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General Guidelines of Hypertension treatment

Sep 19, 20243 min read

Internal Medicine

TREATMENT

Aim of BP : < 120/80

  1. First, a trial of diet & exercise for about 2 months ( depending on the BP)
    • low salt diet * wt. reduction * exercise
    • eat more fruits & vegetables * stop smoking
  2. Add medicine if the above fails.
  3. Start with 1 medicine and gradually go to the max dose
  4. Give at least 2-3 wks for a medicine to work fully. Then add another medicine if needed.

DRUG CLASS FOR HTN & COMMON SIDE EFFECTS/AVOID IN

EXAMPLES COMMON SIDE EFFECTS AVOID IN ****   DIURETICS - THIAZIDES

  • WEAKNESS, HYPOKALEMIA, HYPERGLYCEMIA, HIGH CHOLESTEROL, HIGH URIC ACID
  • DM, GOUT, HIGH CHOLESTEROL   ACE INHIBITORS CAPTOPRIL, ENALAPRIL, LISINOPRIL, RAMIPRIL
  • DRY COUGH, RASH, ANGIOEDEMA,HYPERKALEMIA, HIGH CREATININE
  • PREGNANCY, RENAL ARTERY STENOSIS   ARBs (angiotensin receptor blockers) VALSARTAN, CANDESARTAN etc
  • ALLERGIC REACTIONS (DON’T CAUSE COUGH)   BETA BLOCKERSZ PROPRANOLOL, BISOPROLOL, ATENOLOL, METOPROLOL
  • BRADYCARDIA, BRONCHOSPASM, WEAKNESS, IMPOTENCE, VASOSPASM
  • ASTHMA/COPD, PVD, DM, HEART BLOCK, ACUTE CHF
  • Avoid beta blockers in asthma/COPD, heart severe bradycardia/heart blocks
  • Avoid beta blockers in DM ( they mask the S/S of hypoglycemia). Not an absolute contraindication.
  • Never stop beta blockers suddenly. Always taper.

CALCIUM CHANNEL BLOCKERS AMLODIPINE, VERAPAMIL, DILTIAZEM

  • CONSTIPATION , BRADYCARDIA & HEART BLOCK (VERAPAMIL), PEDAL EDEMA, HEADACHE,
  • CHF, HEART BLOCK & BRADYCARDIA

OTHERS METHYLDOPA, ALPHA BLOCKERS, HYDRALAZINE, CLONIDINE

  • VARIOUS  

GUIDELINES TO START Rx.

Suggested by National Institute of Clinical Excellence , U.K. ( NICE guidelines)

  1. Age < 55 or white race : ACE or ARB
  2. Age > 55, black race : Calcium channel blocker or diuretic

These are just “guidelines”, & they are different in different countries

SPECIAL  SITUATIONS

  1. HTN w/ DM:   First choice ACE or ARB
  2. HTN w/ IHD:  First choice is beta blocker , ACEI
  3. HTN w/ pregnancy: Methyldopa(aldomet), hydralazine, labetolol ( all safe)      ACEI  AND ARBs  ABSOLUTELY  “NO ” IN PREG.& Bilateral renal artery stenosis
  4. Patient w/ high sympathetic activity (tachycardia, anxious looking, hyperthyroid      ⇒     beta blocker is better

Therapeutic

TREATMENT - Aim of BP: < 120/80

Rx  contd.

  1. First, a trial of diet & exercise for about 2 months ( depending on the BP)
    • low salt diet * wt. reduction * exercise
    • eat more fruits & vegetables * stop smoking
  2. Add medicine if the above fails.
  3. Start with 1 medicine and gradually go to the max dose
  4. Give at least 2-3 wks for a medicine to work fully. Then add another medicine if needed.

DRUGS FOR HTN

  1. Diuretics
  2. ACE inhibitors
  3. ARBs (angiotensin receptor blockers)
  4. Beta blockers
  5. Ca. channel blockers
  6. Others

GUIDELINES TO START Rx.

Suggested by National Institute of Clinical Excellence , U.K. ( NICE guidelines)

  1. Age < 55 or white race : ACE or ARB
  2. Age > 55, black race : Calcium channel blocker or diuretic

These are just “guidelines”, & they are different in different countries

SPECIAL  SITUATIONS

  1. HTN w/ DM:   First choice ACE or ARB
  2. HTN w/ IHD:  First choice is beta blocker , ACEI
  3. HTN w/ pregnancy: Methyldopa(aldomet), hydralazine, labetolol ( all safe)      ACEI  AND ARBs  ABSOLUTELY  “NO ” IN PREG.& Bilateral renal artery stenosis
  4. Patient w/ high sympathetic activity (tachycardia, anxious looking, hyperthyroid      ⇒     beta blocker is better

SOME IMPORTANT POINTS

  1. Avoid beta blockers in asthma/COPD, heart severe bradycardia/heart blocks

  2. Avoid beta blockers in DM ( they mask the S/S of hypoglycemia). Not an absolute contraindication.

  3. Never stop beta blockers suddenly. Always taper.

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