Hypertension Management for Specific Comorbid Diseases

Aka: Hypertension Management for Specific Comorbid Diseases, AntiHypertensives for Specific Comorbid Diseases

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II. Management: Endocrine Conditions

  1. Diabetes Mellitus (with or without Diabetic Nephropathy)
    1. See Hypertension in Diabetes Mellitus
    2. ACE Inhibitor or Angiotensin Receptor Blocker
    3. In black patients, use Calcium Channel Blocker or Thiazide Diuretic instead
  2. Obesity
    1. Diuretics

III. Management: Cardiovascular Conditions

  1. Left Ventricular Hypertrophy (Risk of sudden death)
    1. Central active Agonists
    2. ACE Inhibitors
    3. Calcium Channel Blockers
  2. Congestive Heart Failure
    1. Systolic Dysfunction
      1. ACE Inhibitor or Angiotensin Receptor Blocker
      2. Diuretic
      3. Beta Blocker (use with caution, CIBIS II, MERIT-HF)
        1. High efficacy with Carvedilol
      4. Spironolactone (use with caution, RALES trial)
    2. Diastolic Dysyfunction
      1. Calcium Channel Blocker
  3. Coronary Artery Disease risk or Myocardial Infarction
    1. General
      1. Beta Blocker (e.g. Metoprolol Succinate)
      2. ACE Inhibitor (HOPE trial) or Angiotensin Receptor Blocker
      3. Thiazide Diuretic
    2. Angina
      1. Beta Blockers (e.g. Metoprolol Succinate)
      2. Calcium Channel Blockers
        1. Dihydropyridine Calcium Channel Blocker
          1. Consider for Hypertension, Angina (may be added to Beta Blocker)
          2. Amlodipine
        2. Non-Dihydropyridine Calcium Channel Blocker (e.g. Diltiazem, Verapamil)
          1. Avoid unless Beta Blocker not tolerated
  4. Atrial Tachycardia and Atrial Fibrillation
    1. Beta Blockers
    2. Nondihydropyridine calcium Antagonists
  5. Dyslipidemia
    1. Alpha Antagonists
    2. Diuretics do not worsen Hyperlipidemia
    3. Beta Blockers do not worsen Hyperlipidemia
  6. Edema
    1. Avoid Calcium Channel Blockers (especially Amlodipine)
  7. Peripheral Vascular Disease
    1. These patients are high risk for cardiovascular event
    2. Calcium Channel Blocker
    3. Beta Blockers may be tolerated
      1. Previously thought to be contraindicated

IV. Management: Genitourinary Conditions

  1. Benign Prostatic Hyperplasia
    1. Alpha Antagonist
    2. Avoid Diuretics
  2. Chronic Kidney Disease
    1. ACE Inhibitor or Angiotensin Receptor Blocker
    2. Diuretic
  3. Pregnancy
    1. Methyldopa
    2. Hydralazine
    3. Labetolol
    4. Do not use ACE Inhibitor

V. Management: Rheumatologic Conditions

  1. Gout
    1. Avoid Thiazide Diuretics
  2. Osteoporosis
    1. Thiazide Diuretics (may prevent Hip Fractures)

VI. Management: Neurologic and psychiatric disorders

  1. Essential Tremor
    1. Noncardioselective Beta Blocker
  2. Migraine Headache
    1. Noncardioselective Beta-Blockers
    2. Nondihydropyridine calcium Antagonists
  3. Major Depression
    1. Avoid Beta Blockers
  4. Substance Abuse
    1. Labetolol (Combined alpha-Beta Blocker)
    2. Calcium Channel Blockers
    3. Nitrates

VII. Management: Miscellaneous Conditions

  1. Obstructive Pulmonary Disease (COPD or Asthma)
    1. Avoid Beta Blockers
  2. Perioperative Hypertension
    1. Beta Blockers should be use preventively
    2. Delay surgery until BP <180/110
  3. Peptic Ulcer Disease
    1. Avoid Calcium Channel Blockers
    2. Gastrointestinal Bleeding risk

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