CDCES Antihypertensive Medications Flashcards

Vocabulary practice flashcards covering antihypertensive medication management, clinical guidelines, targets, and special population considerations for diabetes care based on CDCES lecture notes.

ADA Blood Pressure Goal (Adults with Diabetes)

Blood pressure target of under $130/80\,\text{mmHg}$, tailored based on individual cardiovascular risk.

Lifestyle Therapy Initiation Threshold

Blood pressure reading exceeding $120/80\,\text{mmHg}$.

First-Line Antihypertensive Monotherapy Threshold

Blood pressure of $130/80\,\text{mmHg}$ or higher.

Initial Two-Drug Combination Threshold

Blood pressure of $150/90\,\text{mmHg}$ or higher at initial evaluation, requiring prompt initiation of two agents simultaneously rather than monotherapy.

First-Line BP Drug for Albuminuria or CAD/ASCVD

An ACE inhibitor or an ARB (indicated when urinary albumin-to-creatinine ratio is $\ge 30\,\text{mg/g}$ or in the presence of established coronary artery disease or atherosclerotic cardiovascular disease).

Albuminuria Diagnostic Threshold

A urine albumin-to-creatinine ratio (UACR) of $30\,\text{mg/g}$ or higher.

First-Line Antihypertensive Classes (Without Albuminuria)

Any one of four recommended drug classes: ACE inhibitors, ARBs, thiazide-like diuretics, or calcium channel blockers (CCBs).

Dual ACE Inhibitor and ARB Therapy

A strictly contraindicated combination that confers no therapeutic benefit while increasing the risk of hyperkalemia and acute kidney injury.

ACE Inhibitor and ARB Laboratory Monitoring

Serum potassium ($\text{K}^+$) and renal function assessment $7\text{--}14\,\text{days}$ after drug initiation or dose titration, followed by annual checks.

ACE Inhibitor-Induced Cough

A signature dry cough mediated by bradykinin accumulation that occurs with ACE inhibitors but does not occur with ARBs.

ACE Inhibitor vs. ARB Nomenclature

ACE inhibitors end in the suffix "-pril" (e.g., lisinopril, enalapril, ramipril), whereas ARBs end in the suffix "-sartan" (e.g., losartan, valsartan, irbesartan).

Management of ACE Inhibitor Intolerance

Discontinuation of the ACE inhibitor and substitution with an ARB (such as losartan), which shares similar clinical efficacy without inducing cough.

Mechanism of ACE/ARB-Induced Hyperkalemia

Inhibition of angiotensin II synthesis or receptor binding reduces downstream aldosterone secretion, diminishing renal excretion and causing retention of potassium.

Thiazide-like Diuretic Metabolic Adverse Effects

Induction of hypokalemia (low potassium), hyperglycemia (worsened blood glucose control), and hyperuricemia (elevated uric acid).

Beta Blockers in Diabetes Hypertension

Considered an add-on therapy rather than a first-line option; reserved primarily for specific cardiac indications such as heart failure, status post-myocardial infarction, or coronary disease.

Beta Blocker Hypoglycemia Masking

Suppression of sympathetic tachycardia (rapid heart rate) during hypoglycemic episodes, while diaphoresis (sweating) and dizziness remain unmasked.

Beta Blocker Safety Precautions

Measurement of heart rate at every visit (adjusting dosage if heart rate drops under $50\,\text{bpm}$) and gradual dose tapering to prevent adverse withdrawal events.

Resistant Hypertension Next-Step Agent

Addition of a mineralocorticoid receptor antagonist (MRA) and referral to a hypertension specialist when blood pressure remains uncontrolled on maximum tolerated doses of an ACE inhibitor or ARB, a CCB, and a diuretic.

Secondary Prevention Aspirin Regimen

Daily dose of $75\text{--}162\,\text{mg/day}$ recommended for patients with diabetes and documented atherosclerotic cardiovascular disease (ASCVD).

Clopidogrel Secondary Prevention Dose

An antiplatelet agent administered at $75\,\text{mg/day}$ for individuals with diabetes and ASCVD who have a documented aspirin allergy.

Primary Prevention Aspirin Criteria

Shared decision-making therapy reserved for adults aged $50$ years or older with elevated cardiovascular risk after weighing clinical benefits against bleeding risks.

SGLT-2 Inhibitor Heart Failure Benefit

Diabetes pharmacotherapy class demonstrated to reduce heart failure hospitalizations in patients with type 2 diabetes.

Finerenone

A nonsteroidal mineralocorticoid receptor antagonist (MRA) indicated to reduce heart failure hospitalizations in adults with type 2 diabetes and chronic kidney disease (CKD).

Pregnancy-Contraindicated Antihypertensives

ACE inhibitors, ARBs (all "-pril" and "-sartan" agents), and the beta blocker atenolol, all of which must be stopped prior to conception.

Preferred Pregnancy Antihypertensives

First-line agents including methyldopa, nifedipine, labetalol, and clonidine.

Pregnancy Blood Pressure Target

Blood pressure maintenance goal under $110\text{--}135/85\,\text{mmHg}$.

Pediatric ACE/ARB Initiation Criteria

Indicated when blood pressure exceeds the $95^{\text{th}}$ percentile (or over $130/80\,\text{mmHg}$ after age $13$) confirmed across 3 separate days following $3\text{--}6\,\text{months}$ of lifestyle intervention.

Older Adult BP Goal (Very Complex / Poor Health)

Blood pressure target of under $140/90\,\text{mmHg}$ for individuals in the very complex or poor health tier, compared to under $130/80\,\text{mmHg}$ for healthy or intermediate tiers.