Definitions
Secondary hypertension
Where either a comorbid disease or a drug (or other product) is responsible for elevating BP
Bonus question: Which is more common, primary (essential) or secondary hypertension?
Drug classes of first-line agents
ACEI, ARB, CCB, thiazide diuretics
Bothersome side effect of ACE inhibitors
Dry cough
What first line agents are recommended for a hypertensive patient with diabetes?
All are acceptable: ACEi, ARB, CCB, Thiazide
What is chronotherapy?
Taking antihypertensive therapies at night
Stage 1 hypertension
*according to the ACC/AHA 2017 guidelines
SBP: 130-139 mm Hg OR
DBP: 80-89 mm Hg
After how many weeks of gestation can aspirin be initiated in a pregnant woman for preeclampsia prevention?
The USPSTF recommends the use of low-dose aspirin (81 mg/day) after 12 weeks of gestation in persons who are at high risk for preeclampsia
Classes of medications that should not be used in pregnancy
ACEI, ARBs, direct renin inhibitors
What are some concerning adverse effects for treating an elderly patient with an antihypertensive agent?
orthostatic hypertension, falls/injury, dizziness, volume depletion (thiazides), sympathetic inhibition
By about how much does losing 10 kg lower SBP?
5-20 mm Hg
What do the letters "DASH" stand for in reference to the DASH diet?
Dietary Approaches to Stop Hypertension (DASH)
Diet that is rich in fruits, vegetables, and low-fat dairy products with a reduced content of saturated and total fat
MOA of chlorthalidone
Inhibits sodium reabsorption in the distal tubules causing increased excretion of sodium and water, as well as potassium and hydrogen ions
First line antihypertensive drug class that has an adverse effect of hyperuricemia
Thiazide diuretics
Name 2 agents that can be used to treat hypertension in pregnancy
nifedipine, methyldopa, labetalol, hydralazine
Stable ischemic heart disease - What is the treatment?
Therapy should generally start with a beta blocker followed by an ACE inhibitor or ARB
Clinical inertia in hypertension
Defined as an office visit for which no therapeutic move was made to lower BP in a patient with uncontrolled hypertension
Diuretic that is especially useful as a third or fourth antihypertensive add-on
Spironolactone (Aldactone)
Initial dose: 25 mg once daily
Most notable AE of CCBs
Peripheral edema
What is the treatment of choice for a diabetic patient with chronic kidney disease
ACE inhibitor
Name 3 classes of medications that can cause secondary hypertension
Amphetamines
Corticosteroids
Calcineurin inhibitors
Decongestants
Ergot alkaloids
Estrogen containing oral contraceptives
Erythropoetin/darbopoetin
NSAIDs
Desvenlafaxine, venlafaxine, bupropion
Testosterone
A substitute for a clinically meaningful endpoint that is expected to predict the effect of a therapy
Surrogate endpoint
Losartan + hydrochlorothiazide combination brand name
Brand: Hyzaar
Class: ARB + Thiazide
This class of antihypertensives should be given at bedtime initially due to first-dose hypotension
Alpha 1 blockers
What underlying condition is the most common cause of hypertension in children and adolescents?
Kidney Disease
True or False: Chronic, high dose, acetaminophen use does NOT increase blood pressure in patients diagnosed with hypertension.
False: Based on the recent PATH BP trial, acetaminophen increased systolic ambulatory blood pressure in white European patients