Race-Specific Drug Selection for Hypertension and Diabetes

What are the two classes of hypertensive crisis that require immediate intervention?

Hypertensive emergency and hypertensive urgency

What blood pressure readings define hypertensive emergency and hypertensive urgency?

SBP exceeds 180 mm Hg or DBP exceeds 120 mm Hg

What factors may contribute to the occurrence of hypertensive emergencies and urgencies?

Secondary hypertension, poorly controlled hypertension, undiagnosed hypertension, abrupt discontinuation of medications

What is the recommended frequency of monitoring blood pressure during treatment of hypertensive emergencies and urgencies?

The exact frequency is a matter of clinical judgment and varies with the patient’s condition Signup and view all the answers

What are the intended effects of beta-blockers?

Slowing the heart rate and lowering the blood pressure. Signup and view all the answers

What are the contraindications for using beta-blockers?

Asthma, reactive airway disease, COPD, heart block, symptomatic bradycardia. Signup and view all the answers

Which beta-blocker is preferred for patients with heart failure with reduced ejection fraction (HFrEF)?

Carvedilol. Signup and view all the answers

What is the mode of action of clonidine?

Acts through the central nervous system, mediated alpha-adrenergic stimulation in the brain, producing blood pressure reduction. Signup and view all the answers

What are the common side effects of Calcium Channel Blockers?

Muscle cramps, joint stiffness, sexual dysfunction, constipation, shortness of breath, edema, dizziness. Signup and view all the answers

What is the mechanism of action of Diuretics?

Block reabsorption of sodium and water in renal tubules. Signup and view all the answers

What are the contraindications for Potassium-Sparing Diuretics?

Significant CKD, severe hepatic disease, hyperkalemia. Signup and view all the answers

What is the mechanism of action of Beta-Blockers?

Block beta-adrenergic receptors and reduce cardiac workload. Signup and view all the answers

What are the first-line antihypertensive agents recommended for most patients?

Thiazide or thiazide-type diuretics, ACE inhibitors, ARBs, and CCBs. Signup and view all the answers

What is the first-line antihypertensive agent recommended for African American patients with hypertension and without heart failure or CKD?

Thiazide diuretic or CCB (not an ACE inhibitor or an ARB). Signup and view all the answers

What are the major actions of thiazide or thiazide-type diuretics?

Directly affect vascular smooth muscle, increase renal blood flow, and decrease cardiac output. Signup and view all the answers

What are the major actions of ACE inhibitors?

Inhibit the conversion of angiotensin I to angiotensin II, reducing peripheral resistance and potentially life-threatening complications. Signup and view all the answers

What are the recommended initial drug therapies for hypertension in individuals of African American descent?

CCB and/or thiazide-type diuretic. Signup and view all the answers

What are the recommended initial drug therapies for hypertension in non-African American populations?

ACE inhibitor, ARB, CCB, and/or thiazide-type diuretic. Signup and view all the answers

What is the recommended first-line therapy for stage 1 hypertension with a blood pressure goal less than 130/80 mm Hg?

Thiazide diuretics (e.g., chlorthalidone, hydrochlorothiazide) used as monotherapy or with an ACE inhibitor, ARB, or CCB. Signup and view all the answers

When should initial drug therapy with a combination of two antihypertensives be considered?

If the patient has a systolic pressure greater than 140 mm Hg or a diastolic blood pressure greater than 90 mm Hg. Signup and view all the answers

What is the definition of resistant hypertension?

Resistant hypertension is diagnosed when a patient takes at least three antihypertensive medications from different classes (including a diuretic) and the blood pressure is still not controlled (i.e., not less than 130/80 mm Hg). A patient with controlled blood pressure but who requires at least four antihypertensive medications in order to maintain that control is also considered to have resistant hypertension. Signup and view all the answers

What are the risk factors for resistant hypertension?

The risk factors for resistant hypertension include older age, being African American, and having obesity, CKD, or diabetes. Signup and view all the answers

What are the different groups of drugs used in the management of primary hypertension?

The drugs used in the management of primary hypertension belong to several different groups, including ACE inhibitors, angiotensin II receptor blockers (ARBs), antiadrenergics, calcium channel blockers (CCBs), diuretics, and direct vasodilators. Signup and view all the answers

How do these drugs act to decrease blood pressure?

In general, these drugs act to decrease blood pressure by decreasing cardiac output or peripheral vascular resistance. Signup and view all the answers

What are some antihypertensive drugs that are reportedly equally effective in African Americans and Caucasians?

CCBs, alpha1 receptor blockers, and the alpha-/beta-adrenergic blocker labetalol. Signup and view all the answers

Which class of antihypertensive drugs is less effective as monotherapy in African Americans?

ACE inhibitors, some ARBs (e.g., losartan and telmisartan), and beta-adrenergic blockers. Signup and view all the answers

What factors contribute to African Americans requiring multiple drugs for hypertension treatment?

Low circulating renin, increased salt sensitivity, and a higher incidence of obesity. Signup and view all the answers

Which class of antihypertensive drugs is recommended as first-line agents for treating hypertension in patients with heart failure or asymptomatic left ventricular dysfunction?

ACE inhibitors. Signup and view all the answers

What are some potential benefits of ACE inhibitors in people with renal impairment?

Reduction of proteinuria and slowing progression of renal impairment. Signup and view all the answers

What are some potential side effects of ACE inhibitors in people without diabetes?

They may cause or aggravate proteinuria and renal damage. Signup and view all the answers