Hypertension: Specific Treatment – Family Medicine | Lecturio
Aug 24, 2023
Hypertension: Specific Treatment – Family Medicine | Lecturio
This video “Hypertension: Specific Treatment” is part of the Lecturio course “Family Medicine” ► WATCH the complete course on http://lectur.io/specifictreatment http://lectur.io/specifictreatment https://app.adjust.com/z21zrf https://app.adjust.com/b01fak http://lectur.io/hypertensionlibrary http://lectur.io/subscribe http://lectur.io/playlists https://www.facebook.com/lecturio.med …https://www.instagram.com/lecturio_me …https://twitter.com/LecturioMed
Content
4.94 -> And, of course, there's – JNC 8 includes
some specific recommendations
8.82 -> based on the patient you may see and these are
good things that may come up on your examination.
13.48 -> Certainly, come up in clinic.
14.88 -> Black patients respond better to
drugs like calcium channel blockers
18.59 -> and thiazide diuretics versus
drugs like ACE inhibitors.
22.27 -> If they have chronic kidney disease,
24.17 -> try to initiate an ACE inhibitor or an ARB
and titrate to at least moderate doses.
29.07 -> It will slow the progression
of chronic kidney disease.
32.26 -> Of course, watch the creatinine and
watch the potassium in those patients too.
36.88 -> Among patients with
coronary artery disease,
38.94 -> the best drugs are beta blocker
41.34 -> and an ACE inhibitor or an
angiotensin receptor blocker
45.45 -> for preventing recurrent cardiac events.
48.82 -> In diabetes, start an ACE inhibitor or an
ARB because it can help with nephropathy.
54.61 -> Interestingly though, remember that
patients who don't have nephropathy
59.03 -> don't necessarily benefit from an ACE
or an ARB when they have diabetes,
64.74 -> so it's really only after they develop
nephropathy or when they have
68.17 -> diabetes and hypertension that
you introduce an ACE or ARB.
72.21 -> And then, finally, non-dihydropyridine
74.83 -> calcium channel blockers can be effective.
77.48 -> They can't tolerate an ACE or an ARB
in those patients with diabetes.
81.72 -> And we’ll talk – heart failure
requires a few different drugs.
85.64 -> The core drugs are listed there,
either an ACE or an ARB,
89.93 -> plus a beta blocker, and then consider
spironolactone for those patients too.
95.07 -> That’s a lot.
96.34 -> And you can feel really
stressed out and lost,
100.14 -> and I understand that,
101.94 -> but you don't want to get too
overly focused on the initial choice.
106.03 -> I see a lot of clinicians really struggling.
108.24 -> Okay, what's the best choice for my patient.
110.74 -> JNC 8 gives you latitude between
several different classes of drugs,
114.07 -> but don't worry about
it too much because
115.84 -> oftentimes you're going to
be adding a second
117.9 -> or even a third agent on to
those patients with hypertension.
121.24 -> So, the one you start now will be a solo act
124.03 -> for only the next two to four weeks
till you evaluate the patient again.
127.95 -> If their blood pressure is still up,
you might add a second agent.
131.44 -> And then, also when choosing drugs,
133.68 -> don't forget that,
135.08 -> really it's that number is the most important thing.
138.42 -> So, say, you have a patient with
diabetes and nephropathy,
141.9 -> but they really have a hard time
taking any of those drugs,
144.6 -> the non-dihydropyridine
146.67 -> calcium channel blocker,
148.17 -> ACE inhibitor, ARB,
149.79 -> they can't tolerate any of them,
150.77 -> but they really enjoy – and what they –
the only thing they can
153.14 -> tolerate is an alpha antagonist
or a beta blocker.
157.7 -> It’s not the ideal drug for that patient,
159.99 -> but if it gets their blood
pressure down towards goal,
163.47 -> that's much more important than
getting them just on the right drug
167.58 -> for their chronic medical condition.
171.03 -> Hopefully, that was really helpful
in our brief review of hypertension.
174.19 -> I enjoyed it.
175.17 -> I enjoyed preparing it.
176.31 -> And I think it'll help a lot of your patients.
178.68 -> Thanks.
Source: https://www.youtube.com/watch?v=2uQAQmi4REk
