Pharmacology HTN 3

What are considered comorbidities with HTN?

CKD, DM, CAD, HF, and cerebrovascular disease

What are the BP goals in someone with CKD?

< 130/80 mm Hg (AHA/ACC)

SBP < 120 mm Hg (KDIGO)

What drug classes are preferred in a patient with HTN and CKD?

ACE-inhibitors (or ARBs)

Expect up to a 10-30% increase in SCr after initiation

What is the goal BP in a patient with DM?

< 130/80 mm Hg (AHA/ACC and ADA)

What drug classes are preferred in a patient with HTN and DM?

ACE-inhibitors (or ARBs)

Thiazide diuretics

CCBs

What do ACE-inhibitors do in a patient with DM?

Reduce the progression of moderately-severely increased albuminuria

What is the goal BP in a patient with CAD?

< 130/80 mm Hg

What are useful agents in a patient with HTN and CAD?

Beta-adrenergic receptor antagonists

RAAS system inhibitors (ACEi and ARBs)

CCBs

What drugs also help with symptoms of CAD?

Beta blockers and CCBs

What are beta blockers used for?

NOT first-line for the management of HTN

Used for comorbid CVDs to decrease morbidity and/or mortality

Define heart failure with reduced ejection fraction (HFrEF)

An issue with PUMPING

Define heart failure with preserved ejection fraction (HFpEF)

An issue with FILLING

What agents are considered evidence-based pharmacotherapy for HFrEF?

Loop diuretics

EB beta blockers = carvedilol, bisoprolol, metoprolol succinate

ACE-inhibitors

EB ARBs = candesartan, losartan, valsartan

ARAs

What is the BP goal in patients with HFrEF?

< 130/80 mm Hg

Describe the treatment of HTN in patients with HFrEF

Non-DHP CCBs are NOT recommended due to negative inotrophy/chronotrophy

Sodium restriction

What are pharmacotherapy agents for HFpEF?

Loop diuretics

Beta-blockers

ACE-inhibitors (ARBs)

ARAs

What is the SBP goal for patients with HFpEF?

< 130 mm Hg

What are pharmacotherapy agents for cerebrovascular disease?

ACE-inhibitors (ARBs)

Thiazide diuretics

Combination of the two

What should be done for patients with previously diagnosed/treated HTN who experienced a stroke ≥ 72 hours from symptom onset and present with stable neurological status/TIA?

Restart antihypertensive treatment

BP goal < 130/80 mm Hg for TIA or stroke

What should be done for patients who have NOT been previously diagnosed/treated for HTN who present with BP of ≥ 140/90 mm Hg and experienced a stroke ≥ 72 hours from symptom onset and present with stable neurological status/TIA?

Initiate antihypertensive treatment

BP goal < 130/80 mm Hg for TIA or stroke

Describe the management of HTN in patients with resistant HTN

Add on last line therapies, like ARAs, vasodilators, a1 antagonists, renin inhibitors, and a2 agonists

Who is hydralazine reserved for?

Hypertensive patients who do not respond adequately to maximum therapeutic doses of a diuretic and 2 other antihypertensive agents

What are first-line agents for initiating treatment in Black patients?

Thiazide-type diuretics or CCBs

What agents should be initiated for Black patients with CKD?

ACE-inhibitors or ARBs

What agents should be initiated for Black patients with HF?

EB beta blockers in combination with ACE-inhibitors or EB ARB

What is the goal BP in Black patients?

< 130/80 mm Hg

2 or more antihypertensive medications are recommended to achieve this

What agents should be used in women with HTN who become/are planning to become pregnant?

Methyldopa, nifedipine, or labetalol

What drug classes should NOT be used in women with HTN who become/are planning to become pregnant?

ACE inhibitors, ARBs, or renin inhibitors

What is the goal SBP in elderly patients?

< 130 mm Hg

Describe management of pediatric HTN

Lifestyle modification is the first-line management strategy

Dosing is age/weight based

What are common classes used in pediatric HTN?

DHP CCBs, thiazide diuretics, ACE-inhibitors/ARBs