Antihypertensives are drugs that Tx hypertension, to prevent complications (e.g. stroke, MI, heart failure).
Classification
Thiazide diuretics, usually considered first line
ACE inhibitors, considered near-first line
ARB's
Reduce heart rate:
Calcium channel blockers, considered near-first line
Beta blockers
Indications
As the INITIAL drug:
In mild BP elevation, lifestyle changes and observation are recommended BEFORE trialling drugs. However, there can be damage to body before BP is even elevated, so Pt's even w/ normal BP but show evidence of HTN-related nephropathy, proteinuria, atherosclerotic vascular disease, as well as other HTN-related organ damage, can be started
Often MORE than 1 agent is required to effectively lower HTN
The starting drug depends on age, race, and other medical conditions, including:
Younger Pt's of non-African ethnicity, started on ACEi's
For Pt's >55yo, use CCB's, thiazide diuretics
For anxiety, tremor, use beta blockers
For asthmatics, avoiding beta blockers
For diabetes, ACEi's or ARB's can be renal protective, as well as prevent retinal complications
For gout, diuretics can worsen, and the ARB losartan can reduce blood urate
For kidney stones, use thiazide diuretics
For heart block, greater than first degree, avoid beta blockers, and non-dihydropyridine CCB's
For heart failure, avoid non-dihydropyridine CCB's. Outcomes however, improve with beta blockers, diuretics, ACEi's, ARB's, and aldosterone antagonists
For pregnancy, the alpha agonist methyldopa is considered first line, but the beta blockers lebetalol and metoprolol are acceptable. The beta blocker atenolol however, is teratogenic. ACEi's and ARB's are contraindicated in women who are or intend on becoming pregnant
In African-Americans, thiazide diuretics and CCB's were found to be more effective than beta blockers, ACEi's, or ARB's
Dual therapy involves ACEi +CCB or thiazide diuretic
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