Antihypertensive Medications Quiz
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Questions and Answers

In managing diastolic hypertension, which of the following antihypertensive drugs is considered effective and widely used?

  • Thiazide diuretics
  • Calcium channel blockers (correct)
  • Sodium nitroprusside
  • Beta-blockers

Which characteristic is most associated with isolated systolic hypertension in elderly populations?

  • Increased arterial stiffness (correct)
  • Low sodium diet adherence
  • Frequent renal complications
  • Decreased pulse pressure

What is a common side effect of Thiazide diuretics when prescribed for hypertension?

  • Weight gain
  • Hyponatremia (correct)
  • Hyperkalemia
  • Hypoglycemia

Which medication is particularly noted for its potential renal protective effects in patients with hypertension?

<p>ACE inhibitors (B)</p> Signup and view all the answers

What factor may influence treatment efficacy for hypertension in diverse populations?

<p>All of the above (D)</p> Signup and view all the answers

What is a common side effect associated with the use of Aliskiren?

<p>Angioedema (A)</p> Signup and view all the answers

Which medication is primarily indicated for managing hypertension emergencies in pregnancy?

<p>Labetalol (D)</p> Signup and view all the answers

What contraindication is specifically associated with the use of diuretics?

<p>Anuria (D)</p> Signup and view all the answers

Which of the following medications is known to potentially cause hepatotoxicity more than other beta-blockers?

<p>Labetalol (C)</p> Signup and view all the answers

Which medication requires caution when taken with high-fat meals due to reduced absorption?

<p>Aliskiren (A)</p> Signup and view all the answers

What is a common reflex response when using Apresoline for hypertension management?

<p>Increased heart rate (A)</p> Signup and view all the answers

What class of antihypertensive has a contraindication related to asthma?

<p>Beta-blockers (B)</p> Signup and view all the answers

Which condition is related to the contraindication of using beta-blockers in hypertensive treatment?

<p>Severe PAD (B)</p> Signup and view all the answers

Which medication is particularly used for prehypertension but contraindicated in pregnancy?

<p>Rasilez (B)</p> Signup and view all the answers

What potential drug interaction should be noted when using Aliskiren?

<p>Inhibition when taken with grapefruit juice (B)</p> Signup and view all the answers

Which of the following statements about ACE inhibitors and ARBs in hypertensive patients with chronic kidney disease is correct?

<p>ACE inhibitors are effective but need renal function monitoring. (D)</p> Signup and view all the answers

What is the recommended management for a patient with isolated systolic hypertension who also has psychiatric diseases?

<p>Caution should be applied when using CCBs or α-blockers with certain antidepressants. (D)</p> Signup and view all the answers

In patients with renovascular disease and hypertension, the initial treatment is affected by which of the following considerations?

<p>Care must be taken for ACE inhibitors or ARBs in certain renal artery conditions. (D)</p> Signup and view all the answers

Which medication combination is contraindicated in patients with severe peripheral artery disease?

<p>β-blockers other than metoprolol (D)</p> Signup and view all the answers

Regarding management of hypertension in pregnancy, which medication is not recommended?

<p>ACE inhibitors (A)</p> Signup and view all the answers

When managing diastolic hypertension in older patients, which of the following medications is preferred?

<p>Calcium channel blockers (C)</p> Signup and view all the answers

Which statement regarding the efficacy of different antihypertensive classes in diverse populations is accurate?

<p>Different populations may respond variably to certain antihypertensive agents. (B)</p> Signup and view all the answers

What is an important consideration when treating hypertension in non-DM CKD patients with proteinuria?

<p>Combination therapy with ACE inhibitors or ARBs may be necessary and should be monitored. (A)</p> Signup and view all the answers

What is the recommended approach for managing resistant hypertension after using three antihypertensives at optimal doses?

<p>Refer to a specialist after optimizing drug therapy (A)</p> Signup and view all the answers

Why should ACE inhibitors be avoided in black patients?

<p>Angioedema risk is significantly increased (C)</p> Signup and view all the answers

What impact do NSAIDs generally have on blood pressure?

<p>Cause a mild increase in blood pressure (C)</p> Signup and view all the answers

Which condition is contraindicated for the use of ACE inhibitors or ARBs?

<p>Bilateral artery stenosis (C)</p> Signup and view all the answers

In managing isolated systolic hypertension, which combination of therapies is not recommended?

<p>Hydralazine and a diuretic (B), Verapamil and β-blocker (C)</p> Signup and view all the answers

What factor may contribute to the reduced effectiveness of certain antihypertensive medications in black populations?

<p>Genetic variations in drug metabolism (C)</p> Signup and view all the answers

What should be considered when prescribing medication to teens for hypertension?

<p>Ensuring no unplanned pregnancies when using certain drugs (B)</p> Signup and view all the answers

Which specific antihypertensive therapy has safety concerns regarding use during pregnancy?

<p>ACE inhibitors (A)</p> Signup and view all the answers

Among the following medications, which is the least preferred option for a patient with asthma and hypertension?

<p>β-blocker (C)</p> Signup and view all the answers

What is a potential side effect of antihypertensive medications that may lead to exclusion from treatment trials?

<p>Orthostatic hypotension (B)</p> Signup and view all the answers

In the context of renal implications, which population should be approached cautiously when prescribing antihypertensive medications?

<p>Patients with bilateral renal artery stenosis (C)</p> Signup and view all the answers

What combination of antihypertensive agents can lead to increased renin and sympathetic activity?

<p>Hydralazine and diuretic (C)</p> Signup and view all the answers

What is the appropriate recommendation for utilizing ARBs in African or black patients with hypertension?

<p>Avoidance is suggested due to angioedema risk (B)</p> Signup and view all the answers

Which medication combination is specifically contraindicated due to increased risk of adverse effects?

<p>ACEi and aliskiren (A)</p> Signup and view all the answers

Which medication is known to significantly elevate blood pressure when used in high doses?

<p>Estrogen &gt;50mcg (C)</p> Signup and view all the answers

What is the potential adverse effect of intensive blood pressure reduction in diabetic patients?

<p>Higher rates of myocardial infarction and stroke (C)</p> Signup and view all the answers

How is the effectiveness of ambulatory blood pressure monitoring viewed in the diagnosis of hypertension?

<p>Preferred over clinic blood pressure measurements (C)</p> Signup and view all the answers

What class of antihypertensives is advised to be used in conjunction with caution due to potential side effects on heart function?

<p>Calcium channel blockers like diltiazem (A)</p> Signup and view all the answers

What impact do hypertensive disorders of pregnancy have on future cardiovascular risk?

<p>Increased risk of future cardiovascular disease (C)</p> Signup and view all the answers

What does the cohort study on antihypertensive therapy suggest regarding treatment effects based on patient age?

<p>Older patients experience worse outcomes than younger patients (B)</p> Signup and view all the answers

What was the main finding regarding the impact of clinic, daytime, and nighttime systolic blood pressure in patients with hypertension?

<p>Nighttime systolic blood pressure correlates highly with adverse cardiovascular events. (C)</p> Signup and view all the answers

Which class of medication was specifically compared in terms of major cardiovascular events and adverse effects?

<p>Chlorthalidone versus hydrochlorothiazide (D)</p> Signup and view all the answers

What was the conclusion of the study regarding the use of felodipine for blood-pressure reduction in patients with non-diabetic chronic renal disease?

<p>No additional benefit was observed from further blood-pressure reduction. (B)</p> Signup and view all the answers

What does the PRECISION-ABPM trial mainly investigate?

<p>Blood pressure effects of ibuprofen, naproxen, and celecoxib in arthritis patients. (A)</p> Signup and view all the answers

What correlation was found between orthostatic hypotension and dementia in patients with specific neurological conditions?

<p>Orthostatic hypotension is associated with an increased risk of dementia. (A)</p> Signup and view all the answers

What is a common side effect associated with the use of non-DHP calcium channel blockers like Verapamil?

<p>Peripheral edema (A)</p> Signup and view all the answers

Which medication may lead to elevated levels of cyclosporin when taken together?

<p>Verapamil (D)</p> Signup and view all the answers

Which statement about diltiazem is true?

<p>It can lead to constipation. (A)</p> Signup and view all the answers

Which condition is a contraindication for the use of Verapamil?

<p>Obstructive hypertrophic cardiomyopathy (C)</p> Signup and view all the answers

What is a significant effect of DHP calcium channel blockers like amlodipine?

<p>They can cause tachycardia. (C)</p> Signup and view all the answers

What is the dosing recommendation for TIAZAC/XC cap to manage hypertension?

<p>Once daily, 240mg (D)</p> Signup and view all the answers

What effect does digoxin have when taken with calcium channel blockers?

<p>It leads to increased digoxin levels. (A)</p> Signup and view all the answers

Which statement about the interactions of Verapamil is accurate?

<p>It increases the effects of cimetidine. (B)</p> Signup and view all the answers

What is a notable side effect related to using DHP calcium channel blockers?

<p>Gingival hyperplasia (D)</p> Signup and view all the answers

What is a significant challenge in managing hypertension that is complicated by chronic kidney disease?

<p>Double challenge of resistant hypertension (D)</p> Signup and view all the answers

Which factor is most important in evaluating the effectiveness of blood pressure monitoring devices?

<p>Accuracy of the readings (C)</p> Signup and view all the answers

What crucial aspect is associated with the variability in blood pressure and its impact on cardiac risk?

<p>Episodic hypertension (A)</p> Signup and view all the answers

What is a common characteristic associated with drug-related hypertension?

<p>Use of certain medications (A)</p> Signup and view all the answers

Which aspect is frequently overlooked that might influence hypertension treatment outcomes?

<p>Individual patient variability (B)</p> Signup and view all the answers

What role does lifelong physical activity play in relation to blood pressure?

<p>It helps in reducing the risk of coronary heart disease. (A)</p> Signup and view all the answers

What is a critically important factor to consider when assessing the prognosis of hypertension?

<p>Visit-to-visit blood pressure variability (D)</p> Signup and view all the answers

Why might the use of certain antihypertensive therapies lead to hospitalization in patients?

<p>Severe hypotensive episodes (B)</p> Signup and view all the answers

Which statement about the prognosis related to hypertension is true?

<p>Maximum systolic blood pressure has prognostic significance. (D)</p> Signup and view all the answers

What is the recommended daily dosage range for valsartan?

<p>80-320mg daily (D)</p> Signup and view all the answers

Which of the following medications is a first-line treatment for diastolic hypertension?

<p>Amlodipine (A)</p> Signup and view all the answers

What is a notable risk associated with candesartan use as indicated by a study?

<p>Elevated cancer risk (C)</p> Signup and view all the answers

Which class of medication is identified as a second-line option for blood pressure control in heart failure with reduced ejection fraction (HFrEF)?

<p>DHP calcium channel blockers (D)</p> Signup and view all the answers

Which of the following statements about the dosing of amlodipine is correct?

<p>Amlodipine is effective in doses of 1-10mg daily. (A)</p> Signup and view all the answers

What concern exists regarding the interaction of amlodipine with certain drugs?

<p>Potentiation of the effects of cyclosporine (B)</p> Signup and view all the answers

How is felodipine described in relation to its negative inotropic effects?

<p>It has fewer negative inotropic effects than nifedipine. (D)</p> Signup and view all the answers

What is a recommended first-line treatment for hypertension in African or black patients that avoids ACE inhibitors?

<p>Thiazide-like diuretics (C)</p> Signup and view all the answers

What is the risk associated with using ACE inhibitors in African or black patients?

<p>Higher incidence of angioedema (A)</p> Signup and view all the answers

What is the preferred approach for managing resistant hypertension after the initial therapy fails?

<p>Optimize drug therapy and assess patient adherence (D)</p> Signup and view all the answers

Which of the following medications should be avoided in patients with asthma?

<p>Beta-blockers (B)</p> Signup and view all the answers

What combination of antihypertensive agents is known to potentially stimulate renin and sympathetic activity when used together?

<p>Hydralazine and diuretics (B)</p> Signup and view all the answers

Which medication is noted for its potential to significantly increase blood pressure when combined with others?

<p>Glucocorticoids (C)</p> Signup and view all the answers

What is the fourth agent option for resistant hypertension when three medications are used unsuccessfully?

<p>Spironolactone (D)</p> Signup and view all the answers

Which agents are recommended to be used with caution in teenage patients during hypertension treatment?

<p>ACE inhibitors and ARBs (C)</p> Signup and view all the answers

What class of antihypertensive medications is contraindicated for individuals who also have high-performance athletic activities?

<p>Beta-blockers (C)</p> Signup and view all the answers

Which medication's interaction with high-fat meals should be considered due to potential absorption issues?

<p>Aliskiren (C)</p> Signup and view all the answers

Flashcards

Myocardial Infarction Contraindications

Certain medications (e.g., diltiazem, verapamil) might be contraindicated or ineffective following a recent myocardial infarction.

Heart Failure & Reduced EF Treatment

Treatment for heart failure with reduced ejection fraction (EF) often involves a combination of medications, such as perindopril and indapamide.

CKD Proteinuria Treatment

For Chronic Kidney Disease (CKD) with proteinuria (protein in urine), ACE inhibitors (ACEi) are often the appropriate first-line treatment, or use ARBs if ACEi are not suitable.

CKD and Renal Artery Stenosis Caution

Caution must be exercised with ACEi or ARBs in cases of bilateral renal artery stenosis or unilateral disease with a solitary kidney.

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Peripheral Artery Disease (PAD) Caution

Beta-blockers should be avoided in patients with severe PAD (Peripheral Artery Disease).

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Psychiatric Disease and Hypertension Treatment

For patients with psychiatric conditions, ACEi, ARBs and diuretics, except atenolol may be used; beta-blockers are often avoided (except metoprolol in tachycardia situations).

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Pregnancy Hypertension Treatment (General)

Several medications are used for hypertension during pregnancy, including oral labetalol, oral nifedipine XL, methyldopa, hydralazine, and diuretics. There are specific guideline differences for first-line medications based on existing studies .

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Lactation and Hypertension Medications

Certain medications are compatible with breastfeeding, such as enalapril, nifedipine XL, labetalol, amlodipine, metoprolol, and diuretics.

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Hypertension Emergency in Pregnancy

A serious condition in pregnant women where blood pressure rapidly increases, needing immediate medical attention.

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Labetalol

A medication used to treat high blood pressure, combining alpha- and beta-blocker actions.

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Direct Renin Inhibitor

A medication (like Aliskiren) that works by blocking the renin enzyme, helping lower blood pressure.

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Aliskiren

A medication to lower blood pressure by inhibiting renin.

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Contraindications (Labetalol)

Conditions like severe heart conditions, asthma, or severe slow heartbeat where Labetalol shouldn't be used.

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Contraindications (Diuretics)

Conditions like symptomatic gout, allergy to sulfa, or kidney/water imbalance that prohibit diuretic use.

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β-Blockers Contraindications

Conditions like asthma, impeded heart, or severe slow heart rate where β-blockers shouldn't be given.

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Postural Hypotension

A sudden drop in blood pressure when changing positions (standing up from lying down), potentially causing dizziness.

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Renin-Angiotensin-Aldosterone System

A powerful system in the body involved in blood pressure regulation.

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Side Effects (Aliskiren)

Possible side effects include diarrhea, headaches, high potassium levels, and skin reactions.

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ACEi/ARB Contraindications

ACE inhibitors (ACEi) and Angiotensin Receptor Blockers (ARBs) should not be used in patients with certain conditions.

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Hypertension in Pregnancy?

Maternal blood pressure before pregnancy could be linked to the sex of the baby. This was discovered from a prospective pre-conception cohort study.

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Combining β-blockers with Other Drugs

Combining β-blockers with other antihypertensive drugs in treating hypertension should be done cautiously, focusing on safety and tolerability.

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Bilateral Artery Stenosis

Narrowing of both arteries leading to a kidney.

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Angioedema

Swelling of the skin and tissues below the skin.

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Chocolate and Blood Pressure

Flavanol-rich chocolate and cocoa products may have minimal but statistically significant blood pressure-lowering effects in the short term.

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Non-drug Hypertension Treatment

Non-drug recommendations like low sodium and calorie intake can be effective in treating hypertension long-term, confirmed in clinical settings.

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CCB Contraindication

Calcium Channel Blockers (CCBs) should be used with caution in individuals with certain blood pressures.

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Blood Pressure in Adolescence & Future Risk

Blood pressure levels in late adolescence are a significant indicator of future cardiovascular event risk, according to a cohort study.

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Orthostatic Hypotension

Drop in blood pressure when moving from a sitting or lying position to a standing position.

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Hypertensive Disorders of Pregnancy

High blood pressure during pregnancy.

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Intensive Blood Pressure Reduction

Aggressive lowering of blood pressure.

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High Blood Pressure in Adults

High blood pressure in adults requires careful management and prevention.

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Ambulatory Blood Pressure Monitoring

Blood pressure is measured over a 24 hours period outside of a clinic setting.

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Antihypertensive Drug Withdrawal

Process of stopping antihypertensive medications, should be done carefully.

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Methyldopa and depression risk

Methyldopa, a blood pressure medication, may increase the risk of depression in some individuals.

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Thiazide-like diuretic + DHP-CCB for hypertension

Combining a thiazide-like diuretic and a DHP-CCB is a first-line approach for hypertension.

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ACEi and ARB caution in Black patients

ACE inhibitors (ACEi) and Angiotensin Receptor Blockers (ARBs) are associated with a higher risk of angioedema in Black patients.

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Beta-blocker avoidance in specific conditions

Beta-blockers should be avoided in patients with asthma, diabetes, and high-performance athletes.

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ACEi, ARB, and MRA caution in teens

Caution is needed when prescribing ACE inhibitors (ACEi), ARBs, and mineralocorticoid receptor antagonists (MRAs) to teens, due to potential impact on pregnancy.

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Resistant Hypertension

High blood pressure that doesn't respond to at least three antihypertensive medications at optimal doses.

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Potential drugs increasing BP (class)

Nonsteroidal anti-inflammatory drugs (NSAIDs), estrogens, sympathomimetics, cyclosporine, tacrolimus are among the drugs which can increase blood pressure.

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Hydralazine and Diuretic combination caution

Combining hydralazine with diuretics can stimulate renin and sympathetic activity, potentially counteracting blood pressure control unless a beta-blocker is used concurrently.

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Verapamil/Diltiazem with beta-blocker caution

Combining verapamil or diltiazem with a beta-blocker can have undesirable negative effects on the heart.

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Resistant Hypertension 4 Steps

Rule-out white coat syndrome, optimize medication, evaluate adherence, refer to specialist.

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CCB for Diastolic HTN

Calcium Channel Blockers (CCBs), particularly long-acting ones like Amlodipine, are often the first-line treatment for diastolic hypertension, isolated systolic hypertension, and stable angina. They can also be helpful in treating heart failure with diastolic dysfunction.

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DIHYDROPYRIDINE (DHP) CCBs

Dihydropyridine Calcium Channel Blockers (DHP-CCBs) like Amlodipine and Felodipine are favored for uncomplicated diabetes and as a second-line option for managing blood pressure in heart failure with reduced ejection fraction (HFrEF).

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CCB Considerations

While effective for blood pressure management, Calcium Channel Blockers have potential interactions with other medications like cyclosporine, fluconazole, and grapefruit juice. These interactions can increase the CCB's effects, so caution is advised.

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Angiotensin II Receptor Blockers (ARBs)

ARBs, like Candesartan and Losartan, are commonly used to manage hypertension. Some data suggests a potential increased risk of cancer with higher doses.

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ARBs for Heart Failure

ARBs are also effective in treating heart failure, as shown in studies like CHARM (candesartan) and Val-HeFT (valsartan).

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Drug Interactions with ARBs

Be cautious when considering ARBs and other medications since some known interactions can affect the effectiveness or increase side effects. For example, grapefruit juice may increase the concentration of certain ARBs.

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Amlodipine Dosage

Amlodipine, a long-acting DHP-CCB, is usually started at a low dose (2.5-5 mg/day) and can be increased to a maximum of 10 mg/day. However, individual needs and response may vary.

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What are non-DHP CCBs?

Non-dihydropyridine calcium channel blockers (CCBs) are a class of drugs that block calcium channels in the heart and blood vessels. They are effective for treating hypertension, angina, and some arrhythmias. Examples include verapamil and diltiazem.

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Verapamil's Inotropic & Chronotropic Effects

Verapamil has a negative inotropic effect, meaning it weakens the heart's ability to contract. It also has a negative chronotropic effect, meaning it slows down the heart rate.

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Diltiazem & Carbamazepine

Carbamazepine (CBZ) can increase diltiazem levels in the body. This can lead to increased side effects of diltiazem, such as hypotension and bradycardia.

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Diltiazem & Cimetidine/Protease Inhibitors

Cimetidine and protease inhibitors can increase the levels of diltiazem in the body, leading to an increased risk of side effects.

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Common Diltiazem Side Effects

Common side effects of diltiazem include flushing (feeling hot), constipation, headache, and edema.

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Verapamil Dosing & Indications

Verapamil is available in regular release (Reg) and sustained release (SR) forms. It's used for hypertension, stable angina, and coronary artery disease.

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Verapamil & Digoxin

Verapamil can increase digoxin levels in the body. This can increase the risk of digoxin toxicity.

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Verapamil's Impact on Heart Rate

Diltiazem & Verapamil can decrease heart rate, while dihydropyridine CCBs can increase heart rate.

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Verapamil & Cyclosporine

Verapamil can increase the levels of cyclosporine in the body. This can increase the risk of cyclosporine toxicity.

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Methyldopa & Depression

Methyldopa, a medication for high blood pressure, may increase the risk of depression in some individuals.

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African/Black Patients & ACEi/ARBs

ACE inhibitors (ACEi) and ARBs are associated with a higher risk of angioedema (swelling) in Black patients. They are generally not recommended.

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Beta-Blockers in Specific Cases

Avoid beta-blockers in patients with asthma, diabetes, and high-performance athletes because of potential side effects.

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Teenage Patients & ACEi/ARBs/MRAs

Use ACE inhibitors (ACEi), ARBs, and MRAs cautiously in teenagers due to potential consequences for unplanned pregnancy.

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Drugs that Increase Blood Pressure (Examples)

NSAIDs, estrogens, certain stimulants, some medications for organ transplants (cyclosporine, tacrolimus), and others can elevate blood pressure.

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Hydralazine & Diuretics: Combination Caution

Combining hydralazine with diuretics can sometimes cause a rebound effect, potentially increasing blood pressure unless accompanied by a beta-blocker.

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Verapamil/Diltiazem & Beta-Blockers: Combination Caution

Combining these calcium channel blockers (CCBs) with beta-blockers can have negative impacts on the heart.

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Resistant Hypertension: 4 Steps to Manage

Managing resistant hypertension involves ruling out white coat syndrome, optimizing medication, assessing adherence, and referring to a specialist if needed.

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Blood Pressure Control for Kidney Protection

For people with chronic kidney disease, controlling blood pressure is crucial for protecting the kidneys. ACE inhibitors are the first-line treatment, but other medications like calcium channel blockers may also be used.

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ACEi/ARB Caution in Pregnancy

ACE inhibitors (ACEi) and angiotensin receptor blockers (ARBs) are not recommended during pregnancy due to potential harm to the developing fetus.

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Evening Dosing for Hypertension

Taking antihypertensive medications in the evening can be more effective in reducing cardiovascular events than taking them in the morning.

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PolyPill

A single pill combining multiple medications to prevent cardiovascular diseases, including aspirin, a statin, and a blood pressure lowering medication.

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Angiotensin-Converting Enzyme (ACE) Inhibitors

Medications that block an enzyme that constricts blood vessels, lowering blood pressure and helping prevent heart disease.

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Beta-Blockers

Medications that block stress hormones, reducing heart rate and blood pressure, important for managing hypertension and protecting the heart.

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Calcium Channel Blockers (CCBs)

Medications that relax blood vessels by blocking calcium from entering, lowering blood pressure.

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Diuretics

Medications that help the body get rid of excess water and salt, lowering blood pressure.

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White Coat Hypertension

High blood pressure only observed in a clinical setting, possibly due to anxiety.

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Episodic Hypertension

Sudden and temporary spikes in blood pressure, often associated with stress or emotional triggers.

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Study Notes

Oral Antihypertensives: Summary/Guidelines Comparison Chart

  • Diuretics are a first-line treatment for hypertension, especially in individuals with diastolic hypertension, isolated systolic hypertension (ISH), left ventricular hypertrophy (LVH), or diabetes.
  • Thiazide-like diuretics are beneficial for patients with reduced creatinine clearance (CrCl) and are less effective in African Americans unless used with a thiazide.
  • Indapamide has minimal effects on lipids/glucose, possibly more effective than HCTZ in patients with reduced CrCl. Adverse events include headache and dizziness.
  • Hydrochlorothiazide (HCTZ) and Chlorthalidone are thiazide-type diuretics with similar benefits to HCTZ but with a higher risk of potassium (K+) loss, and possible increased risk of hip/pelvic fractures.
  • Spironolactone (Aldactone) is a potassium-sparing diuretic, first-line for heart failure, hypertension, and hyperaldosteronism. Adverse events include gynecomastia, menstruation irregularities, and gastrointestinal (GI) issues.

B-Blockers

  • Cardio-selective: Bisoprolol and Metoprolol lower heart rate (HR) and are beneficial in heart failure (HFrEF), stable angina, and myocardial infarction (MI).
  • Non-selective: Propranolol, and others have a higher risk of adverse effects, including exacerbation of conditions, but are sometimes useful in specific cases. Adverse events can include headache, dizziness, cold extremities, and bronchospasm.
  • Contraindications for use include: severe asthma/COPD, peripheral artery disease (PAD), and second/third-degree heart block, decompensated heart failure.

ACE Inhibitors (ACEi) and Angiotensin Receptor Blockers (ARBs)

  • ACEi: Lisinopril and Ramipril are first-line treatments for hypertension, particularly in diabetics, those with coronary artery disease (CAD), and those who have had a prior stroke/transient ischemic attack (TIA), and chronic kidney disease (CKD). A dry cough is a common adverse effect, especially among East Asians. Other adverse events include loss of taste, rash (especially with captopril), headache, dizziness, and blood pressure issues from diuretics.
  • ARBs: Irbesartan, Losartan, Valsartan, similar use as ACEi, sometimes preferred if ACEi intolerance. These drugs reduce cough risk but may cause other adverse events such as headache, dizziness, and hypotension.
  • Contraindications for use of both ACEi and ARBs: include bilateral renal artery stenosis, a history of angioedema, and pregnancy.

Calcium Channel Blockers (CCB)

  • DHPs (dihydropyridines): Amlodipine and Felodipine are usually first-line choices for treating uncomplicated diabetes, and are also useful for treating stable angina and left ventricular hypertrophy (LVH). Adverse events include headache, dizziness, and peripheral edema, especially in females.

  • Non-DHPs (non-dihydropyridines): Diltiazem and Verapamil have a higher risk of negative inotropic & chronotropic effects, and are sometimes used for specific conditions such as atrial fibrillation (AF) and supraventricular tachycardia (SVT). Adverse events include headache, dizziness, and peripheral edema.

  • Other considerations: In some cases, multiple medications may be needed, and combinations of drugs might be used to manage blood pressure. It is crucial to monitor patients for adverse events and adjust treatment as needed. Consider initial therapy of choice, and second/third line therapy, including indications/contraindications, particularly for people with specific health conditions like diabetes, heart failure, or chronic kidney disease.

  • Important to note the potential for drug-drug interactions, such as increasing lithium or digoxin levels. The potential for some medications to be less effective in African Americans should be considered. Some medications are not recommended in pregnancy. Consult updated guidelines for the most current information.

  • Antihypertensive drug regimens are often more effective when taken in the morning. This, however, may need to be changed if the patient experiences dizziness or lightheadedness during the day.

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Oral Antihypertensives Summary PDF

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Test your knowledge on antihypertensive medications and their effects with this quiz. Questions cover drug efficacy, side effects, and special considerations for diverse populations. Ideal for students and professionals in healthcare and pharmacy.

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