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Optimize Combo Therapy for Hypertension

front 1

Therapy for HTN with comorbidities?

back 1

  • ACEI/ARB + beta blockers for pt with recent heart attack

front 2

First line BP therapy?

back 2

  • ACEI/ ARB
  • CCB
  • Thiazide

They lower BP AND reduce CV risk

front 3

Why want combo?

back 3

  • 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

front 4

ACEI vs ARB

back 4

  • ARB preferred due to lower side effects such as cough or angioedema

front 5

Add-on to pt with hypokalemia?

back 5

  • Spironolactone

front 6

Add-on to pt with migraine prophylaxis?

back 6

  • Beta-blocker: metoprolol

front 7

Add-on to pt with BPB?

back 7

  • alpha blocker: doxazosin

front 8

Some last resorts BP meds?

back 8

  • Vasodilator (hydralazine)
  • Alpha-2 agonists (clonidine)

due to adherence, side effects

front 9

Risky combos

back 9

  • ARB + ACEI
  • Aliskiren

They increase risk of hyperkalemia, hypotension, kidney injury..and lack CV benefit

front 10

Some CCB combo?

back 10

  • Okie to mix dihydropyridine CCB (amlodipine) with NON-dihydropyridine CCB (diltiazem, verapamil)...if options are limited such as chronic kidney disease or resistent HTN