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HTN (Med Selection for comorbid conditions (HF & CAD (Stroke (CKD (DM …

- - - - ACEi :spades: & Thiazide
      - CKD
        
        ACEi :spades: or ARB
        
        :warning:exception: stage IV CKD, small rise in Cr can precipitate stage V.
        
        DM :candy:
        
        ACEi :spades:
        
        if microalbuminemia
        (HCTZ, CCB, ACEi good for DM anyway)
        :warning:no ACEi for AA :man::skin-tone-6:
  - - - Peripheral edema
        
        Anti-anginal Rx: CP
        :pencil2: useless in HFrEF :<3:
      - ACEi/ARB :spades:
        
        rise in Cr, K :banana:
        
        ACEi: dry cough, angioedema
        
        DO use ARBs after presentation of angioedema
        
        Thiazides
        
        decr. K :banana:, decr. Urinary Ca :glass_of_milk:
        
        sulfa drug: but no cross reactivity
        
        Used in kidney stones
        
        BBlockers :trumpet:
        
        decr. HR :two_hearts:
        
        exacerbation of OLD (obs lung disease): bogus in real life
        
        HFrEF & CAD, still good
        
        Aldosterone antagonist: Spironolactone/Eplerenone
        
        incr. K :banana:
        
        spironolactone: gynecomastia, switch to eplerenone
        
        1º , 2º hyperaldosterone, or CHF class III
        
        Combo dilator: Hydralazine (arterial), isosorbide dinitrate (venous)
        
        Hydralazine dilates aa, causes reflex tachy, also drug induced lupus
        
        isosorbide dinitrate dilates veins, can't use w/ other nitrates or PDE5i
        
        1 more item...
        
        Alpha antagonists
        
        2 more items...
        
        :pencil2:Everyone gets
        
        BBlocker/ ACEi
        
        then loops
        
        then more BP control: AA or combo dilator
- - - - < 80
        
        q1y checkup
    - - Stage I
        
        Stage II
        
        Urgency
        
        Emergency
        
        same as urgency + signs of end organ damage
        
        Tx: Drip + moved to ICU
        
        goal: 25% reduction in MAP (not normalized 120/80)
        
        add PO meds
        
        ≥220
        
        ≥120
        
        Tx: IV meds + home PO Rx
        
        ≥140
        
        ≥90
        
        LSM (lifestyle mod) &
        
        2 meds w/ q1m visit
        
        2,2,2 or HBPM
        
        <140
        
        <90
        
        LSM (lifestyle mod) & q3m checkup to consider starting meds
        
        another RF for CAD? LSM (lifestyle mod) + 1 kind of med :pill: & q1m checkup
        
        compliance?
        
        side effects?
        
        need to titrate modify meds
        
        :pencil2:old guidelines:
        
        2 readings
        
        2 weeks apart
        
        2 visits
        
        1 more item...
        
        :pencil2:Medicate if there is comorbid conditions (10% ASCVD calc score; ie have another RF for CAD)
        
        :pencil2: Don't try so hard (in wards): doesn't matter since no strong indication for a particular Rx, focus on LSM.
      - <130
        
        <80
        
        LSM (lifestyle mod)
        
        :pencil2:What are these?
        
        eating: < 0.4g NaCl/day, DASH diet, K :banana:supplementation (citrus fruit), stop EtOH :beer: (2x :beer:/ :male_sign:, 1x :beer: / :female_sign:)
        
        exercise: 30 min/day; 2hrs/week (goal)
        
        weight loss: if obese or overweight (BMI >25) need to lose weight
        
        Disregard mmHg drops per lb lost.
      - :pencil2:Goal for most patients under Tx