaine, ephedra, anabolic steroids |
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Term
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Definition
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Term
|
Definition
SBP: 120-139; OR
DBP: 80-89; |
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Term
|
Definition
SBP: 140-159; OR
DBP: 90-99; |
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Term
|
Definition
SBP: > or = 160; OR
DBP: > or = 100; |
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Term
| Isolated Systolic HTN (ISH) |
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Definition
SBP > or = 140 and DBP <90;
More common in elderly;
Result of decreased flexibility of arterial wall; |
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Term
|
Definition
rise in BP within medical setting - returns to normal within a few hrs of leaving;
Occurs in approx. 15-20% of pts;
More likely to occur in young, female pts;
Home BP monitoring may be useful |
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Term
| Major Risk Factors for CVD |
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Definition
| HTN, smoking, obesity (BMI > 30), physical inactivity, dyslipidemia, diabetes mellitus, microalbuminuria OR GFR <60 mL/min, Age (>55 men, >65 women), family hx of premature dx (Male relative <55 yrs, female relative <65 yrs) |
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Term
| RISK of CVD in pts w/ HTN determinants |
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Definition
BP;
presence or absence of risk factors for CVD;
presence or absence of target organ damage |
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Term
| Target Organ Damage/Disease that can cause CVD |
|
Definition
heart diseases: LVH, angina/prior MI, CABG (bypass), HF;
Brain: stroke, transient ischemic attack;
Nephropathy: SCr > or = 1.5 (males) or 1.3 (females), proteinuria & microalbuminuria;
Peripheral arterial dx: absence of 1 or more major pulses in extremities w/ or without intermittent claudication, anuerysm, carotid artery stenosis |
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Term
|
Definition
prevent morbidity & premature morbidity;
decrease cardiovascular risk;
prevent or reverse end-organ damage;
attain target BP goal;
minimize adverse effects & drug toxicity |
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Term
|
Definition
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|
Term
| Diabetes, Kidney Dx, CAD (angina, NSTEMI or STEMI - MI), CAD risk equivalents (PAD, AAA, carotid artery dx), high CAD risk (>10-20% Framingham), HF Goal BP |
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Definition
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Term
|
Definition
recommend for ALL pts;
Use as adjunctive therapy for pts on medications;
Lifestyle Modifications:
- lose weight (if overweight), limit EtOH intake, increase aerobic physical activity, reduce sodium intake, diet modifications (fruits, veggies, low-fat dairy, decreased sat./total fat), stop smoking, reduce intake of dietary saturated fat & cholesterol |
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Term
| Average Decrease in SBP w/ Weight Reduction |
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Definition
| Decreases 5-20 mmHg/10 kg weight loss |
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Term
| Average Decrease in SBP with Moderate Alcohol Consumption |
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Definition
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|
Term
| Average Decrease in SBP with Sodium Restriction |
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Definition
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Term
| Average Decrease in SBP with DASH Eating Plan |
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Definition
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Term
| Average Decrease in BP with Physical Activity |
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Definition
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Term
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Definition
| 1st line drug therapy, unless compelling indications; |
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Term
| If SBP >20 mmHg or DBP >10 mmHg above goal: |
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Definition
| INITIATE drug therapy with 2 drugs (1 should be thiazide diuretic); combo products may be useful |
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Term
| Initial Drug Choices for Stage 1 HTN without Compelling Indications |
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Definition
| Start with thiazide diuretic alone; ACE-I, ARB, CCB are also all valid alternatives |
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Term
| Initial Drug Choices for Stage 2 HTN (or >20/10 over goal) without Compelling Indications |
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Definition
| Start with 2 drug combination (generally one is a thiazide diuretic) |
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Term
| Preferred Therapy for HTN w/ CAD prevention (no compelling indication, BP Goal = <140/90) |
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Definition
| ACEI, ARB, CCB, thiazide OR combo |
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Term
| Preferred Therapy for HTN w/ High CAD Risk or CAD Risk Equivalents (Goal BP = <130/80) |
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Definition
| ACE-I, ARB, CCB, thiazide, OR combo |
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Term
| Preferred Therapy for HTN w/ Renal Disease (BP Goal: <130/80 or <125/75) |
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Definition
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Term
| Preferred Therapy for HTN with CAD: Angina, MI (BP Goal: <130/80) |
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Definition
| Beta-blocker +/- ACE-I or ARB |
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Term
| Preferred Therapy for HTN with Heart Failure (Goal BP: <130/80 or optional: <120/80) |
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Definition
| Beta-Blocker +/- ACE-I or ARB +/- diuretic +/- aldosterone antagonist (Class III or IV only) |
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Term
| Preferred Therapy for HTN with Diabetes Mellitus (Goal BP = <130/80) |
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Definition
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Term
| Pros of Thiazide & Thiazide-like diuretics (hydrochlorothiazide, metolazone, chlorthalidone) |
|
Definition
literature-based evidence of decreased morbidity & mortality;
effective;
low-cost;
may be of benefit in salt-sensitive pts, especially African-Americans; |
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Term
| Adverse Effects of Thiazide Diuretics |
|
Definition
volume depletion, frequent urination;
decreased K, Mg, Na levels;
increased uric acid levels (caution w/ gout pts);
increased Ca levels;
sexual dysfunction;
photosensitivity/rash - recommend sunscreen; |
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Term
|
Definition
Used as 1st line therapy;
recommended agent of choice when combo therapy is needed;
diuretic of choice for HTN w/ normal renal fcn (NOT useful if CrCl <30 mL/min; |
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Term
| Pros of Loop Diuretics (furosemide, bumetanide, torsemide, ethacrynic acid) |
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Definition
literature-based evidence of decreased morbidity & mortality;
low-cost; useful in pts w/ CrCl <30 mL/min;
may be of benefit in salt-sensitive pts, including African-Americans; |
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Term
| Adverse Effects of Loop Diuretics |
|
Definition
volume depletion, frequent urination;
decreased K, Mg, Na;
increased uric acid levels (caution in gout pts);
decreased Ca levels;
photosensitivity/rash (sunscreen);
tinnitus or loss of hearing (high doses); |
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Term
| K-Sparing Diuretics (amiloride, spironolactone, triamterene) |
|
Definition
weak antihypertensive agents when used alone - better if used in combination;
Effective in combo to prevent HYPOkalemia;
ADRs: increased K, uric acid levels (HYPERkalemia, Gout), gynecomastia, irregular menses; |
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Term
| Drug Interactions of Diuretics |
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Definition
| decreased effect w/ NSAIDs, steroids; increased Li levels |
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Term
| Monitoring Parameters of Diuretics |
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Definition
| BP; BMP-7, especially SCr, electrolytes [K], Mg; Weight; Uric Acid |
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Term
| Patient Education for Diuretics |
|
Definition
1) Increased frequency & urgency of urination;
2) May cause thirst & dry mouth --> use sugarless hard candy;
3) Sodium restriction is important |
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Term
| hydrochlorothiazide (Microzide) |
|
Definition
thiazide diuretic;
Dose: 12.5 - 25 mg;
Daily Frequency: 1 |
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Term
|
Definition
loop diuretic;
Dose: 20-80 mg;
Daily Frequency: 1-2 |
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Term
| Triamterene/Hydrochlorothiazide (Dyazide) |
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Definition
potassium-sparing diuretic/thiazide diuretic combo;
Dose: 37.5-75 mg/25-50 mg;
Daily Frequency: 1 |
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Term
| Beta-Adrenergic Blockers (atenolol, bisoprolol, metoprolol, nadolol, nebivolol, propanolol, timolol) |
|
Definition
MoA: decrease in CO due to decrease in HR & contractility, reduction in renin activity, inhibition of NE release;
PROS:
- lit.-based evidence of decreased morbidity & mortality;
- first line: post-MI (CAD), angina;
- useful in heart failure;
- beneficial for pts w/ migraines, essential tremor, anxiety; |
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Term
| Adverse Effects of Beta-Blockers |
|
Definition
bradycardia;
exercise intolerance;
bronchospasm;
glucose intolerance;
sexual dysfunction;
masks symptoms of hypoglycemia (except sweating); |
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Term
| acebutalol, pindolol (ISA - intrinsic sympathomimetic activity) |
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Definition
| beta-blockers that have partial Beta-agonist activity (ISA) and should be AVOIDED when treating HTN |
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Term
| carvedilol, labetalol (alpha/beta-blocker) |
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Definition
| combined alpha/beta-blockers that cause peripheral vasodilation and can cause MORE HYPOtension |
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Term
|
Definition
more lipid soluble beta-blockers that cause more CNS adverse effects (i.e. depression);
increases nitric oxide;
also undergoes extensive first-pass metabolism |
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Term
|
Definition
beta-blockers that increase nitric oxide;
also excreted RENALLY |
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Term
| Drug Interactions with Beta-Blockers |
|
Definition
concomitant non-dihydropyridine CCBs may lead to heart block;
concomitant sympathomimetics (cocaine, amphetamines) cause unopposed alpha vasoconstriction |
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Term
| Monitoring Parameters for Beta-Blockers |
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Definition
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|
Term
| Patient Education for Beta-Blockers |
|
Definition
do NOT abruptly D/C: tachycardia, aggravation of angina, death;
educate pts w/ diabetes of masking effect of hypoglycemia |
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Term
|
Definition
cardioselective beta-blocker (B1>>>B2);
Dose: 25-100 mg once daily |
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Term
| metoprolol tartrate (Lopressor) |
|
Definition
cardioselective beta-blocker (B1>>>B2);
Dose: 50-200 mg twice daily; |
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Term
| metoprolol succinate (Toprol XL) |
|
Definition
cardioselective beta-blocker (B1>>>>B2);
Dose: 50-200 mg once daily; |
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Term
|
Definition
mixed alpha/beta blockers;
Dose: 12.5-50 mg twice daily |
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Term
| Angiotensin-Converting Enzyme Inhibitors (ACE-Is) - benazepril, captopril, enalapril, lisinopril |
|
Definition
Used as 1st line agents for HTN;
MoA: inhibits ACE --> decreases formation of Angiotensin II --> decreased vasoconstriction; also decreases aldosterone production;
Pros:
- slows progression of DIABETIC nephropathy;
- decreased morbidity & mortality in HF & acute-MI; |
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Term
| Adverse Effects of ACE-Is |
|
Definition
non-productive, dry cough;
hyperkalemia;
angioedema (more common in African-Americans & smokers);
acute renal failure (RARE); |
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Term
| Absolute Contraindications for ACE-Is |
|
Definition
bilateral renal artery stenosis;
pregnancy |
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Term
| Hyperkalemia due to ACE-Is |
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Definition
| seen in pts w/: renal dx, diabetes, concimitant use of NSAIDs, K supplements, K-sparing diuretics, aldosterone antagonists, ARBs, direct renin inhibitors; |
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Term
| Drug Interactions with ACE-Is |
|
Definition
NSAIDs may DECREASE efficacy;
May increase Li levels;
Caution w/ use of K-supplements |
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Term
| Monitoring Paramters for ACE-Is |
|
Definition
BP;
BMP-7, especially SCr, electrolytes (K);
Cough;
Angioedema; |
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Term
|
Definition
ACE-I
Dose: 10-40 mg daily or BID |
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Term
| lisinopril (Prinivil, Zestril) |
|
Definition
ACE-I;
Dose: 10-40 mg daily |
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Term
|
Definition
ACE-I;
Dose: 2.5-10 mg daily or BID |
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Term
| Angiotensin-II Receptor Blockers (ARBs) - candesartan, losartan, valsartan |
|
Definition
MoA: inhibits ALL Ang-II receptors;
Pros: slows progression of diabetic nephropathy, beneficial in HF;
ADRs: similar to ACE-Is but LESS incidence of cough;
CAN be given to pts w/ hx of ACE-I-induced angioedema if: mild-moderate rxna AND compelling indication; |
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Term
|
Definition
ARB;
Dose: 50-100 mg daily or BID |
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Term
|
Definition
ARB;
Dose: 80-320 mg once daily |
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Term
| losartan/hydrochlorothiazide (Hyzaar) |
|
Definition
combination ARB/thiazide diuretic;
Dose: 50/12.5 - 100/25 mg once daily |
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Term
|
Definition
MoA: direct renin inhibitor;
Pros: additional option for BP control;
ADRs: diarrhea, cough, angioedema, anemia, hyperkalemia, creatine kinase increases;
C/I'd in pregnancy;
Drug Interactions: metabolized by 3A4 - irbesartan decreases, atorvastatin increases;
Monitoring Parameters:
-BP, BMP (K, SCr), cough, angioedema, diarrhea
High fat meals may reduce absorption;
Dose: 150-300 mg daily |
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Term
| non-dihydropyridine CCBs - diltiazem, verapamil |
|
Definition
MoA: decrease HR, slow AV nodal conduction;
Pros: efficacious, useful in pts w/ tachycardia & atrial fibrillation, MAY delay onset of diabetic nephropathy, no changes in lipid panel;
ADRs: bradycardia, 1st-degree heart block, negative inotropic effects, constipation, anorexia;
Use w/ caution w/ Beta-blockers --> heart block; Avoid in systolic HF;
Different formulations are NOT interchangeable;
Monitoring Parameters: BP, HR, constipation;
Pt Education: constipation management (increase fluid intake, high fiber diet, regular exercise); |
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Term
| diltiazem SR (Cardizem SR) |
|
Definition
non-dihydropyridine CCB;
Dose: 180-360 mg BID |
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Term
| diltiazem SR (Cardizem CD, Cartia XT) |
|
Definition
non-dihydropyridine CCB;
Dose: 120-480 mg once daily |
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Term
|
Definition
non-dihydropyridine CCB;
Dose: 180-480 mg once daily or BID |
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Term
| dihydropyridine CCBs (amolidipine, felodipine, nifedipine, nicardipine, isradipine) |
|
Definition
Pros: efficacious, no changes in lipid profiles, effective in pts w/ ISOLATED SYSTOLIC HTN, drug of choice for blood pressure control in COMBO therapy when pt is already on beta-blocker;
ADRs: HA, tachycardia (especially IR), peripheral edema, flushing;
Long-acting preferred over short-acting;
Avoid in systolic HF;
Monitoring Parameters: BP, HR, peripheral edema;
Patient Education: peripheral edema, do not crush or chew SR products, avoid large qts of grapefruit juice |
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Term
|
Definition
dihydropyridine CCB;
Dose: 2.5-10 mg once daily |
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Term
|
Definition
dihydropyridine CCB;
Dose: 5-20 mg once daily; |
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Term
| alpha-1 blockers (prazosin [Minipress], doxazosin [Cardura], terazosin [Hytrin]) |
|
Definition
MoA: inhibit uptake of catecholamines in smooth muscle & cause vasodilation;
Pros: beneficial in pts w/ BPH;
ADRs: "first dose" syncope, postural hypotension, tachycardia, edema due to Na/H2O retention w/ chronic admin.;
DO NOT use as initial 1st line therapy or as monotherapy;
If used, must use w/ diuretic to limit fluid retention;
Monitoring Parameters:
- BP, orthostasis;
Patient Education:
- take at bedtime;
- rise slowly from seated/supine position |
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|
Term
| central alpha-2 agonists - clonidine [Catapres], methyldopa [Aldomet] |
|
Definition
MoA: stimulate central pre-synaptic alpha-2 receptors;
Pros: available as patch (improves compliance), most safety & efficacy in pregnancy (methyldopa);
ADRs: sedation, dry mouth, bradycardia, sexual dysfunction, skin rash, depression, hemolytic anemia, hepatic dysfunction;
Significant rebound HTN if abrupt D/C (taper over 2-4 days);
Best in combo w/ diuretic;
Avoid in elderly;
Have pt take oral dose day of converting to patch! |
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|
Term
| direct vasodilators - hydralazine [Apresoline), minoxidil [Loniten] |
|
Definition
MoA: direct arteriolar smooth muscle relaxation;
Pros: effective for REFRACTORY HTN;
ADRs:
H - tachycardia, fluid retention, worsening angina, HA, drug-induced lupus, peripheral neuropathy;
M - tachycardia, fluid retention, worsening angina, hypertrichosis (increased hair growth);
Causes profound vasodilation;
Need to use diuretic & beta-blocker in combo to counteract compensatory changes to profound vasodilation;
LAST-LINE THERAPY;
Monitoring: BP, HR, edema, ADRs; |
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Term
| 1st line agents for HTN with High Coronary Disease Risk |
|
Definition
1) diuretic;
2) beta-blocker (depends on which guidelines you use);
3) ACE-I;
4) ARB;
5) CCB |
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Term
| 1st line agents for HTN with DM |
|
Definition
1) diuretic;
2) beta-blocker (per JNC, NOT AHA);
3) ACE-I;
4) ARB;
5) CCB; |
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|
Term
| 1st line agents for HTN with CKD |
|
Definition
|
|
Term
| 1st line agents for HTN with Recurrent Stroke Prevention |
|
Definition
|
|
Term
| 1st line agents for HTN with Stable Angina (High Coronary Disease Risk) |
|
Definition
1) beta-blocker - DRUG OF CHOICE;
2) CCB (long-acting) - Alternative |
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