0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13
Hypertension 765■Treatment goal generally to BP <140/<90, except in patients at high
risk for cardiovascular complications (130/<85)Side Effects and Contraindications:
■General info on drug classes, check for more complete prescribing
information
■Diuretics: Volume depletion, hypokalemia (hyperkalemia for pota-
ssium-sparing agents), hypomagnesemia, gout, worsening blood
sugar and lipid profile, rash and erectile dysfunction
➣Absolute Contraindications: Anuria
➣Relative Contraindications: Gout, renal insufficiency (pota-
ssium-sparing), dyslipidemia (high dose)
■Beta-blockers: use acutely worsens bronchospasm and LV dysfunc-
tion (though indicated for CHF), sinus/AV node depression, CNS
symptoms (depression, nightmares, excitement, confusion), fatigue,
lethargy, impotence, hypotension, increased triglycerides (depres-
sion of HDL)
➣Absolute Contraindications: Severe peripheral vascular disease,
severe bronchospastic disease, liver disease (labetalol)
➣Relative Contraindications: Types I and II diabetes, depression,
dyslipidemia, peripheral vascular disease
■ACE inhibitors: Hyperkalemia (especially with Type IV RTA), hypo-
tension, chronic dry cough (causes∼5% to discontinue in blinded
trials; should rechallenge later to establish diagnosis), angioedema,
dizziness, skin rash, dysgusia (captopril; often resolves sponta-
neously)
➣Absolute Contraindications: Any prior angioedema, pregnancy,
hyperkalemia, renovascular disease
➣Relative Contraindications: Renal failure (although ACE inhibi-
tors may improve renal dysfunction)
■Calcium channel blockers: Hypotension, headache, flushing, con-
gestive heart failure, peripheral edema, bradycardia with sinus/AV
node depression (especially verapamil and diltiazem), palpita-
tions/reflex tachycardia, constipation (especially verapamil in
elderly), GI distress, exacerbate heart failure in patients with systolic
dysfunction, possible increase in myocardial infarction in diabetics
with renal disease (nisoldipine, amlodipine)
➣Absolute Contraindications: 2nd/3rd-degree AV block, sick sinus
syndrome, systolic dysfunction (perhaps except amlodipine),
post-myocardial infarction, hypotension, pulmonary congestion
➣Relative Contraindications: Impaired liver or renal function