Hypertension |
|
|
Classification
of Blood Pressure |
|
|
Category |
SBP |
|
DBP |
|
|
Normal |
< 120 |
and |
< 80 |
|
|
Pre-hypertension |
120-139 |
or |
80-89 |
|
|
Stage 1
Hypertension |
140-159 |
or |
90-99 |
|
|
Stage 2
Hypertension |
> 160 |
or |
> 100 |
|
|
|
Treatment
Options |
|
|
1. Thiazide diuretics - first
line agents in all patients with good renal function (CrCl > 30):
Hydrochlorothiazide 12.5-25mg qd; In patients with impaired renal function
(CrCl < 30) or congestive heart failure, use loop diuretics |
|
|
|
|
|
|
2. Beta-blockers - also used as a
first line agent, especially in post-MI, treatment of migrane, angina, and
atrial fibrillation; do not use in 2nd or 3rd degree heart block; monior
heart rate and EKG |
|
|
|
|
|
|
3. ACE Inhibitors - first line
agent in diabetic patients (with proteinuria); also useful in post-MI, heart
failure, renal insufficiency, and hyperlipidemia. Do not use in renal artery stenosis, and watch for hyperkalemia |
|
|
|
|
|
|
4. Angiotensin Receptor Blockers
- useful in diabetic patients where an ACE inhibitor cannot be tolerated or
failed |
|
|
|
|
5. Calcium Channel Blockers -
mainly second line agent. Useful in
isolated systolic hypertension (diuretic first line), diabetes with
proteinuria (ACE inhibitor first line), atrial fibrillation (only non-DHP
agents), renal insufficiency, and dyslipidemia. Do not use in heart block or congestive heart failure. Only use norvasc/plendil in heart failure. |
|
|
|
|
|
|
|
|
6. Centrally acting Alpha
Receptor Agonists - not used as first line agents. Useful in diabetic patients, renal insufficiency, and
tachycardia (methyldopa, clonidine) |
|
|
|
|
7. Alpha-1
Blockers - useful in BPH, but do not use as primary treatment of hypertension |
|
|
|
Return
to Main Index |
|
|
|
|
|
|
|
|
|
|
|
|