Hypertension

1. BP > 140/90

    if age>60 y/o ⇒ BP > 150/90

2. if there were any secondary cause for HTN, refer the pt to specialists otherwise, start treatment

3. Check:

    1. CBC, BUN, Cr, Na, K, Ca U/A

    2. TSH, FBS, TG, CHOLESTROL, LDL, HDL

    3. URIC ACID, Urine Alb/ Urine Cr

    4. CXRAY, ECG

4. First line treatment

    1. ACIs

        1. tab captopril 25, 50 mg bid, tds, qid

        2. tab enalapril 5, 10 mg bd, qd

        3. tab lisinopril 5, 10 mg bid, qd

    2. ARBs

        1. Tab losartan 25, 50 mg qd or bid

        2. Tab valsartan 40, 80, 160 mg qd

    3. CCBs:

        1. Tab amlodipine 5 mg qd

        2. Tab Diltiazem 60, 120 mg qd

    4. Thiazide:

        1. Tab Hydrochlorothiazide 50 mg qd

    5. check BP after starting medication in 2-4 weeks

    6. if started ACE/ARBs, check Na, K, BUN, Cr after one week

    7. Goal of treatment BP<130/80

    8. After using 3 drugs, if BP is not controlled, refer the pt for secondary causes

    9. Combined Pills:

        1. tab Losamix-H 50/12.5 mg (losartan, thiazide)

        2. tab Valtizide 80/12.5 or 160/12.5 (Valsartan, thiazidde)

        3. Tab valfort 5/160/12.5 (Amlodipine, valsartan, thiazide)

    10. Tab Indapamide 1.25, 2.5 mg qd

        1. another thiazide

        2. less side effects than hydrochlorothiazide

    11. If Cr>1.5 and GFR<30 ⇒ do not use Thiazide

    12. ACIs may cause cough but resolves after 1 month of cessation

    13. If Heart failure + Pulmonary edema + HTN

        1. ACIs or ARBs

        2. Tab frusemide (Lasix) 40 mg bid #30

    14. If Angina or LVF is present use b-blockers

        1. Tab metoprolol 50, 100 mg bid #60

        2. do not use in

            1. heart block

            2. asthma

            3. COPD with active wheezing

            4. HR< 55 bpm

5. Pt follow-up

    1. side effects:

        1. Angioedema in ACIs

        2. hyperkalemia in ACIs or ARBs

    2. orthostatic hypotension

6. Urgent HTN: high BP without end-organ damage

    Emergency HTN: high BP with end-organ damage

7. Emergency HTN treatment

    1. IV drugs

    2. Reach goal in 48 hours

    3. start po drugs in 6-12 hours

    4. in 2-4 hours, reduce 25% of BP to reach 160/100

8. Urgent HTN treatment

    1. repeat BP check in 30 minutes

    2. if still high, start Po drugs:

        1. captopril

        2. amlodipine

        3. hydrochlorothiazide

    3. after BP reaches <180/120, discharge with PO drugs and re-visit in 1-7 days