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HTdrugs
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<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> ''NICE guidelines - 2012'' CCB better than thiazides bendroflumethazide not thiazide of choice ABCD algorithm - (Ace BB Ca channel Diuretic) Step 1 <55 - ACE or ARB (don't combine as no added benefit and inc SE) step 1 >55 / blacks - CCB step 2 - CCB + ACE/ARB step 3 - Add diuretic - esp if in failure (not bendroflumethazide but Indapamide SR (1.5-2.5), or chlorthalidone (12.5 or 25mg)) step 4 (resistent HT) ?under specialist advice? or consider ... if K>4.5 double dose diuretic if K<4.5 - Spironolactone 25mg od ??alpha blocker (doxasocin) or BB or other new BB - reduce stroke and heart disease but not as well as other drugs, if using BB for other things - migraine, anxiety or used already - then use ?ARB better tolerated than ACE and longer action ''Resistant HT '' already on ACD (optimal or best tolerated dose) and still not controlled (>140/90 in clinic) 1/2 million people in UK remember lifestyle advice (smoking weight exercise) and compliance if acute volume depletion (eg vomiting, diarrhoea, dehydrated) can get rapid drop in BP with acute renal impairment / acute hypotension (already lots of treatment so no reserve) usually resistant HT retains Na - so different diuretic which blocks a different part of renal tubule often consider referral but may try .... ''spironolactone '' may work dramatically may raise potassium (so beware in renal impairment esp with diabetes, or if K already up) - so must monitour K - check at base and only give if below 4.5, check U/E within 2-3/52 and once stable, annual check (Na can slowly drop) can cause gynaecomastia / nipple tenderness - have to stop if really dramatic remember Conn's adenoma ''Blacks'' CCB (or D) at any age as HT is more related to Na problems (low renin HT so ACE less good) often HT is resistent and needs 2nd drug - better to use ARB as ACE causes inc incidence of angioedema ''Direct Renin Inhibitors'' (Aliskiren) inhibits renin so blocks angiotensinogen to angiotensin trials looked at BP fall (sim to ACE) but not yet at mortality SE uncommon ? diarrhoea role ? in pts intolerant of older drugs
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Hypertension