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Updated: Jul 28 2022

Hypertension

4.4

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Images
https://upload.medbullets.com/topic/120007/images/htncomplications.jpg
  • 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 Pressure
      CategorySystolic (mmHg)
      And/OrDiastolic (mmHg)
      Normal
      • < 120
      • And
      • < 80
      Elevated
      • 120-129
      • And
      • < 80
      Hypertension stage 1
      • 130-139
      • Or
      • 80-89
      Hypertension stage 2
      • > 140
      • Or
      • > 90
      Hypertensive crisis
      • > 180
      • And/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
    • Drug
      Indications
      Contraindications
      Side Effects
      β-blockers
      • No comorbid disease
      • Previous MI
      • CAD
      • Pregnancy
        • use labetolol
        • avoid atenolol due to intrauterine growth restriction
      • Young Caucasian
      • Low EF
      • Angina
      • CAD
      • Coexistent benign essential tremor
      • Perioperative BP management
      • COPD
      • Hyperkalemia
      • Hypoglycemic events
      • Asthmatics
      • Bradycardia
      • Bronchospasm
      • Erectile dysfunction
      Thiazide diuretics
      • 1st-line medication if no comorbid disease
      • 1st-line medication in isolated systolic hypertension
      • African-Americans
      • CHF
      • Osteoporosis (thiazides)
      • Gout
      • Diabetes (thiazide)
      • Renal failure (K+ sparing)
      • Decrease excretion of calcium and uric acid; hypoNa
      ACEIs
      • Diabetics
      • Previous MI
      • Chronic Kidney Disease
      • Low EF
      • Pregnancy
      • Renal artery stenosis
      • Renal failure
      • Cough (substitute ARB)
      • Angioedema
      • Hyperkalemia
      Calcium channel blockers
      • Second-line agents
      • If other medication fails or if needed for controlling comorbidities
      • Lower extremity edema
      α-blockers
      • BPH
      • CHF: can increase risk of heart failure
      • Dizziness
      • Headache
      • Weakness
  • Complications
  • High Yield Medication Chart for Hypertension Treatment for Diseases
    • Disease
      Blood Pressure Medication Indication
      Coronary artery disease
      • β-Blocker
      Hyperthyroidism
      Grave's disease
      Congestive heart failure
      • β-Blocker
      • ACE-I
      • ARB
      Migraine
      • β-Blocker
      • Calcium channel blcoker
      Osteoporosis
      • Thiazide diuretics
      Hypocalcemia
      Depression
      • Avoidβ-blockers
      Asthma
      Pregnancy
      • α-Methyldopa
      • Labetalol
      • Nifedipine
      Benign prostatic hypertrophy
      • α-Blocker
      Diabetes
      • ACE-I
      • ARB
      Scleroderma
      • ACE-I
      Peri-operative blood pressure management
      • β-blockers (metoprolol)
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