Treatment of HTN Flashcards

1
Q

What is the goal BP for HTN patients?

A

140/90 or less if >65

130/80 or less if <125 / 75

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2
Q

Why treat HTN? What are the benefits?

A

Reduces:
CVD-associated mortality
Risk of stroke
Risk of other coronary events

Thus improves QOL

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3
Q

Who should be instructed on non-pharmacological methods to lower BP?

A

All patients

Some high-risk patients will need to be started on pharmacological treatment immediately, but all patients should modify lifestyle factors to further decrease CVD risk

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4
Q

Drug therapy should be given to which patients?

A

Patients with sustained high initial readings
Patients with target organ damage (heart, retina, kidneys, brain)
Patients in whom non-pharmacological management has failed

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5
Q

First, 2nd, then 3rd line drugs for HTN treatment

A
1. ACEI / ARB
OR 
CCB
OR
Low-dose thiazide (if 65 years or older)
  1. If target not reached:
    ACEI + CCB
    OR
    ACEI + Thiazide (>65)
  2. If target still not reached
    ACEI + CCB + Thiazide
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6
Q

Guidelines for undergoing drug therapy

A

Start with single drug at low dose
Wait 4-6 weeks for full effect to become apparent
If ineffective:
Consider either raising dose, or adding another low-dose drug, or changing to another drug class
Use only 1 drug from a single class at a time

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7
Q

What if HTN is refractory to treatment?

A

Re-consider that an underlying kidney or adrenal lesion may have been missed

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8
Q

When to refer the HTN patient?

A
  1. In refractory HTN
  2. Suspected white coat HTN, for ambulatory monitoring
  3. Severe HTN diastolic >115
  4. Hypertensive emergency
  5. If evidence of ongoing target organ damage
  6. If there is significant kidney impairment
  7. If a treatable cause of secondary HTN is found
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