Hypertension Medications
FAQs on First-Line BP Meds
As a clinical pharmacist, you often encounter questions about choosing blood pressure medications for the initial treatment of uncomplicated hypertension. We know to turn to an ACEI or ARB , calcium channel blocker (CCB) , or thiazide first, CV benefits seem similar overall. But be ready with answers to common questions about nuances... …
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Pts W/ DM and HF
Angiotensin-converting enzyme (ACE) inhibitors
Therapeutic actions ㅡ ACE inhibitors block ACE in the lungs from converting angiotensin 1, activated when renin is released from the kidneys, to angiotensin 2, a powerful vasoconstrictor. Blocking this conversion leads to decreased BP, decreased aldosterone secretion, a small increase in serum potassium levels, and sodium and fluid loss; increased prostaglandin synth…
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Pediatric
Suggest lifestyle changes first for HYPERtensive kids
As a clinical pharmacist, you will hear buzz about how to treat hypertension in children and adolescents, due to Hypertension guidelines. About 2% to 4% of children in have hypertension . Kids are considered hypertensive if their BP is at the 95th percentile or higher for their age, sex, and height, measured on at least 3 separate occasions. …
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Hypertension Medications
Treat HYPERtension more aggressively in BLACK patients
As a clinical pharmacist, you will be asked more how to treat hypertension in black patients. There's controversy about whether hypertension should be treated more aggressively in black patients than in other races. Over 40% of black adults have hypertension . They also have higher BPs than whites and therefore a higher risk of complications. Now some experts…
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Nutrition
Watch for drugs and supplements that may increase blood pressure
As a pharmacy specialist, patients will ask you about medications and supplements that may cause hypertension. They are often surprised when they learn they're taking medications that can INCREASE blood pressure (BP). Check for common culprits if patients have new or worsening high BP. Explain that most patients won't have a significant BP increase with these…
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Hypertension Medications
How to choose CCB for your patient
As a clinical pharmacist, there’s often confusion about how to choose a calcium channel blocker (CCB) due to the laundry list of products and uses. Think of dihydropyridine CCBs (amlodipine, nifedipine, etc) as more potent vasodilators, but they can bump up heart rate. NONdihydropyridines (diltiazem, verapamil) slow heart rate. Preferred choice…
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Hypertension
How to treat MILD hypertension
As a cardiovascular pharmacist, you will hear debate about when to start drugs in patients with MILD hypertension, systolic blood pressure (BP) 140 to 159 mmHg or diastolic 90 to 99 mmHg. The latest analysis questions whether BP drugs benefit stage 1 or mild hypertension. It suggests that only one cardiovascular (CV) event is prevented for ever…
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Pain Management
Is it okay for HYPERtensive patients to take NSAIDs?
Is it okay for patients with hypertension to take NSAIDs e.g., ibuprofen, celecoxib, etc? ― Many can, but you need to be careful... On average, NSAIDs increase blood pressure (BP) by around 5 mmHg in patients with hypertension, but some patients are more susceptible than others. Elevations are more likely in the elderly, obese men and patients with diabetes ,…
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Renal Function
Expect a serum creatinine bump when starting an ACEI or ARB in kidney disease
How to safely use ACEIs or ARBs in patients with chronic kidney disease, this is an important question. We know these medications slow the progression of kidney disease. But blocking angiotensin can reduce kidney filtration and sometimes lead to a bump in serum creatinine (SCr) and potassium. See " Algorithm (1) of using ACEI or ARB after AKI ". …
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Hypertension Medications
Managing hypertension in older adults (60 years or older)
Lowering systolic blood pressure (BP) can benefit even very old patients with hypertension (reducing CV events, heart failure , and death). But older adults may be at higher risk for more side effects from antihypertensive medications, such as dizziness, electrolyte problems, and bumps in serum creatinine. Use the same general approach to manage hypertension in all …
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Hypertension Medications
Recommend the right antihypertensive combination for hypertension
Many patients with uncomplicated hypertension will need two or more medications to reach blood pressure (BP) goals. Comorbidities often drive medication combination choices, such as an angiotensin converting enzyme inhibitors (ACEI) plus beta-blocker in some patients with heart failure or after a heart attack. Emphasize lifestyle changes, assess adherence and check …
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Hypertension Medications
Overview of hypertension
Introduction ― Hypertension is defined as persistently elevated arterial blood pressure (BP) or usual office blood pressure of 140/90 mm Hg or higher, but recent U.S. guidelines have changed the definition to 130/80. Normal blood pressure (BP) in adults: systolic BP < 120 mmHg and diastolic < 80 mmHg. According to NICE guidelines, hypertension (HTN) can be cla…
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