|
Introduction
  • There are a variety of different antihypertensive medications available
    • variables that determine which antihypertensive medications are appropriate include
      • degree of hypertension
        • essential hypertension
        • malignant hypertension
      • concomitant diseases
        • CHF
        • diabetes mellitus (DM)
        • pregnancy
        • COPD
        • BPH
        • post-MI
Degree of Hypertension and Indicated Antihypertensive Therapy
  • Essential hypertension
    • diuretics
    • ACEI/ARBs 
    • calcium channel blockers (CCB) 
  • Malignant hypertension
    • nitroprusside
    • fenoldopam
    • diazoxide
Concomitant Diseases and Indicated Antihypertensive Therapy
 
Disease Diuretics
ACEI/ARB  β-blocker 
 α-blocker 
CCB
Misc
CHF  Y Y Y  -  -  
DM  Y Y Y  Y  Y -
COPD/asthma  - - -  -    Y  
-
BPH  - - -  Y  - -
Post-MI  -
Y
Y
-
Y
-
 
  • CHF
    • diuretics
      • K+-sparing diuretics (e.g., spironolactone)
    • ACEI/ARBs
    • β-blockers 
      • do not use β-blockers in decompensated patients
      • decrease cardiac contractile force
      • decrease heart rate
  • DM
    • diuretics
    • ACEI/ARBs 
      • added benefit of ↓ risk of diabetic nephropathy
      • ACEIs can cause a dry, non-productive, persistent cough 
      • ACEIs can cause hyperkalemia 
    • CCBs
    • β-blockers
      • mechanism of action includes blocking catecholamine-induced renin release by the kidney 
      • use cardioselective (β1-selective) drugs to avoid bronchoconstrictive effects (e.g. metoprolol)
    • α-blockers (-zosin's)
  • Pregnancy
    • methyldopa
    • hydralazine
    • labetalol
    • contraindicated
      • do not use ACEI/ARBs due to teratogenicity
  • COPD/asthma
    • CCB
    • avoid non-selective β-blockers
    • no contraindication to selective β-blockers if indication to use (i.e., CAD, CHF)
  • BPH
    • α-blockers
      • can treat both BPH and hypertension at same time 
  • Post-MI
    • β-blockers
    • ACEI/ARB's  
    • CCB if β-blockers are contraindicated
 

Please rate topic.

Average 4.7 of 7 Ratings

Questions (9)
EVIDENCE & REFERENCES (18)
Topic COMMENTS (4)
Private Note