1
Therapy for HTN with comorbidities?
- ACEI/ARB + beta blockers for pt with recent heart attack
2
First line BP therapy?
- ACEI/ ARB
- CCB
- Thiazide
They lower BP AND reduce CV risk
3
Why want combo?
- To offset side effects if pushing higher dose of one med
- ACEI/ ARB counteract peripheral edema due to CCB
- ACEI/ ARB reduce risk of hypokalemic due to thiazide
4
ACEI vs ARB
- ARB preferred due to lower side effects such as cough or angioedema
5
Add-on to pt with hypokalemia?
- Spironolactone
6
Add-on to pt with migraine prophylaxis?
- Beta-blocker: metoprolol
7
Add-on to pt with BPB?
- alpha blocker: doxazosin
8
Some last resorts BP meds?
- Vasodilator (hydralazine)
- Alpha-2 agonists (clonidine)
due to adherence, side effects
9
Risky combos
- ARB + ACEI
- Aliskiren
They increase risk of hyperkalemia, hypotension, kidney injury..and lack CV benefit
10
Some CCB combo?
- Okie to mix dihydropyridine CCB (amlodipine) with NON-dihydropyridine CCB (diltiazem, verapamil)...if options are limited such as chronic kidney disease or resistent HTN