HTN
First line treatment without compelling indications
Thiazide like, ACEi, ARB, Long acting CCB, BB
What do you do if statin is not tolerated?
Discontinue for 1 week then reintroduce at lower dose or can switch to different statin
Clinical manifestations of nicotine consumption
- Increased BP/HR
- Increased 02 consumption
- Depression
- Skeletal muscle relaxation
Medications that may cause secondary HTN
Any meds that cause drug induced kidney disease: ACEi, ARB, NSAID, aminoglycosides, contrast dye, amphotericin B
How long does it take BP medications to achieve desired effect?
Around 4 weeks
What are the special considerations for Black and Asian patients with HTN?
CCB and thiazides first line for Black patients, higher incidence of cough with ACEi in Asian patients
hepatic impairment, pregnancy
What are the 5 A's of smoking cessation?
Ask
Advise
Assess
Assist
Arrange
What is initial therapy for HTN in nondiabetic CKD
ACEi or ARB (ACEi/ARB combo not recommended)
What might be indications to stop/switch from ACE?
If K>5.5 or 30% decrease in baseline creatinine
What laboratory investigations are required for newly diagnosed HTN?
ECG, urinalysis, FPG, CBC, Lytes, Creat/GFR, lipid profile, calcium
What type of monitoring is indicated for statin therapy?
At 3 months - lipid panel, LFTs, CK (if myalgias)
Pros/cons of varenicline?
- First Line - most effective
- Quit date 7-14d after starting
- AE: CV events, insomnia, SJS
- DI: only DI with NRT
- Resistant hypertension
- Malignant hypertension
- <30yo
Modifiable CV risk factors
Diet/sodium
Weight
Alcohol intake
Exercise
What type of monitoring is necessary for patients on thiazide diuretics
Monitor for hypokalemia and hyponatremia
What therapy is indicated for treatment of dyslipidemia in pregnancy and lactation?
Bile acid sequestrants (must stop statin/ezetimibe and switch)
Bupropion is contraindicated in
pregnancy (however still safer than smoking)
patients with eating disorders
renal impairment (renal dosing)
hepatic impairment
seizure disorders
Physiological causes of secondary htn
Primary Kidney disease
Primary aldosteronism
OSA
Pheochromocytoma
Cushing's
What is the appropriate NRT patch dosing for a patient smoking >10 cigarettes/day?
21mg transdermal patch x 6 weeks
14mg x 2 weeks
7mg patch x 2 weeks
Monitoring for ACE
Creatinine, BUN, electrolytes within 2 weeks of starting
*Monitor for hyperkalemia*
Name medications that are secondary causes of dyslipidemia
Thiazide diuretics, Corticosteroids, Atypical antipsychotics, Beta blockers, Hormone replacement therapy, Isotretinoin
Pros/Cons of NRT?
- First line option, patch most effective form
- Quit date: same day up to 4 weeks post start
- AE: nightmares, insomnia
Triad of pheochromocytoma
headache
palpitations
sweating
A common adverse effect of statins is
myalgias