lecture 27 raja
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| at SBP of 150 or DBP of 90 or greater, pt's absolute risk of coronary heart dz starts to rise immensely | these pts must be treated, not just monitored
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| DASH sodium diet | for pts with HTN reducing salt intake to 3g/day (from 6-8g that nl American might ingest) reduces SBP/DBP by up to 10 points within a month's time
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| thiazide diuretics are the 1st line choice for almost every pt | as long as they don't have DM, CAD, etc.
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| best drug choice for pt who presents with high BP and is diabetic | ACEI like Captopril, Lisinopril - shown to be preventive of nephropathy in these pts
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| best drug choice for a pt who presents with high BP and has angina | beta blockers like Atenolol or Metoprolol - provides some exercise tolerance to those who are post-angioplasty or who have angina
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| best drug choice for a pt who presents with high BP and has hx of MI | ACEI have been shown dec mortality from heart failure after MI and beta blockers prevent inc in myocardial oxygen demand and allow for more complete ventricular filling to help with LVEF
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| target BP for most pts | 130/80 is the recommended goal and maybe a little lower if pt has DM or chronic kidney dz
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| as a general rule observation is indicated if pt has never been diagnosed with HTN and presents with a marginally elevated BP | aggressive tx is indicated howerver if pt has been diagnosed already OR if he/she is an older person
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| if pt develops angioedema or insistent dry cough from taking Captopril, what's the next best choice for their HTN regimen? | angiotensin receptor inhibitors like Losartan
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| labetolol and carvedilol | great drg choices for AA pts especially when they are refractory to other meds b/c of their mixed sympatholytic activity
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| special case in which only ACEI will work effectively to treat pt | hypertensive renal crisis from scleroderma
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| pt is on HCTZ and present with hypokalemia 4 wks after starting med, what do you change the med to? | Maxzide (triamterene-HCTZ) usually prevents K wasting and should reverse hypokalemia
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| don't be afraid to treat the elderly aggressively b/c their high BP greatly inc their CV risk for fatal CHD and stroke | great choice is thiazide + ACEI like Lisinopril-HCTZ
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| if pt is still refractory after 3 med regimen then next step is? | control BP with another med (HCTZ good choice) and start secondary HTN investigation (order serum lytes, metanephrines, get CTA of abd)
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| pt on HCTZ presents with a K of 2.5. what's likely the cause? | HCTZ will almost never cause K to drop below 3. check for another cause like Conn syndrome or primary hyperaldosteronism that will be causing K wasting
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| first choice for pt in hypertensive emergency (SBP above 160 or DBP above 100 but with sx of target organ damage) | IV nitroprusside to drastically vasodilate and get BP down. good b/c compared to other vasodilators, it only causes a modest inc in HR and overall reduces O2 demand. [second IV labetalol and third choice is IV hydralazine]
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| target for treating hypertensive emergency | want to bring BP down slowly (over 24-48 hrs) using IV drugs
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