The AHA Guidelines and Scientific Statements Handbook

The AHA Guidelines and Scientifi c Statements Handbook

Box 11.1 Summary of evidence-based recommendations for management of hypertension in patients

with endocrine disease and pregnancy

Indication Recommendation

Lifestyle modifi cation Weight loss (in overweight patients)

Sodium restriction (2.3–3 g/day)

Potassium intake ≥3.5 g/day

Alcohol restriction 1 oz/day

Exercise ≥30 min/day

Type 2 diabetes Goal BP ≤130/80 mm Hg

Goal BP ≤120/75 mm Hg when severe proteinuria exists

ACEI or ARB as fi rst- or second-line agent

Thiazide diuretic as fi rst- or second-line agent (in low dosage with adequate potassium replacement

or sparing)

β-B (preferably drugs that block both α and β receptors) as second- or third-line agent

CCB (preferably nondihydropyridine) as second-, third-, or fourth-line agent

Pheochromocytoma α-Adrenergic blocker as fi rst-line agent, in conjunction with β-B or CCB (or both) as needed

Hyperaldosteronism Surgical resection for unilateral adenoma

Aldosterone antagonists, ACEI, or ARB for hyperplasia

Low-dose glucocorticoid for GRA

Cushing’s syndrome Surgical or ablative therapy for adenoma

Medical inhibition of steroid synthesis (especially ketoconazole) in intractable cases

Pregnancy All major antihypertensive agents except ACEI/ARB (preferably methyldopa or nifedipine)

Magnesium for preeclampsia at high risk for seizures 1–2 A

Reproduced, with permission, from Reference [7]. ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; BB,

β-adrenergic blocker; BP, blood pressure; CCB, calcium channel blocker; GRA, glucocorticoid-remediable aldosteronism

Box 11.2 Treatment pearls: Management of high blood pressure in African-Americans

• Compared with white Americans, African-Americans are at greater risk for the development of high BP, type 2 diabetes
  mellitus, coronary heart disease (CHD), heart failure, left ventricular hypertrophy, stroke, and end-stage renal disease.


• These facts suggest the need to obtain BP measurements and assess risk for cardiovascular disease in African-Americans
  at regular intervals across the lifespan in all primary care settings.


• Clinicians should make concerted efforts to increase awareness among African-Americans of the links between lifestyle
  choices and cardiovascular and renal outcomes.


• Both high dietary sodium and low dietary potassium intake may contribute to excess high BP in African-Americans. Clini-
  cians should recommend increasing dietary potassium while moderating sodium intake to the recommended <2.4 g/d.


• Obesity and inactivity are particularly prevalent among African-American women and should be viewed as major risk
  factors in all African-Americans.


• The DASH diet was found to be particularly benefi cial in lowering BP in African-Americans. Information about this diet is
  readily available and should be provided to patients.