| Hypertension | ||||||||||
| Classification of Blood Pressure | ||||||||||
| Category | SBP | DBP | ||||||||
| Normal | < 120 | and | < 80 | |||||||
| Pre-hypertension | 120-139 | or | 80-89 | |||||||
| Stage 1 Hypertension | 140-159 | or | 90-99 | |||||||
| Stage 2 Hypertension | > 160 | or | > 100 | |||||||
| Treatment Options | ||||||||||
| 1. Thiazide diuretics - first line agents in all patients with good renal function (CrCl > 30): Hydrochlorothiazide 12.5-25mg qd; In patients with impaired renal function (CrCl < 30) or congestive heart failure, use loop diuretics | ||||||||||
| 2. Beta-blockers - also used as a first line agent, especially in post-MI, treatment of migrane, angina, and atrial fibrillation; do not use in 2nd or 3rd degree heart block; monior heart rate and EKG | ||||||||||
| 3. ACE Inhibitors - first line agent in diabetic patients (with proteinuria); also useful in post-MI, heart failure, renal insufficiency, and hyperlipidemia. Do not use in renal artery stenosis, and watch for hyperkalemia | ||||||||||
| 4. Angiotensin Receptor Blockers - useful in diabetic patients where an ACE inhibitor cannot be tolerated or failed | ||||||||||
| 5. Calcium Channel Blockers - mainly second line agent. Useful in isolated systolic hypertension (diuretic first line), diabetes with proteinuria (ACE inhibitor first line), atrial fibrillation (only non-DHP agents), renal insufficiency, and dyslipidemia. Do not use in heart block or congestive heart failure. Only use norvasc/plendil in heart failure. | ||||||||||
| 6. Centrally acting Alpha Receptor Agonists - not used as first line agents. Useful in diabetic patients, renal insufficiency, and tachycardia (methyldopa, clonidine) | ||||||||||
| 7. Alpha-1 Blockers - useful in BPH, but do not use as primary treatment of hypertension | ||||||||||
| Return to Main Index | ||||||||||