management of hypertension

 Oral Drugs Used in Treatment of Hypertension

Drug Class Examples Usual Total Daily Dosea (Dosing Frequency/Day)  Other Indications Contraindications/Cautions
  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
  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