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cardio:hypertension:start [2026/02/13 01:30] – [3. Diuretics] andrew2393cnscardio:hypertension:start [2026/02/13 01:36] (current) – [Hypertensive Emergency] andrew2393cns
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 Before initiating therapy: Before initiating therapy:
  
-• Ensure correct cuff size and technique   +  * • Ensure correct cuff size and technique   
-• Repeat readings on separate visits   +  * • Repeat readings on separate visits   
-• Consider home or ambulatory monitoring   +  * • Consider home or ambulatory monitoring   
-• Assess medication adherence   +  * • Assess medication adherence   
-• Review contributing substances (NSAIDs, decongestants, stimulants, alcohol)  +  * • Review contributing substances (NSAIDs, decongestants, stimulants, alcohol)  
  
 If severe, resistant, or early-onset → evaluate for secondary causes. If severe, resistant, or early-onset → evaluate for secondary causes.
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 ==== 1. RAAS Blockade ==== ==== 1. RAAS Blockade ====
  
-• [[cardio:raas:acei|ACE Inhibitors]]   +  * • [[cardio:raas:acei|ACE Inhibitors]]   
-• [[cardio:raas:arb|Angiotensin Receptor Blockers (ARBs)]]   +  * • [[cardio:raas:arb|Angiotensin Receptor Blockers (ARBs)]]   
-• [[cardio:raas:renin_inhibitors|Direct Renin Inhibitors]]  +  * • [[cardio:raas:renin_inhibitors|Direct Renin Inhibitors]]  
  
 Effect: ↓ Angiotensin II → ↓ SVR and ↓ aldosterone-mediated sodium retention Effect: ↓ Angiotensin II → ↓ SVR and ↓ aldosterone-mediated sodium retention
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 ==== 2. Calcium Channel Blockers ==== ==== 2. Calcium Channel Blockers ====
  
-• [[cardio:ccb:dhp|Dihydropyridine Calcium Channel Blockers]]   +  * • [[cardio:ccb:dhp|Dihydropyridine Calcium Channel Blockers]]   
-• [[cardio:ccb:non_dhp|Non-Dihydropyridine Calcium Channel Blockers]]  +  * • [[cardio:ccb:non_dhp|Non-Dihydropyridine Calcium Channel Blockers]]  
  
 DHP CCBs: DHP CCBs:
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 [[cardio:diuretics:start|Diuretics]] [[cardio:diuretics:start|Diuretics]]
  
-Thiazide / Thiazide-like:+[[cardio:diuretics:thiazide:start|Thiazide / Thiazide-Like]]
   * • [[cardio:diuretics:chlorthalidone|Chlorthalidone]]     * • [[cardio:diuretics:chlorthalidone|Chlorthalidone]]  
   * • [[cardio:diuretics:hydrochlorothiazide|Hydrochlorothiazide]]     * • [[cardio:diuretics:hydrochlorothiazide|Hydrochlorothiazide]]  
   * • [[cardio:diuretics:indapamide|Indapamide]]     * • [[cardio:diuretics:indapamide|Indapamide]]  
  
-Loop Diuretics: +[[cardio:diuretics:loop|Loop Diuretics]]  
-• [[cardio:diuretics:loop|Loop Diuretics]]  +
   *   - [[cardio:diuretics:furosemide|Furosemide]]     *   - [[cardio:diuretics:furosemide|Furosemide]]  
   *   - [[cardio:diuretics:torsemide|Torsemide]]     *   - [[cardio:diuretics:torsemide|Torsemide]]  
  
-Potassium-Sparing Diuretics: +[[cardio:diuretics:mra|Mineralocorticoid Receptor Antagonists]]  
- +
-• [[cardio:diuretics:mra|Mineralocorticoid Receptor Antagonists]]  +
   *   - [[cardio:hf:spironolactone|Spironolactone]]     *   - [[cardio:hf:spironolactone|Spironolactone]]  
   *   - [[cardio:hf:eplerenone|Eplerenone]]     *   - [[cardio:hf:eplerenone|Eplerenone]]  
  
-• [[cardio:diuretics:enac|ENaC Inhibitors]]  +[[cardio:diuretics:enac|ENaC Inhibitors]]  
   *   - [[cardio:diuretics:amiloride|Amiloride]]     *   - [[cardio:diuretics:amiloride|Amiloride]]  
   *   - [[cardio:diuretics:triamterene|Triamterene]]     *   - [[cardio:diuretics:triamterene|Triamterene]]  
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 Combined Alpha/Beta Blockade: Combined Alpha/Beta Blockade:
-• [[cardio:beta_blockers:labetalol|Labetalol]]   +  * • [[cardio:beta_blockers:labetalol|Labetalol]]   
-• [[cardio:beta_blockers:carvedilol|Carvedilol]]  +  * • [[cardio:beta_blockers:carvedilol|Carvedilol]]  
  
 Central Alpha-2 Agonists: Central Alpha-2 Agonists:
-• [[cardio:hypertension:clonidine|Clonidine]]   +  * • [[cardio:hypertension:clonidine|Clonidine]]   
-• [[cardio:hypertension:methyldopa|Methyldopa]]  +  * • [[cardio:hypertension:methyldopa|Methyldopa]]  
  
 Alpha-1 Blockade: Alpha-1 Blockade:
-• [[cardio:alpha_blockers:start|Alpha-1 Blockers]]  +  * • [[cardio:alpha_blockers:start|Alpha-1 Blockers]]  
  
 Effect: ↓ Sympathetic tone → ↓ CO and ↓ SVR Effect: ↓ Sympathetic tone → ↓ CO and ↓ SVR
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 ==== 5. Direct Vasodilators ==== ==== 5. Direct Vasodilators ====
  
-• [[cardio:hypertension:hydralazine|Hydralazine]]   +  * • [[cardio:hypertension:hydralazine|Hydralazine]]   
-• [[cardio:hypertension:minoxidil|Minoxidil]]  +  * • [[cardio:hypertension:minoxidil|Minoxidil]]  
  
 Potent arteriolar vasodilation   Potent arteriolar vasodilation  
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 ==== Hypertensive Urgency ==== ==== Hypertensive Urgency ====
  
-• Severe BP elevation   +  * • Severe BP elevation   
-• No acute end-organ damage   +  * • No acute end-organ damage   
-• Gradual reduction over 24–72 hours  +  * • Gradual reduction over 24–72 hours  
  
 Oral agents: Oral agents:
  
-• [[cardio:raas:captopril|Captopril]]   +  * • [[cardio:raas:captopril|Captopril]]   
-• [[cardio:beta_blockers:labetalol|Labetalol]]   +  * • [[cardio:beta_blockers:labetalol|Labetalol]]   
-• [[cardio:hypertension:clonidine|Clonidine]]  +  * • [[cardio:hypertension:clonidine|Clonidine]]  
  
 ---- ----
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 ==== Hypertensive Emergency ==== ==== Hypertensive Emergency ====
  
-• Severe BP elevation   +  * • Severe BP elevation   
-• Evidence of end-organ damage   +  * • Evidence of end-organ damage   
-• Requires IV therapy and admission  +  * • Requires IV therapy and admission  
  
 Common IV agents: Common IV agents:
  
-• [[cardio:hypertension:nicardipine|Nicardipine]]   +  * • [[cardio:ccb:nicardipine|Nicardipine]]   
-• [[cardio:beta_blockers:labetalol|Labetalol]]   +  * • [[cardio:beta_blockers:labetalol|Labetalol]]   
-• [[cardio:hypertension:nitroprusside|Nitroprusside]]   +  * • [[cardio:hypertension:nitroprusside|Nitroprusside]]   
-• [[cardio:angina:nitroglycerin|Nitroglycerin]]+  * • [[cardio:angina:nitroglycerin|Nitroglycerin]]
  
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 ===== Clinical Pearls ===== ===== Clinical Pearls =====
  
-✔ Most chronic hypertension is driven by increased SVR   +  * ✔ Most chronic hypertension is driven by increased SVR   
-✔ Most patients require ≥2 medications   +  * ✔ Most patients require ≥2 medications   
-✔ [[cardio:diuretics:chlorthalidone|Chlorthalidone]] often superior to HCTZ   +  * ✔ [[cardio:diuretics:chlorthalidone|Chlorthalidone]] often superior to HCTZ   
-✔ [[cardio:hf:spironolactone|Spironolactone]] is the most effective 4th-line agent   +  * ✔ [[cardio:hf:spironolactone|Spironolactone]] is the most effective 4th-line agent   
-✔ Avoid combining [[cardio:raas:acei|ACE Inhibitor]] + [[cardio:raas:arb|ARB]]   +  * ✔ Avoid combining [[cardio:raas:acei|ACE Inhibitor]] + [[cardio:raas:arb|ARB]]   
-✔ Treat physiology, not just numbers  +  * ✔ Treat physiology, not just numbers  
  
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cardio/hypertension/start.1770946241.txt.gz · Last modified: by andrew2393cns