Initial Diagnostic Evaluation of Hypertension

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A. 15 Lead electrocardiography may document evidence of ischemic heart disease, rhythm and conduction disturbances, or left ventricular hypertrophy.

B. Screening labs include a complete blood count, glucose, potassium, calcium, creatinine, BUN, uric acid, and fasting lipid panel.

C. Urinalysis. Dipstick testing should include glucose, protein, and hemoglobin.

D. Selected patients may require plasma renin activity, 24 hour urine catecholamines, or renal function testing (glomerular filtration rate and blood flow). II. Antihypertensive Drugs

A. Thiazide Diuretics

1. Hydrochlorothiazide (HCTZ, HydroDiuril), 12.5-25 mg qd [25 mg].

2. Chlorothiazide (Diuril) 250 mg qd [250, 500 mg].

3. Thiazide/Potassium Sparing Diuretic Combinations a. Maxzide (hydrochlorothiazide 50/triamterene 75 mg) 1 tab qd.

b. Moduretic (hydrochlorothiazide 50 mg/amiloride 5 mg) 1 tab qd.

c. Dyazide (hydrochlorothiazide 25 mg/triamterene 37.5) 1 cap qd.

B. Beta-Adrenergic Blockers

1. Cardioselective Beta-Blockers a. Atenolol (Tenormin) initial dose 50 mg qd, then 50-100 mg qd, max 200 mg/d [25, 50, 100 mg].

b. Metoprolol XL (Toprol XL) 100-200 mg qd [50, 100, 200 mg tab ER].

c. Bisoprolol (Zebeta) 2.5-10 mg qd; max 20 mg qd [5,10 mg].

2. Non-Cardioselective Beta-Blockers a. Propranolol LA (Inderal LA), 80-160 mg qd [60, 80, 120, 160 mg].

b. Nadolol (Corgard) 40-80 mg qd, max 320 mg/d [20, 40, 80, 120, 160 mg].

c. Pindolol (Visken) 5-20 mg qd, max 60 mg/d [5, 10 mg].

C. Angiotensin-Converting Enzyme (ACE) Inhibitors

1. Ramipril (Altace) 2.5-10 mg qd, max 20 mg/day [1.25, 2.5, 5, 10 mg].

2. Quinapril (Accupril) 20-80 mg qd [5, 10, 20, 40 mg].

3. Lisinopril (Zestril, Prinivil) 10-40 mg qd [2.5, 5, 10, 20, 40 mg].

4. Benazepril (Lotensin) 10-40 mg qd, max 80 mg/day [5, 10, 20, 40 mg].

6. Enalapril (Vasotec) 5-40 mg qd, max 40 mg/day [2.5, 5, 10, 20 mg].

D. Angiotensin Receptor Antagonists

2. Valsartan (Diovan) 80-160 mg qd; max 320 mg qd [80, 160 mg].

3. Irbesartan (Avapro) 150 mg qd; max 300 mg qd [75, 150, 300 mg].

4. Candesartan (Atacand) 8-16 mg qd-bid [4, 8, 16, 32 mg].

E. Calcium Entry Blockers

1. Diltiazem SR (Cardizem SR) 60-120 mg bid [60, 90, 120 mg] or Cardizem CD 180-360 mg qd [120, 180, 240, 300 mg].

2. Nifedipine XL (Procardia-XL, Adalat-CC) 30-90 mg qd [30, 60, 90 mg].

3. Verapamil SR (Calan SR, Covera-HS) 120-240 mg qd [120, 180, 240 mg].

4. Amlodipine (Norvasc) 2.5-10 mg qd [2.5, 5, 10 mg].

5. Felodipine (Plendil) 5-10 mg qd [2.5, 5, 10 mg].

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Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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