Hypertension & Hyperlipidemia


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Aug 06 2018 29 mins   12
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