Therapy for HTN with comorbidities?

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

First line BP therapy?

• ACEI/ ARB
• CCB
• Thiazide

They lower BP AND reduce CV risk

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

ACEI vs ARB

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

Add-on to pt with hypokalemia?

• Spironolactone

Add-on to pt with migraine prophylaxis?

• Beta-blocker: metoprolol

Add-on to pt with BPB?

• alpha blocker: doxazosin

Some last resorts BP meds?

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

due to adherence, side effects

Risky combos

• ARB + ACEI
• Aliskiren

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

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