Cardiovascular management:
1. Know Initial treatment choices for HTN
1st line options: ACE Inhibitors OR ARB, Calcium Channel Blocker, thiazides
Black people 1st line: CCB and/or thiazides preferred (better outcomes)
CKD (regardless of ethnicity): ACE Inhibitor OR ARB (but not together)
For someone with gout: thiazides increase uric acid (Do NOT use); CCBs and
Losartan (but not other ACEIs decrease the risk)
ALL other antihypertensives are 2nd line
Could consider BB if indicated for a comorbidity (eg arrhythmia, tremor, need
for migraine prophylaxis) but no longer considered 1 st line
2. Diuretics:
Loop diuretics; Thiazide-type diuretics; Potassium-Sparing Diuretics
The loop diuretics inhibit sodium reabsorption in the ascending loop of Henle. These
drugs are short-acting and cause a large natriuresis. The thiazide-type diuretics act on
the distal renal tubule to inhibit sodium reabsorption. Their effect is generally longer-
lasting, and they cause less brisk diuresis. Both classes increase potassium excretion.
The potassium-sparing diuretics include aldosterone antagonists and agents like
amiloride that inhibit excretion of potassium distally. These agents are weak diuretics,
often used in combination with thiazides to reduce potassium loss.
Diuretics may also be used as adjunct therapy for disease processes in which the
treatment itself may contribute to fluid retention—for example, use of some CCBs and
antiarrhythmics. Spironolactone blocks the mineral corticosteroid receptor that
aldosterone binds to; *Aldosteronism. It is also useful in ventricular remodeling and
decreasing the inflammatory cascade that can occur in the days following an MI.
Amiloride's potassium-sparing characteristics are used to counter any chronic
potassium losses that cannot be reliably corrected with diet or supplements.
Uses
Diuretics are first-line therapy in the treatment of HF & HTN through their reduction in
ECF volume. Ones most commonly used in primary care are the distal tubular (thiazides
and aldosterone antagonists) & loop diuretics.
Side effects
1. Know Initial treatment choices for HTN
1st line options: ACE Inhibitors OR ARB, Calcium Channel Blocker, thiazides
Black people 1st line: CCB and/or thiazides preferred (better outcomes)
CKD (regardless of ethnicity): ACE Inhibitor OR ARB (but not together)
For someone with gout: thiazides increase uric acid (Do NOT use); CCBs and
Losartan (but not other ACEIs decrease the risk)
ALL other antihypertensives are 2nd line
Could consider BB if indicated for a comorbidity (eg arrhythmia, tremor, need
for migraine prophylaxis) but no longer considered 1 st line
2. Diuretics:
Loop diuretics; Thiazide-type diuretics; Potassium-Sparing Diuretics
The loop diuretics inhibit sodium reabsorption in the ascending loop of Henle. These
drugs are short-acting and cause a large natriuresis. The thiazide-type diuretics act on
the distal renal tubule to inhibit sodium reabsorption. Their effect is generally longer-
lasting, and they cause less brisk diuresis. Both classes increase potassium excretion.
The potassium-sparing diuretics include aldosterone antagonists and agents like
amiloride that inhibit excretion of potassium distally. These agents are weak diuretics,
often used in combination with thiazides to reduce potassium loss.
Diuretics may also be used as adjunct therapy for disease processes in which the
treatment itself may contribute to fluid retention—for example, use of some CCBs and
antiarrhythmics. Spironolactone blocks the mineral corticosteroid receptor that
aldosterone binds to; *Aldosteronism. It is also useful in ventricular remodeling and
decreasing the inflammatory cascade that can occur in the days following an MI.
Amiloride's potassium-sparing characteristics are used to counter any chronic
potassium losses that cannot be reliably corrected with diet or supplements.
Uses
Diuretics are first-line therapy in the treatment of HF & HTN through their reduction in
ECF volume. Ones most commonly used in primary care are the distal tubular (thiazides
and aldosterone antagonists) & loop diuretics.
Side effects
