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Taming the Devil Inside: Pharmacologic Management of Hypertension

Taming the Devil Inside: Pharmacologic Management of Hypertension. Christopher Roe, MSN, ACNP-BC Lead Nurse Practitioner Christiana Care Cardiology Consultants. Why Bother?. 78 million adults have HTN Directly linked to myocardial infarction, stroke, heart failure, and kidney disease

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Taming the Devil Inside: Pharmacologic Management of Hypertension

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  1. Taming the Devil Inside:Pharmacologic Management of Hypertension Christopher Roe, MSN, ACNP-BC Lead Nurse Practitioner Christiana Care Cardiology Consultants

  2. Why Bother? • 78 million adults have HTN • Directly linked to myocardial infarction, stroke, heart failure, and kidney disease • Estimated cost $51 billion in 2009 Statistics from:http://www.heart.org/idc/groups/heart-public/@wcm/@sop/@smd/documents/downloadable/ucm_319587.pdf

  3. Who is the Devil?

  4. Who is the Devil? • Hormonal Mechanisms • Neural Mechanisms • Vascular Mechanisms • Renal Mechanisms

  5. Hormonal Mechanisms

  6. Neural Mechanisms

  7. Vascular Mechanisms

  8. Renal/Salt Mechanisms

  9. Guidelines for Management of HTNJNC-7 or ESH/ESC

  10. What is the definition? EHA/ESC Guidelines JNC-7 Guidelines

  11. Treatment of Stage or Grade 1 HTN (without compelling indications) • JNC-7 • Thiazide Diuretic • May consider ACEi, ARB, BB, CCB, or combo • ESH/ESC • Your choice: no agent is superior • Thiazide Diuretic, BB, CCB, ACEi, or ARB

  12. Thiazide Diuretics • Hydrochlorothiazide • Chlorthalidone • Indapamide (“thiazide-like”) • Mechanism of Action—diuresis & vasodilation • Side Effects • Disease related issues

  13. Angiotensin Converting Enzyme Inhibitors (ACEi) captopril, lisinopril, ramipril, enalapril, trandopril, benazepril Mechanism of Action

  14. Angiotensin Converting Enzyme Inhibitors (ACEi) • Side Effects • Cough • Angioedema • Hyperkalemia • Elevated BUN/Cr • Disease Related issues

  15. Angiotensin Receptor Blockers • valsartan, losartan, telmisartan, candesartan • Mechanism of Action • Side Effects • Disease related issues

  16. Calcium Channel Blockers Dihydropyridine Non-dihydropyridine

  17. Calcium Channel BlockersDihydropyridine • amlodipine, felodipine, nicardipine, nifedipine • Mechanism of Action • Side Effects • Disease related issues

  18. Calcium Channel BlockersNon-dihydropyridine • diltiazem and verapamil • Mechanism of Action • Side Effects • Disease Related Issues

  19. Beta Blocker • atenolol, propranolol, metoprolol, nadolol • Subtypes of Beta Recptors • β-1 • β-2 • Mechanism of Action • Subgroupings of Beta Blockers • Nonselective • Selective • Nonselective with alpha-1 blocking

  20. Beta Blocker • Side Effects • Disease Related Issues

  21. Other Antihypertensives • Aldosterone Antagonists • Central Acting Alpha-2 Agonists (presynaptic) • Alpha-1 Adrenergic Antagonists (postsynaptic) • Direct Vasodilators • Renin Inhibitors • Others

  22. Novel Pharmacologic Therapies • Vitamin D • Fish Oil • Statins • Aspirin

  23. Not So Novel Non-Pharmacologic Agents Reduce Salt Intake Reduce Alcohol Intake Increase Aerobic Activity

  24. Novel Interventional Techniques Renal Nerve Denervation

  25. Questions?

  26. Thank you and Goodbye!

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