X Applied HTN Questions

Given a patient has dyslipidemia or BPH, what antihypertensive drug is recommended to treat this comorbidity?

Alpha blockers

What antihypertensive drugs have favorable effects on angina and severe CAD?

Beta blockers

Non-dihydropyridine CCBs (diltiazem, verapamil)

What antihypertensive drugs have favorable effects on atrial tachycardia and fibrillation?

Beta blockers

Non-dhp CCB

ACEI or ARBs

How many months after initiating hypertensive therapy should you follow up?

What medications require earlier monitoring?

1-2 months

Diuretics, ACE, ARB

What antihypertensive medications are favorable for use in CKD With albuminuria + DM?

ACEI or ARB

What antihypertensive medications are favorable for secondary stroke prevention?

ACEI, ARB, or thiazide

What are the 4 first line therapies for hypertension?

ACEI, ARB, thiazide, CCB

For clinical CVD, a 10-year CVD risk over 7.5%, CKD, or DM, what is the initial treatment and next steps?

Initiate medications

Add medications

For blood pressure over 130/80 with no CKD, 10-year risk of CVD over 7.5%, CKD, or DM, what is the initial treatment and next steps?

3–6-month lifestyle recommendations

Initiate medications

What is the MOA of central alpha 2 agonists?

What are the drug names?

stimulate central alpha 2 receptors to inhibit NE release and sympathetic outflow

clonidine, methyldopa, guanfacine

Is methyldopa contraindicated in pregnancy?

No

When are alpha 1 antagonists used to treat hypertension?

Only with comorbid BPH

If a patient has asthma, what antihypertensive should you avoid?

Non-cardioselective beta blockers

Which is more potent: thiazide-type or thiazide-like?

Thiazide-like: better potency and half-life

In what comorbid condition can eplerenone and spironolactone treat?

CKD + proteinuria

What medications increase potassium levels?

ACEI, ARB, K+ sparing diuretics

What class of antihypertensives are contraindicated in patients with bilateral renal artery stenosis or pregnancy?

ACEI and ARBs

What class of antihypertensives should be avoided in patients with peripheral edema?

CCBs

Above what blood pressure is stage 2 hypertension?

140/90

What medications can be used to improve CCB induced edema?

ACE-I/ARB or nitrates

What are the drug interactions of the CCBs?

Diltiazem and Verapamil: CYP3A4 and PGP inhibitor

Nifedipine, amlodipine, felodipine: CYP3A4 substrate

What suffix do ACEI end in?

-pril

What drugs can increase serum potassium levels?

ACEI, ARB, spironolactone/eplerenone

What suffix do ARBs end in?

-sartan

What class of drug are hydralazine and minoxidil?

Direct vasodilator

Which class of diuretics can lead to an increase in calcium excretion in the urine?

Loop diuretics

What urinary electrolyte concentrations are increased through use of loop diuretics?

Na, K, Ca, Mg

Explain the RAAS system given hypotension.

Juxtaglomerular cells sense low pressure and release renin. Renin converts angiotensinogen from the liver into angiotensin I. ACE converts angiotensin I into angiotensin II. angiotensin II promotes vasoconstriction, sodium reabsorption, and aldosterone release. Aldosterone promotes sodium retention and potassium secretion.

What are the names of the cardioselective and non-selective beta blockers?

Cardioselective: Metoprolol, atenolol, esmolol

Non-selective: Propranolol, nadolol

For patients with resistant hypertension, what is the preferred add-on therapy?

MRAs

Which medications are known to increase blood pressure?

Tacrolimus and NSAIDs

When are thiazide diuretics contraindicated?

Gout and diabetes

What is the recommended treatment for stage 2 HTN?

2 medications: ACE/ARB + Thiazide

What antihypertensive is indicated for proteinuria, and PAD?

ACE

What antihypertensive is indicated for HFrEF?

Beta blockers (carvedilol, metoprolol, bisoprolol only), CCB (amlodipine or felodipine only), ACE

What antihypertensives should be avoided in bradycardia?

CCBs, non-dhp beta blockers

How do you manage cough or angioedema from an ACE?

Switch to ARB

How do you manage gynecomastia with an MRA?

Swap to eplerenone

How do you manage gout with a thiazide?

Swap to ACE/ARB