Hypertension 3: antihypertensives

Listen to Tina the pharmacist discuss the 5 first-line antihypertensives:

  1. Thiazides
  2. ACE Inhibitors
  3. Angiotensin Receptor Blockers
  4. Beta Blockers
  5. Calcium Channel Blockers

She lists the mechanism of action, dosing, side effects, drug interactions, and cautionary notes of each drug classes and their representative drug.

This episode is wrapped up with Billy’s summary of the learning points from the 3-episode series on Hypertension:

  • essential hypertension is a diagnosis of exclusion. we need to consider treatable causes of hypertension especially for people who do not have the usual risk factors.
  • diagnosing a patient with hypertension is a careful process. for those without comorbidities or cardiovascular treatment, it can take a many as 5 visits averaging a BP of 140/90 to make a diagnosis. use home BP measurement if you suspect white coat hypertension.
  • the treatment threshold for uncomplicated patients is 160/100, and threshold for those with end organ damage or increased CV risk is 140/90.
  • a trial of lifestyle management to control BP is appropriate for most uncomplicated patients. it should always be a part of the management plan even for those who are on medication.
  • Treatment target is 140/90, unless the patient has diabetes, for this the threshold is 130/80.
  • For an elderly patient above 80 yo, systolic treatment target is 150
  • the first line agents are thiazides, ACEI, ARB, BB, and CCB. specific agents may be indicated for specific comorbidities
  • antihypertensive are among the most commonly used medications, but one must not forget that they carry many potentially serious side effects and can interact with other medications. when in doubt, consult your favorite pharmacist