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HYPERTENSION

When to consider secondary HTN: young patient, very high BP, HTN difficult to control

Causes of secondary hypertension  
-Pheocromocytoma Hyperthyroidism
-RAS (bilateral renal artery stenosis) Hyperparathyroidism
-Renal parenchymal diz Primary Aldosteronism
-Polycystic kidneys Cushing Syndrome
-OSA (Obstructive Sleep apnea) Aortic Coarctation

CAD Risk factors (Mnemonic: CDEFGH) Hypertension complications
C – Cigarettes CVA
D – Diabetes CAD
E – Epidemiology (male>45,female>55) CHF/Cardiomyopathy
F – Family History PVD
GGlycerides (hyperlipidemia) Kidney disease
H – Hypertension Retinopathy

Classes of anti-hypertensives Adding medications: AB/CD rule
A – Ace inhibitor/ARB/Alpha-blocker If initial drug is A or B,
then second drug should be C or D
B – Beta blocker
C – Calcium channel blocker  
D – Diuretic If initial drug is C or D,
then second drug should be A or B
E – Everything else: vasodilators,
Minoxidil, Centrally acting  
   

   
Ace Inhibitor PROS Ace Inhibitor CONS
DM, CHF, Post MI, CAD, Chronic Kidney Disease

Increased BUN/CR (AKI), Bilateral Renal
Artery Stenosis, 10% develop dry cough, Angioedema, Hyperkalemia, Pregnancy,

Less effective in AA
 

B-Blocker PROS B-Blocker CONS
CAD/Post-MI/Angina
CHF (Systolic AND Diastolic)
Tachy-arrhythmias
Performance anxiety
Headache prophylaxis
Glaucoma
Essential Tremor

 
Depression, Fatigue, Decreased stamina
Sexual dysfunction
Danger of withdrawal
Heart block/Bradycardia
Asthma/COPD
Less effective in AAs

 
CCBs PROS CCBs CONS
CHF (only Diastolic)
Tachy-arrhythmias
Angina
Headache prophylaxis
Raynaud’s disease
Systolic CHF
Leg edema
Constipation
Headache
GERD
Heart block/Bradycardia

 
Diuretics PROS Diuretics CONS
Osteoporosis
Kidney stones
Peripheral edema
Synergistic with other meds
Cheap ($3 – 10/month)
Hypokalemia (must monitor lytes, Cr)
Gout
Slight increase glucose intolerance
Slight increase in lipids

 

Author(s): Wayne Altman, M.D.
Created: Friday November 2, 2012
Modified: Monday March 24, 2014

Copyright Information: Copyright 2012, Tufts University

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