Hypertension & Hyperlipidemia

PA Study Sesh

Disclaimer: new guidelines as of late 2017
Unlikely to be reflected on PANCE yet.
New BP Guidelines:
Elevated: 120-129/< 80
Stage 1: 130-139/80-89
Stage 2: 140+/90+
Hypertensive crisis: 180+/120+ with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage.
Medication for Stage 1 only if high ASCVD risk (same calculator used in prescribing statins)
Now Back to the PANCE:
Hypertension
* Definition
* Prehypertension 120-139/80-89
* Stage 1 140-159/90-99
* Stage 2 160+/100+
* Urgency 180+/120+ & NO end organ damage
* Emergency 180+/120+ & end organ damage (HERB)
* ON 2 DIFFERENT READINGS
* Symptoms
* Primary Hypertension is typically asymptomatic
* Hypertensive emergency
* Encephalopathy
* Intracranial hemorrhage
* Nephropathy
* Unstable angina/MI
* Papilledema=malignant hypertension
* Treatment (non-urgent/emergent)
* Lifestyle Modifications 1stALWAYS (Including those with Pre-HTN)
* DASH Diet
* Lower Sodium
* Exercise
* Healthy weight
* Smoking Cessation
* Medication Therapy
* Begin at 140/90 (this is also BP goal)
* Unless
* Over age 60
* Normal Kidneys
* No Diabetes
* Then 150/90
* Which med?
* 4 Main Classes to Choose From
* ACE Inhibitor
* Angiotensin converting Enzyme
* -“pril”
* Side Effects:
* Cough
* Hyperkalemia
* Angioedema
* Contraindications:
* Renal artery stenosis
* Pregnancy
* ARB
* Angiotensin II Receptor Blocker
* -“sartan”
* Side Effects:
* Hyperkalemia
* Angioedema
* Contraindications:
* Renal Artery Stenosis
* Pregnancy
* Calcium Channel Blocker
* -“dipine”
* More effective as vasodilators than verapamil and diltiazem
* Side Effects:
* Cardiac depression
* Still have some cardiac effects
* Thiazide Diuretic (HCTZ)
* Side Effects:
* Hypokalemia
* Gout
* Dyslipidemia
* Contraindication:
* Sulfa Allergy
* How to choose?
* If they have CKD or DM
* ACE/ARB (Renal Protective)
* African American
* TZD or CCB
* None of the above?
* Then just pick one!
* You can max out the dose before adding a 2ndor add a 2ndif goal isn’t met, doesn’t matter
* NEVER MIX AN ACE AND AN ARB
* Both inhibit the RAAS
* Renin angiotensin aldosterone system
* So at most, they’ll be on ACT
* Other possible additions
* Beta blockers “olols”
* fib
* Post MI
* Stable Angina
* Heart failure
* Alpha blockers “zosin”
* Pts with BPH
* Pregnant? Use Methyldopa
* Resistant to medication? Consider secondary hypertension
* Renal artery stenosis
* Coarctation of the Aorta (think Peds)
* Sleep Apnea
* Pheochromocytoma
* Primary Hyperaldosteronism
* Thyroid disease
* Treatment
* Urgency
* Decrease by 25% over 24-48 hours
* Rest in a quiet room