Hypertension Management per JNC 8

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Oral Lasix Equivalents (OLE)

Oral Lasix Equivalents (OLE)

Thiazide Diuretics: Additional Information

  • Contraindicated if GFR < 30 (exception = metolazone)

  • Renal effects

    • Decrease excretion of

      • Calcium → reduced bone mineralization

      • Uric acid → increased gout

      • Lithium → increased toxicity

    • Increase potassium and magnesium excretion

  • Agents

    • HCTZ 12.5 and 25 mg daily produce similar decrease in BP

    • Chlorthalidone supported by ALLHAT and SPRINT trials

Secondary Hypertension

Common Etiologies

  • Potential contributing factors

    • Diet: Sodium

    • Substances: Caffeine, nicotine, alcohol, cocaine

    • OTC medications: NSAIDs, herbal supplements

    • Prescriptions: OCPs, steroids, EPO

  • Hyperaldosteronism

    • Most common pathophysiology

    • May be associated with hypoglycemia

    • Diagnose with aldosterone:renin ratio

Additional Considerations

  • Pediatric

    • Coarctation of the aorta: Obtain echocardiogram

    • Renal parenchymal disease: Obtain BMP, U/A, renal ultrasound

  • Adult

    • Obstructive sleep apnea

    • Renal artery stenosis

      • Risk factors: Age > 50 years, atherosclerotic disease, fibromuscular disease, smoking

      • May be associated with refractory heart failure, flash pulmonary edema, CKD (ischemic nephropathy)

      • Diagnosis: Renal artery ultrasound with Doppler (or MRA if inconclusive) shows > 60% luminal occlusion

      • Treat cardiovascular risk factors and evaluate for revascularization (e.g. transluminal renal angioplasty +/- stenting)

    • Endocrine: Hyperthyroidism, hypercortisolism, pheochromocytoma