Snapshot Introduction Presentation Physical exam S4 heart sound with prolonged hypertension Studies Studies to evaluate for end-organ damage electrocardiography urinalysis fasting blood glucose hematocrit electrolytes (including calcium) creatinine lipids profile Blood PressureCategorySystolic (mmHg)And/OrDiastolic (mmHg)Normal< 120And< 80Elevated120-129And< 80Hypertension stage 1130-139Or80-89Hypertension stage 2> 140Or> 90Hypertensive crisis> 180And/Or>120 Treatment Goals of treatment want to get BP < 140/90 mmHg in most patients consider treating patients with ACE inhibitors even sooner if they have an underlying condition that can lead to hyperfiltration damage (diabetes, scleroderma renal crisis) Medical lifestyle modifications indications first line of treatment modalities including weight loss (most effective) exercise abstaining from alcohol smoking cessation salt restriction decrease in fat intake and cholesterol control to reduce risk of CAD diuretic (HCTZ) and β-blockers(first line medications) indications lifestyle modification fail after 6 months to 1 year medications include diuretic (first-line HCTZ) and β-blockers (no comorbid disease) calcium channel blockers and ACEIs (second-line medications) indications lifestyle modification and first line medication fail DrugIndicationsContraindicationsSide Effectsβ-blockersNo comorbid diseasePrevious MICADPregnancyuse labetololavoid atenolol due to intrauterine growth restrictionYoung CaucasianLow EFAnginaCADCoexistent benign essential tremorPerioperative BP managementCOPDHyperkalemiaHypoglycemic eventsAsthmaticsBradycardiaBronchospasmErectile dysfunctionThiazide diuretics1st-line medication if no comorbid disease1st-line medication in isolated systolic hypertensionAfrican-AmericansCHFOsteoporosis (thiazides)GoutDiabetes (thiazide)Renal failure (K+ sparing)Decrease excretion of calcium and uric acid; hypoNaACEIsDiabeticsPrevious MIChronic Kidney DiseaseLow EFPregnancyRenal artery stenosisRenal failureCough (substitute ARB)AngioedemaHyperkalemiaCalcium channel blockersSecond-line agentsIf other medication fails or if needed for controlling comorbiditiesLower extremity edemaα-blockersBPHCHF: can increase risk of heart failureDizzinessHeadacheWeakness Complications High Yield Medication Chart for Hypertension Treatment for Diseases DiseaseBlood Pressure Medication IndicationCoronary artery diseaseβ-BlockerHyperthyroidismGrave's diseaseCongestive heart failureβ-BlockerACE-IARBMigraineβ-BlockerCalcium channel blcokerOsteoporosisThiazide diureticsHypocalcemiaDepressionAvoidβ-blockersAsthmaPregnancyα-MethyldopaLabetalolNifedipineBenign prostatic hypertrophyα-BlockerDiabetesACE-IARBSclerodermaACE-IPeri-operative blood pressure managementβ-blockers (metoprolol)