0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13
766 Hypertension■Angiotensin II receptor blockers: Hyperkalemia (especially with
Type IV RTA), hypotension, angioedema (less frequent than ACE
inhibitor), dizziness, skin rash (less frequent than ACE inhibitor),
hepatotoxicity
➣Absolute Contraindications: Any prior angioedema, pregnancy,
hyperkalemia, renovascular disease
➣Relative Contraindications: Renal failure, volume depletion
■Alpha-adrenoreceptor antagonists: Marked hypotension, orthosta-
sis, syncope, palpitations, headache, agitation, somnolence, arrhy-
thmias, ALLHAT discontinued due to increased CHF and stroke in
patients treated with doxazosin
➣Absolute Contraindications: Hypotension
➣Relative Contraindications: Impaired liver function
■Central sympatholytic agents: sedation, dry mouth, fatigue, postural
hypotension, impotence; rebound hypertension with withdrawal
➣Absolute Contraindications: Depression, liver disease (methyl-
dopa)
➣Relative Contraindications: Coronary artery disease, impaired
renal or liver function
■Arteriolar vasodilators: headache, palpitations, reflex tachycardia,
fluid retention, GI distress, rash, neutropenia, agranulocytosis, SLE-
like syndrome (hydralazine), pericardial effusion and hirsutism
(minoxidil)
➣Absolute Contraindications: Pheochromocytoma, pericardial
effusion (minoxidil); stenotic valvular disease
➣Relative Contraindications: Impaired renal function, acute MI
■Peripheral sympatholytic agents: mental depression, orthostatic
hypotension (especially with guanethedine and guanadrel), seda-
tion, sleep disturbances, fluid retention, nasal congestion, peptic
ulcers, diarrhea
➣Absolute Contraindications: Depression, orthostatic hypotension
➣Relative Contraindications: Impaired liver or renal function
follow-up
During Treatment
■Every 4–6 weeks during dose titration and regimen adjustmentRoutine
■Recommended follow-up as per JNC VII by classification
➣Normal: Recheck in 2 years
➣Pre-hypertension: Recheck in 1 year
➣HTN Stage 1–2: Every 6–12 months, when stable