Cardiovascular Medicine Book

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Hypertension Management

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  1. See Also
    1. Hypertension
    2. Hypertension Criteria
    3. Hypertension Evaluation
    4. Hypertension Risk Stratification
  2. General Guidelines
    1. See patients back at one month after starting agent
      1. Significantly improves compliance
      2. BP requires 1 month on agent to equilibrate
    2. Maximize compliance
      1. Work with patients to reduce adverse effects
      2. Switch to other agents if adverse effects significant
    3. Do not be overzealous
      1. Risk of overcorrection of Blood Pressure
      2. Avoid lowering diastolic pressure <70 mmHg
      3. Greater tolerance for elevated BP with increased age
        1. Study of 484 Swedish men over 70 from 1982-1992
        2. Risk if Diastolic Blood Pressure lowered below 90
          1. Increased cardiac event risk 3.9x
          2. Controlled for confounding factors
        3. Reference
          1. Merlo (1996) BMJ 313:457
    4. Medications that prevent Hypertension vascular sequelae
      1. Beta-Blockers
      2. Diuretics
      3. ACE Inhibitors
      4. Calcium Channel Blockers
    5. Medications that prevent Left Ventricular Hypertrophy
      1. Most effective at reduced LVH risk
        1. ACE Inhibitors
        2. Diuretics
        3. Beta-Blockers
      2. Least effective at reduced LVH risk
        1. Prazosin
        2. Clonidine
        3. Diltiazem
      3. Reference
        1. Gottdiener (1997) Circulation 95:2007
  3. Management Protocol
    1. See Hypertension Risk Stratification
    2. See Hypertension Reduction Goal
  4. Management Strategies
    1. Hypertension General Measures
    2. Antihypertensive Selection
    3. Hypertension Combination Therapy
    4. Hypertension Management for Specific Comorbid Diseases
    5. Hypertension Management for Specific Populations
    6. Hypertension Management for Specific Emergencies
  5. References
    1. (2000) Lancet 356:1955

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