10-26-2008, 07:54 PM
Goal Blood Pressures for Hypertensive Patients
Hypertension without Co-morbidity:
Hypertension without Co-morbidity:
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Hypertension Rx goals - VERY IMP topic - goody
Hypertension Rx goals - VERY IMP topic - goody
|
Hypertension Rx goals - VERY IMP topic - goody
|
10-26-2008, 07:55 PM
Goal Blood Pressures for Hypertensive Patients
Hypertension without Co-morbidity:
10-26-2008, 07:55 PM
Goal Blood Pressures for Hypertensive Patients
Hypertension without Co-morbidity: less than 140/90 Diabetes Mellitus: less than 130/80 Congestive Heart Failure: less than 130/80 Renal Insufficiency: less than 130/80 Renal Failure and more than 1g Proteinuria/24 hours: less than 125/75 The goals for Rx in each case is different as above
10-26-2008, 08:08 PM
Some conditions where one antihypertensive is preferred over other or contraindicated :
1. Diabetes Mellitus (with or without Diabetic Nephropathy) - Use ACEI 2. Left Ventricular Hypertrophy (Risk of sudden death) Use : ACE Inhibitors Calcium Channel Blockers to help with diastolic CHF 3. Congestive Heart Failure - Systolic Dysfunction Use: - ACE Inhibitor - Angiotensin Receptor Blocker - Diuretic - Beta Blocker (use with caution, CIBIS II, MERIT-HF trials) - Highest efficacy observed with Carvedilol - Spironolactone (RALES trial) - used in class III/IV HF 4. CHF - Diastolic Dysyfunction Calcium Channel Blocker 5.Coronary Artery Disease risk or Myocardial Infarction Beta Blocker ACE Inhibitor (HOPE trial) - ramipril 6. Angina Beta Blockers Calcium Channel Blockers (Not Nifedipine) 7. Atrial Tachycardia and Atrial Fibrillation Beta Blockers Nondihydropyridine calcium antagonists 8. Benign Prostatic Hyperplasia Alpha antagonist Avoid Diuretics 9. Dyslipidemia Alpha antagonists Diuretics do not worsen Hyperlipidemia Beta Blockers do not worsen Hyperlipidemia 10. Renal Disease with microalbuminuria ACE Inhibitor Diuretic 11. Pregnancy Methyldopa Hydralazine Labetolol Do not use ACE Inhibitor - can cause renal agenesis 12.Obesity Diuretics Gout Avoid Thiazide Diuretics 13. Osteoporosis Thiazide Diuretics (may prevent Hip Fractures) 14. Severe Obstructive Pulmonary Disease (COPD or Asthma) Avoid Beta Blockers 15.Perioperative Hypertension with risk factors for CAD Beta Blockers should be use preventively Delay surgery until BP
10-26-2008, 08:09 PM
16. Edema
Avoid Calcium Channel Blockers 17.Peripheral Vascular Disease These patients are high risk for cardiovascular event Calcium Channel Blocker Beta Blockers may be tolerated - especially carvedilol, labetalol Beta blockers Previously thought to be contraindicated - not any more 18. Neurologic and psychiatric disorders A. Essential Tremor Noncardioselective Beta Blocker - PROPRANOLOL B. Migraine Headache Noncardioselective Beta-Blockers - PROPRANOLOL Nondihydropyridine calcium antagonists C.Major Depression - Avoid Beta Blockers D. Substance Abuse ( Cocaine etc) - Labetolol (Combined alpha-Beta Blocker) - dont use a plain beta blocker! Calcium Channel Blockers Nitrates 19. Variceal bleed prohylaxis Noncardioselective Beta Blocker - PROPRANOLOL, NADOLOL |
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