Hypertension

Drug starting dose
ACE inhibitors / ARBs lisinopril 20 mg QD
DHP CCB amlodipine 5 mg QD
thiazide hydrochlorothiazide (max 25 mg, no increased efficacy above this only side effects)
beta blockers not first line for HTN

 

Drug equivalency

β blocker ACE-i ARB
atenolol  50 mg QD lisinopril 10 mg losartan 25 mg
bisoprolol  5 mg QD benazepril 10 mg candesartan 8 mg
carvedilol (Coreg)  12.5 mg BID captopril 50 mg irbesartan 75 mg
labetalol  100 mg BID enalapril 5 mg valsartan 80 mg
metoprolol succinate (extended release) (Toprol XL) 100 mg QD ramipril 2.5 mg    
metoprolol tartrate (Lopressor)  50 mg BID        
nadolol  80 mg QD        
timolol  5 mg BID        

PRN treatment of inpatient HTN

  • Treat underlying causes (pain, nausea, etc.)
  • Give their home HTN meds
  • Amlodipine 5 mg PO
  • Labetalol 20 mg IV if cannot take PO
  • Hydralazine 5 mg PO if patient bradycardic (pure vasodilator/compensatory tachycardia); otherwise not preferred (can increase myocardial oxygen demand, not good for angina/CAD) and a little unpredictable

Hypertensive urgency/emergency

  • Hypertensive urgency = severe asymptomatic hypertension (DBP ≥ 120 mmHg) - low risk, no acute end-organ damage
  • Hypertensive emergency (crisis!) = severe HTN (usually ≥ 180/120) with symptoms related to acute end-organ damage
    • Malignant HTN = severe HTN + retinal exudates/hemorrhages/papilledema, +/- involvement (end stage; rare now; generally fatal)
    • HTN encephalopathy = severe HTN + signs of cerebral edema
  • If BP > 200/120, should probably treat even if asymptomatic
  • Rapid lowering of high BP in asymptomatic patients has no evidence of benefit (may cause harm)
  • Promptly (over few hrs) lowering BP - PO
    • Clonidine 0.1-0.2 mg PO
    • Captopril 6.25-12.5 mg PO (?)
    • Labetalol 100-200 mg PO
    • Can do lasix 20 mg PO if volume overloaded
    • Do not use short-acting CCBs (e.g. nifedipine) unless no CV risk factors
    • Sublingual nitro is not a good BP med (short-acting); use if indicated e.g. anginal chest pain
  • HTN emergency will require IV meds
  Dose Mechanism Notes
Nitroprusside     CN poisoning?
Nitroglycerin   reduce afterload and preload (venodilation)  
Nicardipine      
Clevidipine      
Fenoldopam      
Labetalol     bb contraindicated in acute heart failure
Esmolol      
Hydralazine      
Enalaprilat   ACE-i  
Phentolamine   a-blocker (only if pheo...)
author: admin | last edited: June 14, 2018, 1 a.m. | pk: 15 | unpublished