Alcohol, amphetamines, antidepressants, antipsychotics, caffeine, decongestants, immunosuppressants, NSAIDs, oral contraceptives, TK inhibitors, corticosteroids THIAZIDE AND LOOP DIURETICS
- MOA: decrease total body salt and water (Decreased blood volume)
- Side effects: dehydration (MUCH more common with loop diuretics eg furosemide), hypokalemia, worsens insulin resistance
- containdicated in pregnancy
ALDOSTERONE ANTAGONISTS
- MOA: competes w/ aldosterone at distal renal tubule, conserves potassium while causing excretion of Na+/water
- Side effects: hyperkalemia and dehydration''
ACE INHIBITORS (ACE-I)
- usually the first-line therapy
- MOA: inhibits RAAS system (prevents A1 >>> A2 conversion at lungs), leading to decreased salt & water retention and decreased PVR
- Side effects: hyperkalemia, dry cough 20-30% patients, hyperkalemia, urticaria/angioedema
- NOT recommended during pregnancy
- can significantly decrease incidence of DM in HTNive individuals
- Meds: Benazepril, Lisinopril, Ramipril
ANGIOTENSIN-RECEPTOR BLOCKERS
- MOA: Inhibits AII binding to receptor, as well as aldosterone secretion
- side effects: hyperkalemia, angioedema
- decreases insulin resistance, similar to ACE-I
CALCIUM-CHANNEL BLOCKERS
- MOA: Dihydropyridine (DHP) vasodilate the peripheral blood vessels and decrease PVR; non-DHP lowers HR, as it has lesser peripheral dialtion properties
- Side effects: Edema, Bradycardia (non-DHP), CHF exacerbation (non-DHP)
BETA BLOCKERS
- MOA: lowers HR (and thus CO), as well as decreases PVR via SNS
- Side effects: containdicated in asthma, bradycardia, CHF exacerbation, can mask hypoglycemia in diabetes BETA BLOCKERS
- unless the patient has a compelling indication (heart failure with reduced EF, post MI, CAD, stable ischemic heart disease) beta blockers should not be first line therapy
- MOA: inhibits the action of endogenous catecholamines (epi and norepi) to lowers HR (and thus CO), lower afterload, lower contractility
- Side effects: contraindicated in asthma, bradycardia, CHF exacerbation, can mask hypoglycemia in diabetes, exercise intolerance (due to decreased contractility), HR and possible heart block
- contraindications: heart block, acute heart failure, severe asthma
- can have rebound hypertension if discontinued quickly, need to taper off
- Meds: see picture "-olol" is a common suffix! "I always -lol whenever I see a tri beta...." HIGH BP (for the history)
H: high risk factors (MONSTER - Meds, Obesity/OSA, Neonatal hx, signs/sx, trends in family, endocrine, renal)
I: integumentary (sweating, rash, skin changes)
G: Gu complaints (hematuria, edema, enuresis)
H: hyper/hypothyroid sx (weight loss, gain, growth failure, diarrhea, constiaption, fevers)
B: brain (blurred vision, gait changes)
P: pain (dyspnea, palpitations, chest pain)
LOOK at them: EDEMA
Endocrine disorders (thyroid enlargement for hyperthyroidism, ambiguous genitalia)
Defects in heart/vasculature (renal bruit for renal vascular disease, 4 extremity BP and brachiofemoral lag for CoA, mumurs and edema for CHD)
End organ damage (focal neurologic deficits, papilledema)
Multipe syndromic findings (neurofibromatosis, growth faltering and syndromic appearance-- Turner syndrome)
Abdominal mass (neuroblastoma, Wilms tumor, pheochromocytoma)
Diagnostics: **note, those >6 yo with FH of HTN or are obese or have a negative hx and PE suggestive of secondary HTN do not need extensive work-up (aka, you are pretty certain it is primary/essential HTN)
- Level 1: electrolytes, BUN/cr, lipid profile, TSH, CBC, UA with microscopy (for glomerular or tubule problems), HgbA1c if obese, ALT and AST for hyperlipidemia (if BMI >95th percentile), renal US, echocardiogram
- Level 2: plasma renin activity, serum aldosterone and cortisol (points us to primary aldosteronism or/and congenital adrenal hyperplasia), a sleep study to detect obstructive sleep apnea (if Level 1 didn't help) LIFESTYLE MODS
- Reduce sodium intake (DASH Diet); limit grocery purchases of salt-added foods, limit meals from fast-food restaurants, not adding salt to cooking
- Increase activity to reduce obesity (ask more about exercise-associated syncope, light headedness, chest pain, dyspnea; FH of sudden death, HOCM); 30-60 minutes activity/session, 3-5 days/week; those with stage 2 HTN should avoid static exercise (as PVR is high and systolic pressure increases, recipe for disaster)
- Quit smoking/tobacco
- Reduce alcohol
MEDS
- main med for kids is an ACE-I, ARBs are fine too
- give meds only with symptomatic HTN, Stage 2 HTN without a modifiable factor, HTN with LVH, persistent HTN despite 6 mo trial lifestyle mods 7th Edition•ISBN: 9780323087896 (1 more)Julie S Snyder, Linda Lilley, Shelly Collins388 solutions
7th Edition•ISBN: 9780323402118Gary A. Thibodeau, Kevin T. Patton1,505 solutions
7th Edition•ISBN: 9780323527361Julie S Snyder, Mariann M Harding2,512 solutions
8th Edition•ISBN: 9781305634350 (2 more)Ann Ehrlich, Carol L Schroeder, Katrina A Schroeder, Laura Ehrlich1,792 solutions