Hypertension Management for Specific Populations

Aka: Hypertension Management for Specific Populations, Antihypertensives for Specific Populations

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II. Approach: Young Hypertensive

  1. Pathophysiology
    1. Active
    2. Increased sympathetic tone
    3. Elevated Plasma Renin Activity (PRA)
  2. First choice medications
    1. ACE Inhibitor or Angiotensin Receptor Blocker
  3. Other medications
    1. Beta-alpha Antagonist
    2. Alpha-1 Antagonist
    3. Calcium Channel Blocker
  4. Avoid
    1. Beta Blockers
      1. Decreased HDL
      2. Sexual activity and Exercise affected

III. Approach: Athletes

  1. See Hypertension in Athletes

IV. Approach: Elderly

  1. See Hypertension in the Elderly
  2. Non-black patients over age 60 years old
    1. Calcium Channel Blocker
    2. Thiazide Diuretic
    3. ACE Inhibitor or Angiotensin Receptor Blocker

V. Approach: Black

  1. Pathophysiology
    1. Low renin
    2. High plasma volume
    3. High vessel resistance
  2. First Choice Medications
    1. Diuretics (Hydrochlorothizides)
      1. Concurrent use improves Beta Blocker response
      2. Concurrent use improves ACE Inhibitor response
    2. Calcium Channel Blockers
  3. Changes (Previously contraindicated)
    1. ACE Inhibitors
      1. ACE Inhibitors are effective in black patients when added to Diuretics or Calcium Channel Blockers
      2. Previously thought not useful with low renin status
      3. Use if indicated for renal protection (however, will require additional Antihypertensive)
      4. AASK study showed benefit with Ramipril
        1. Retarded renal disease progression
        2. Wright (2002) JAMA 288:2421-31 [PubMed]
  4. Other Medications
    1. Labetalol
    2. Hydralazine 37.5 mg with Isordil 20 mg three times daily
      1. Consider in NYHA Class 3-4 Heart Failure with Reduced Ejection Fraction
      2. Added as adjunct to ACE Inhibitor and Beta Blocker
      3. See Systolic Dysfunction

VI. Approach: Obesity (even 10 pounds or 4.5 kg over Ideal Weight)

  1. Pathophysiology
    1. Modestly elevated vessel resistance
    2. Higher Cardiac Output
    3. High plasma volume
    4. Low renin
  2. First Choice Management
    1. Weight Reduction
    2. Diuretics

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