management of hypertension

Oral Drugs Used in Treatment of Hypertension

Drug Class	Examples	Usual Total Daily Dosea (Dosing Frequency/Day)	Other Indications	Contraindications/Cautions
Diuretics
Thiazides	Hydrochlorothiazide	6.25–50 mg (1–2)		Diabetes, dyslipidemia, hyperuricemia, gout, hypokalemia
	Chlorthalidone	25–50 mg (1)
Loop diuretics	Furosemide	40–80 mg (2–3)	CHF, renal failure	Diabetes, dyslipidemia, hyperuricemia, gout, hypokalemia
	Ethacrynic acid	50–100 mg (2–3)
Aldosterone antagonists	Spironolactone	25–100 mg (1–2)	CHF, primary aldosteronism	Renal failure, hyperkalemia
	Eplerenone	50–100 mg (1–2)
K+ retaining	Amiloride	5–10 mg (1–2)		Renal failure, hyperkalemia
	Triamterene	50–100 mg (1–2)
Beta blockers				Asthma, COPD, 2nd or 3rd degree heart block, sick-sinus syndrome
Cardioselective	Atenolol	25–100 mg (1)	Angina, CHF, post-MI, sinus tachycardia, ventricular tachyarrhythmias
	Metoprolol	25–100 mg (1–2)
Nonselective	Propranolol	40–160 mg (2)
	Propranolol LA	60–180 (1)
Combined alpha/beta	Labetalol	200–800 mg (2)	? Post-MI, CHF
	Carvedilol	12.5–50 mg (2)
Alpha antagonists
Selective	Prazosin	2–20 mg (2–3)	Prostatism
	Doxazosin	1–16 mg (1)
	Terazosin	1–10 mg (1–2)
Nonselective	Phenoxybenzamine	20–120 mg (2–3)	Pheochromocytoma
Sympatholytics
Central	Clonidine	0.1–0.6 mg (2)
	Clonidine patch	0.1–0.3 mg (1/week)
	Methyldopa	250–1000 mg (2)
	Reserpine	0.05–0.25 mg (1)
	Guanfacine	0.5–2 mg (1)
ACE inhibitors	Captopril	25–200 mg (2)	Post-MI, CHF, nephropathy	Renal failure, bilateral renal artery stenosis, pregnancy, hyperkalemia
	Lisinopril	10–40 mg (1)
	Ramipril	2.5–20 mg (1–2)
Angiotensin II antagonists	Losartan	25–100 mg (1–2)	CHF, diabetic nephropathy, ACE inhibitor cough	Renal failure, bilateral renal artery stenosis, pregnancy, hyperkalemia
	Valsartan	80–320 mg (1)
	Candesartan	2–32 mg (1–2)
Calcium antagonists				Heart failure, 2d or 3d degree heart block
Dihydropyridines	Nifedipine (long acting)	30–60 mg (1)	Angina
Nondihydropyridines	Verapamil (long acting)	120–360 mg (1–2)	Post-MI, supraventricular tachycardias, angina
	Diltiazem(long-acting)	180-420 mg (1)
Direct vasodilators	Hydralazine	25–100 mg (2)		Severe coronary artery disease
	Minoxidil	2.5–80 mg (1–2)

Preferred parenteral drugs for hypertensive emergencies                                                                                      

Hypertensive encephalopathy	Nitroprusside, nicardipine, labetalol
Malignant hypertension (when IV therapy is indicated)	Labetalol, nicardipine, nitroprusside, enalaprilat
Stroke	Nicardipine, labetalol, nitroprusside
Myocardial infarction/unstable angina	Nitroglycerin, nicardipine, labetalol, esmolol
Acute left ventricular failure	Nitroglycerin, enalaprilat, loop diuretics
Aortic dissection	Nitroprusside, esmolol, labetalol
Adrenergic crisis	Phentolamine, nitroprusside
Postoperative hypertension	Nitroglycerin, nitroprusside, labetalol, nicardipine
Preeclampsia/eclampsia of pregnancy	Hydralazine, labetalol, nicardipine

Table 241-7 Lifestyle Modifications to Manage Hypertension

Weight reduction	Attain and maintain BMI <>2
Dietary salt reduction	<>
Adapt DASH-type dietary plan	Diet rich in fruits, vegetables, and low-fat dairy products with reduced content of saturated and total fat
Moderation of alcohol consumption	For those who drink alcohol, consume 2 drinks/day in men and 1 drink/day in women
Physical activity	Regular aerobic activity, e.g., brisk walking for 30 min/d